Elmira Woman Indicted for Embezzling Workers’ Pension and Health Care Money

ROCHESTER, NY—U.S. Attorney William J. Hochul, Jr. announced today that a federal grand jury in Rochester has returned a three-count indictment charging Linda Riner, 62, of Elmira, New York, with embezzling money from Local Laborer’s 1358 employee pension and welfare benefit funds and lying to federal investigators about this matter. Each charge carries a maximum sentence of five years in prison, a fine of $250,000, or both.
Assistant U.S. Attorney John J. Field, who is handling the case, stated that Riner was the funds administrator of the Local Laborer’s 1358 employee benefit plans and owed those plans a fiduciary duty. Instead of honoring that duty, the defendant took advantage of her position to pay herself and her staff thousands of dollars in “Christmas bonuses” without authorization. In addition, when interviewed by special agents with the Federal Bureau of Investigation and Department of Labor about these bonuses, Riner sought to mislead investigators by claiming that the payments had been approved. In total, the defendant stole approximately $9,000 from the plans.
The indictment is the result of an investigation by special agents of the Federal Bureau of Investigation, under the direction of Acting Special Agent in Charge Richard M. Frankel, and the Department of Labor, under the direction of Special Agent in Charge Robert Lapina.
The fact that a defendant has been charged with a crime is merely an accusation, and the defendant is presumed innocent until and unless proven guilty.

Physician Pleads Guilty to Health Care Fraud Charges

BUFFALO, NY—U.S. Attorney William J. Hochul, Jr. announced that Daniel C. Gillick, 63, a physician residing in Youngstown, New York, pleaded guilty to obtaining controlled substances by fraud and health care fraud. The charges carry a maximum sentence of 10 years in prison, a $500,000 fine, or both.
Assistant U.S. Attorney Maura K. O’Donnell and Timothy C. Lynch, who are handling the case, stated that between August 2011 and September 7, 2011, the defendant was employed as an emergency room physician at Schuyler Hospital. During that time, Gillick devised a scheme whereby on September 7, 2011, his girlfriend reported to the emergency room at Schuyler Hospital and pretended to suffer from a medical condition known as trygeminal neuralgia. The defendant then performed an apparent examination of her, fraudulently diagnosed her as suffering from trygeminal neuralgia and issued a prescription to her for Dilauded, a controlled substance.
In reality, Gillick’s girlfriend was not suffering from this condition and had no medical need for the drug Dilaudid. In participating in this illegal scheme, the defendant defrauded Schuyler Hospital and also aided and abetted his girlfriend in obtaining a controlled substance by fraud.
“With the abuse of prescription drug medications at epidemic levels in our community and across the country, our office will not stand for a member of the medical community defrauding the health care system by illegally prescribing such medications,” said U.S. Attorney Hochul. “When used appropriately, prescription pain medications can be of great benefit to a patient, but when abused, they can lead to a lifetime of addiction resulting in serious, even deadly complications. Our office, along with our law enforcement partners, will not hesitate to prosecute those in the medical profession who abuse their positions of trust.”
Gillick and his girlfriend Christina Guilfoyle were arrested in November 2012. Charges are pending again Guilfoyle.
The plea is the result of an investigation on the part of special agents of the United States Drug Enforcement Administration, under the direction of Brian R. Crowell, Special Agent in Charge, New York Field Division; special agents of the Federal Bureau of Investigation, under the direction of Acting Special Agent in Charge Richard M. Frankel; the New York State Police, under the direction of Major Michael Cerretto, Customs and Border Protection, under the direction of James Engleman, Director of Field Operations; the New York State Attorney General Medicaid Fraud Control Unit; the Amherst Police Department, under the direction of Chief John Askey; the Buffalo Police Department, under the direction of Commissioner Daniel Derenda; the Lancaster Police Department, under the direction of Chief Gerald Gill; the Erie County Sheriff’s Department, under the direction of Sheriff Timothy Howard; the Depew Police Department, under the direction of Chief Stan Carwile; and the Niagara County Sheriff’s Drug Task Force, under the direction of Sheriff James Votour.

Two Area Women Convicted in Home Health Services Conspiracy

CORPUS CHRISTI, TX—Sylvia Salinas Ramirez, of Driscoll, and Debra Jean Velasquez, of Robstown, have been convicted of wire fraud and conspiring to do so as part of a scheme to defraud the Texas Medicaid program through fraudulent home health billings, United States Attorney Kenneth Magidson announced today along with Texas Attorney General Greg Abbott.
Ramirez, 52, and Velasquez, 41, were charged in a 14-count federal indictment returned Wednesday, May 8, 2013. Today, they appeared before U.S. District Judge Nelva Gonzales Ramos and entered pleas of guilty to conspiring to submit false and fraudulent bills to the Texas Medicaid Program by wire transmissions, as well as wire fraud for using interstate wire transmissions to bill.
The two women admitted that from or about August 1, 2009 through on or about June 15, 2010, they were employed by the Corpus Christi office of MRNG Inc. doing business as Caring Touch Home Health. During that time, they conspired to submit false and fraudulent bills through wire transmissions to the Texas Medicaid program and the Medicaid funded managed care organizations known as Evercare of Texas LLC and Superior Health Plan Inc. for home health services that had not been provided. Ramirez and Velasquez admitted they created false and fraudulent time sheets for former Caring Touch employees for home health services that had not been provided and then fraudulently billed Medicaid, Evercare, and Superior in the name of Caring Touch for those non-existent services. They sent approximately 562 of those false and fraudulent bills by wire.
Ramirez and Velasquez also admitted that in order to personally profit from their fraudulent billings, they created phony payroll records from the fraudulent time sheet which they then sent to Caring Tough’s payroll staff. Ramirez and Velasquez then obtained the payroll checks generated from the false and fraudulent time records, forged the signatures of the former Caring Touch employees, and then cashed the checks and divided the money among themselves. Caring Touch and the former employees whose names were used on the false time sheets and checks were not accused of any wrongdoing.
Ramirez and Velasquez admitted that as a result of their false and fraudulent claims, Texas Medicaid, Evercare, and Superior paid the approximate aggregate sum of $155,127.72. As part of their pleas, the women have agreed to pay restitution in that amount.
Conspiracy to commit wire fraud and wire fraud each carry a maximum punishment of 20 years in federal prison without parole as well as a possible $250,000 fine. Judge Ramos has set sentencing December 3, 2013. Ramirez and Velasquez were permitted to remain on bond pending that hearing.
The charges were the result of a joint investigation conducted by officers and agents of the Corpus Christi Police Department, the FBI, Department of Health and Human Services-Office of Inspector General, and the Texas Attorney General’s Medicaid Fraud Control Unit. Special Assistant United States Attorney Rex Beasley and Assistant United States Attorney Jeffery Preston are prosecuting the case.

Abilene Dentist Pleads Guilty in Medicaid Fraud Scheme

ABILENE, TX—A dentist who practiced pediatric dentistry at Kool Smiles in Abilene, Texas, has admitted that he made false and fraudulent statements and entries on patient records, which caused Medicaid to be billed for, and pay, at least $120,000 for services falsely claimed to have been performed, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
Dr. Tuan Truong, aka “Terry Truong,” of Abilene, pleaded guilty this afternoon before U.S. District Judge Jorge A. Solis to an information charging one count of making a false statement in connection with a health care matter. Truong, who will remain on bond, faces a maximum statutory penalty of five years in federal prison, a $250,000 fine, and restitution. A sentencing date was not set.
According to documents filed in the case, in summer 2008, Truong began working for Kool Smiles, which paid him a base salary and offered opportunities for bonuses based on additional procedures he performed in excess of daily targets set by Kool Smiles management. Dentists were required to use professional judgment in the treatment and management of patient care.
Beginning on June 30, 2008 and continuing to July 10, 2009, Truong made false entries on Kool Smiles patient records, purporting to have performed dental services for Medicaid beneficiaries that he well knew he had not performed. As a result of the false and fraudulent statements and entries Truong made, Kool Smiles billed Medicaid for procedures that were not performed. In fact, during this time period, Truong made false entries in the Kool Smiles electronic database that caused Kool Smiles to bill and receive payment from Medicaid (and Medicaid affiliates) of more than $120,000 but less than $200,000 for services he claimed to have performed but did not.
In addition, according to the factual resume filed, Truong personally benefitted from this scheme by receiving bonuses of $32,749 to which he would not have been otherwise entitled.
Kool Smiles has cooperated throughout the investigation, which was conducted by the Medicaid Fraud Control Unit of the Office of the Attorney General for the state of Texas and the FBI. Assistant U.S. Attorney Amy Burch, of the U.S. Attorney’s Office in Lubbock, Texas, is in charge of the prosecution.

Former Office Manager for Health Care Solutions Network Sentenced in $63 Million Medicare Fraud

WASHINGTON—A former office manager at the defunct health care provider Health Care Solutions Network Inc. (HCSN) was sentenced today in Miami to serve 68 months in prison for her role in a fraud scheme that resulted in more than $63 million in fraudulent claims to Medicare and Florida Medicaid.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations, Miami office, made the announcement.
Lisset Palmero, 45, of Miami, was sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to her prison term, Palmero was sentenced to three years of supervised release and ordered to pay restitution in the amount of $17.4 million.
During the course of the conspiracy, Palmero was employed as a receptionist and office manager at HCSN, a mental health facility that purported to provide Partial Hospitalization Program (PHP) services. A PHP is a form of intensive treatment for severe mental illness.
HCSN of Florida (HCSN-FL) operated community mental health centers at two locations. According to court documents, Palmero was aware that HCSN-FL paid illegal kickbacks to owners and operators of Miami-Dade County Assisted Living Facilities (ALF) in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid. Palmero also knew that many of the ALF referral patients were ineligible for PHP services because they suffered from mental retardation, dementia, or Alzheimer’s disease.
Court documents reveal that Palmero was aware that HCSN-FL personnel were fabricating patient medical records. Many of these medical records were created weeks or months after the patients were admitted to HCSN-FL for purported PHP treatment. Palmero was also aware that medical records were fabricated for “ghost patients” who were never admitted to the HCSN-FL PHP. During her employment at HCSN-FL, Palmero actively concealed the fabrication of medical records by preparing, and causing others to prepare, documentation that was later utilized to support false and fraudulent billing to government-sponsored health care benefit programs, including Medicare and Florida Medicaid.
According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported HCSN-FL mental health services.
This case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case was prosecuted by Trial Attorney Allan J. Medina and former Special Trial Attorney William J. Parente.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

Alcohol Abuse Treatment

If you or someone you love is struggling with drug or alcohol addiction, you understand all too well how difficult it is to deal with it on your own. In most cases, it's nearly impossible to get well without some kind of help. When you finally decide you want to live a clean and sober life, one of the best things you can do is check into a drug and alcohol abuse treatment center. Choosing the right facility is one of the most important decisions you will ever make. Contrary to popular belief, not all of these places are the same. Philosophies and treatment plans will vary from facility to facility. The key is to find the drug and alcohol abuse treatment center that you are most comfortable with and best addresses your specific needs.

Things To Consider

The increase in drug and Alcohol Addiction over the last several years has led to treatment facilities popping up everywhere. This being the case, you should have a few available options no matter where you live. One of the first things to consider when looking at a drug and alcohol abuse treatment center is their philosophy. As stated above, this will vary among different facilities. The reason this is so important is that their philosophy is the basis for everything that they do, from policies to treatment plans. You need to ask them how they view addiction and it's possible cure. A good facility will have a number of different treatment options available. These include inpatient, outpatient, and short stay options to aid Alcohol Rehab.

They also need to have highly trained and experienced doctors on staff that can help you determine which is the best option for you and your specific disease. They can identify the severity of your addiction and recommend the appropriate course of action. Another nice feature of many drug and alcohol abuse treatment centers is on site medical services and (alcohol rehab). This can give you the comfort of knowing that the staff can safely see you through the withdrawal period. This is especially important with alcohol withdrawals, because they are typically far more dangerous than drug withdrawals.

Often, a person's drug or alcohol addiction will affect their family members almost as much as themselves. You may want to choose a facility that can address the mental and emotional needs of them as well. Many drug and alcohol abuse treatment facilities offer counselling for the family members of the addict. Obviously, the cost of the Alcohol Treatment is another important factor to consider. Ask about the fees for the different types of services offered. If they do have on site medical services, find out what kinds of costs are associated with it.

Also, find out what kind of aftercare services are provided. Obviously, you can't expect to walk out of the facility after you've completed the program and be cured. Addiction recovery is a lengthy process and must be worked at every day. A good facility will provide adequate follow up care to assist you with adjusting to everyday life after your stay. With so much riding on this decision, take your time and choose the drug and alcohol abuse treatment center that you feel will give you the best chance at starting a clean and sober life.

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Did You Binge Drink Last Night? Why You May Need an Alcohol Treatment Program

Alcohol treatment programs across the country are getting calls today, from women who have relapsed or realized over the weekend that perhaps their alcohol problem has gotten out of hand.

Perhaps it used to be a lighthearted enough social event: drinking with your friends throughout an evening or while out for a day at the beach or the ballpark. However, somewhere a while back you realized that you crossed the line from social drinking to binge drinking, and you know that it has caused consequences in your life. You may even be feeling miserable when you drink, but you continue to drink because you just can't stop. You are beginning to wonder if you need an alcohol treatment program.

What Is Binge Drinking?

Binge drinking is the excessive consumption of alcohol over a short period of time. It is often a group event, especially if you have friends who also are problem drinkers. Binge drinking is most often characterized by multiple drinks resulting in heavy intoxication. It can take place only on weekends or days off, giving the impression that the person is in control of his or her drinking; however, once the person begins drinking, she often can't stop until heavy ingestion has occurred. Because of the heavy intake of alcohol over a relatively short period of time, blackouts and vomiting often occur and hangovers are the common morning-after greeting. While a blackout may signal the need for an alcohol treatment program, there are plenty of other signals that should trigger you to consider joining a program.

Signs that you need an alcohol treatment program

Here are some signs that your drinking has progressed to the point that you need professional help:

• craving alcohol or finding yourself wanting to drink
• drinking more than you told yourself you would
• needing more alcohol to achieve a desired level of intoxication
• engaging in risky behavior while under the influence of alcohol
• missing work or family commitments due to either drinking or hangovers
• blackouts or periods of time you cannot remember
• legal consequences such as citations for drinking in public or arrests for driving under the influence
• broken or strained family relationships due to your drinking
• arguing with those who confront you about your drinking

Alcohol treatment programs help women of all ages and with all types of alcohol abuse problems. Binge drinking is commonly brushed off as a weekend habit, but when this habit affects your daily life or causes you to engage in risky behavior or results in legal consequences it is time to recognize that you need help. Be assured that admitting the need for help is the first step to recovery and often the most difficult one. An alcohol treatment program for women might be the right place for you to receive the treatment and support you need to regain control in your life.

If you or a woman you love is having problems with alcohol abuse and recovery, an alcohol treatment program for women can help reduce the risk of relapse. Remember that recovery from addiction and alcohol abuse treatment means learning how to cope with intensely emotional situations, and identifying when you need help and support.