Prominent Tri-State Cardiologist Sentenced to 78 Months in Prison in $19 Million Fraud Scheme and for Exposing Patients to Unncessary Medical Treatment

NEWARK, NJ—A well-known cardiologist and the founder, CEO, and sole owner of two large medical services companies in New Jersey and New York was sentenced today to 78 months in prison and ordered to pay $19 million in restitution for conspiring in a multi-million-dollar health care fraud scheme that subjected thousands of patients to unnecessary tests and potentially life-threatening, unneeded treatment, as well as treatment by unlicensed or untrained personnel. The sentence was announced today by U.S. Attorney Paul J. Fishman of the District of New Jersey.
Jose Katz, 69, of Closter, New Jersey, previously pleaded guilty to an information charging him with one count of conspiracy to commit health care fraud and one count of Social Security fraud arising from a separate scheme to give his wife a “no show” job and make her eligible for Social Security benefits. Judge Linares imposed the sentence today in Newark federal court.
“Katz prized illegal profits over patients to a staggering degree, committing record-breaking fraud and compromising care,” said U.S. Attorney Fishman. “Prison is an appropriate consequence for ripping off the government and insurance companies through the shocking exposure of patients to unneeded or untrained treatment.”
As part of his plea agreement with the government, Katz agreed that the loss amount sustained by Medicare, Medicaid, and other insurers victimized by the fraudulent billings was $19 million. U.S. Department of Health and Human Services-Office of the Inspector General and FBI records indicate the loss amount suffered by the victims is the largest recorded in New Jersey, New York, and Connecticut for an individual practitioner convicted of health care fraud.
According to documents filed in this case and statements made in court:
Katz was the founder, CEO, and sole equity-holder of Cardio-Med Services LLC (Cardio-Med) and Comprehensive Healthcare & Medical Services LLC (Comprehensive Healthcare). From 2004 through 2012, Cardio-Med had offices in Union City, Paterson, and West New York, New Jersey, and Comprehensive Healthcare had offices in Manhattan and Queens, New York. Both Cardio-Med and Comprehensive Healthcare provided cardiology, internal medicine, and other medical services to individual patients. During that time period, Katz conspired to bill Medicare Part B, Medicaid, Empire BCBS, Aetna, and others for unnecessary tests and unnecessary procedures based on false diagnoses and for medical services rendered by unlicensed practitioners.
Between July, 2006 and February, 2009, Katz spent more than $6 million for advertising on Spanish-language television and radio stations. The ads attracted hundreds of patients to Cardio-Med and Comprehensive Healthcare every day. Overall, Katz was able to bill Medicare and Medicaid more than $75 million for his services from 2005 through 2012.
Over the course of the conspiracy, Katz ordered and performed essentially the same battery of diagnostic tests for nearly all the patients he treated, regardless of their symptoms. Katz also instructed his non-physician employees to order and perform diagnostic tests for patients of other doctors working at his offices, even though he had not examined those patients and the other physicians had not ordered the tests.
Most significantly, Katz admitted that he falsified patient charts with fictitious and boilerplate symptoms and falsely diagnosed a majority of his Medicare and Medicaid patients with coronary artery disease and debilitating and inoperable angina. He also admitted to making the diagnoses to justify prescribing and administering an unnecessary treatment for those patients called enhanced external counter pulsation, or EECP. Katz even prescribed EECP treatments for some patients with contraindications for the treatment, therefore subjecting those patients to a substantial risk of serious injury or death.
From 2005 through 2012, Medicare and Medicaid paid Katz more than $15.6 million just for his EECP treatments, most of which were fraudulent.
In addition, Katz ordered conspirator Mario Roncal, 62, of Woodland Park, New Jersey—who had a medical degree from San Juan Bautista School of Medicine in San Juan, Puerto Rico, but did not have a license to practice medicine in any of the 50 states—to treat patients, knowing he was not licensed. At Katz’s direction, Roncal held himself out to fellow employees and to patients as “Dr. Roncal,” examined new patients as well as Katz’s follow-up patients, ordered diagnostic tests, diagnosed patients with medical conditions and diseases, and recommended and prescribed courses of treatment and surgery—including falsely diagnosing patients with angina and prescribing EECP treatments for those patients.
To conceal this illegal and unlicensed practice of medicine, Roncal forged Katz’s signature on paperwork associated with Roncal’s unlawful medical services, including on patient charts. During the conspiracy, Katz used his own billing numbers to bill Medicare Part B and Medicaid for the illegal services Roncal provided as though they were provided by Katz.
Roncal was indicted on March 2, 2012, for conspiracy to commit health care fraud. He entered a guilty plea on January 4, 2013, and awaits sentencing.
Katz also admitted to a Social Security fraud scheme in which, from 2005 through 2012, he kept his wife on Cardio-Med’s payroll though she performed little or no work. During the course of the scheme, Katz sent false W-2 forms for calendar years 2005 through 2011 to the U.S. Social Security Administration purportedly reflecting $1,251,604 in earnings for his wife, making her eligible for an estimated $263,000 in Social Security benefits to which she was not entitled.
In addition to the prison term and restitution, Judge Linares sentenced Katz to serve three years of supervised release.
U.S. Attorney Fishman credited special agents of the FBI, under the direction of Special Agent in Charge Aaron T. Ford; the U.S. Department of Health and Human Services, Office of the Inspector General, under the direction of Special Agent in Charge Thomas O’Donnell; the U.S. Postal Inspection Service, under the direction of Inspector in Charge Maria Kelokates; the Social Security Administration, Office of the Inspector General, under the direction of Special Agent in Charge Edward J. Ryan; IRS-Criminal Investigation, under the direction of Special Agent in Charge Shantelle P. Kitchen; and criminal and civil investigators with the U.S. Attorney’s Office for the investigation leading to today’s sentence. He also thanked the Medicaid Fraud Division of the Office of the New Jersey State Comptroller for its assistance.
The government is represented by Assistant U.S. Attorney Scott B. McBride of the U.S. Attorney’s Office Health Care and Government Fraud Unit in Newark.

A Teenager Needs Help For Drug And Alcohol Problems

There are times when the curve balls of life are a little more than we can handle on our own. The good news is, you are not alone and healing and treatment opportunities are readily at your disposal. Drug and alcohol addiction can creep up on the best of us, and the slavery that follows can be a period of time where darkness just seems to envelope everything around us. There is light at the end of the tunnel.

Addiction treatment can be successful when paired with love, education, diligence, community, motivation and recovery. There are a plethora of counseling agencies, therapeutic communities, specialized drug treatment programs and drug and alcohol rehabilitation centers available that offer hope, freedom and resurgence. Determination and support amongst family members is a vital component of helping addicted youths overcome dependence.

Seeking out educational, reliable information is a good first step. Gaining a better understanding of addiction and the symptoms it brings can help parents and other family members communicate more effectively and convey their love, concern and support. The first step is to get professional help; help that can offer trustworthy, unswerving guidance and therapy, both to teens and their families.

There are many options available for families who have a teen that is involved with substance and or alcohol abuse. Residential facility care is one such option which involves edification, medical care and localized treatment methods. Most programs are founded on the twelve step model, and group meetings are a central component of treatment. Many residential programs are substantially controlled in order to give residents the best possible opportunity for success and triumph over their specific addiction.

Infiltrating free time with structured events, activities, therapy sessions and group meetings allows little opportunity for addictive stumbling blocks. Teens can receive encouraging support and will have time to express themselves freely to trained, licensed professionals. In many cases, these sessions open doors of communication between youths and their family members bridging the painful gap that addiction can cause in meaningful, loving relationships.

Outpatient programs can offer success to those whose schedules and addiction may not require in-house rehabilitation, or who have already completed a more stringent residential program. Outpatient treatment offers a variety of key tools that can help families and those suffering from addiction find confidence, hope and autonomy through sober living. Outpatient services can include drug and alcohol assessments, both group and individual therapy sessions, and specialized counseling for family members. Enlightening and instructive courses on drug and alcohol addiction and methods are used to combat and treat addictions, including drug screening, and medical treatments, if necessary.

The ability to combat and find freedom against addiction and enjoy the wonder and beauty of a sober life is within reach for anyone who desires to make a change. Family members and their teens are not alone and there are facilities, professionals and treatment options that can and will bring additional support and encouragement and create a foundation of healing, not only for the addict, but to the relationships that have been damaged by the dependence. Liberty from addiction is one phone call away and the choice to restore sobriety and renew life is available to everyone. The choice and the opportunity are yours! Success awaits you!

Illinois Physician Indicted on Federal Charges for Allegedly Illegally Dispensing Prescription Medications

CHICAGO—A LaSalle County physician was taken into federal custody this morning after being indicted on federal charges alleging that he illegally dispensed prescription narcotics to three patients in 2012 and 2013. The defendant, Dr. Constantino Perales, was charged with 17 counts of illegally dispensing oxycodone and/or alprazolam in an indictment returned by a federal grand jury on Wednesday and made public today.
Perales, 62, of Peru, Illinois, was expected to appear at 2 p.m. today before U.S. Magistrate Judge Sidney I. Schenkier in federal court in Chicago. Perales has been in state custody on related charges, which were dismissed today by LaSalle County prosecutors. Perales’ Illinois medical license was suspended and he surrendered his DEA registration after federal and local authorities executed a search warrant at his office and he was arrested on state charges in August.
According to the indictment, Perales dispensed oxycodone and/or alprazolam outside the scope of professional practice and without a legitimate medical purpose to three different patients on 17 occasions between May 2012 and August 2013.
Each count carries a maximum penalty of 20 years in prison and a $1 million fine. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The arrest and charge were announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Robert J. Shields, Jr., Acting Special Agent in Charge of the Chicago Office of the Federal Bureau of Investigation, Jack Riley, Special Agent in Charge of the Drug Enforcement Administration; Lamont Pugh, III, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General in Chicago; and the Peru Police Department.
The government is being represented by Assistant U.S. Attorney Lela Johnson.
An indictment contains merely charges and is not evidence of guilt. The defendant is presumed innocent and is entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.

Five Damaging Effects of Alcoholism on Your Body

Many studies have been done on the effects of consuming high amounts of alcohol over an extended period, and they have consistently shown that alcoholism has long-term and damaging effects on your body. Below, we've listed five major consequences and the most vital organs that alcohol attacks.

1. Your Liver

Over 2 million people in the United States suffer from a form of alcoholic liver disease. The liver detoxes the alcohol and removes it from your bloodstream, preventing it from accumulating and destroying other cells and organs. However, the act of metabolizing the alcohol actually creates substances that are harmful to the liver itself. This can lead to:

• Inflammation
• Liver scarring
• Liver failure
• Death

2. Your Brain

According to the National Institute of Alcohol Abuse and Alcoholism, studies have consistently shown that people with a history of alcoholism or repeated alcohol abuse have smaller, lighter and more shrunken brains than others of the same age and gender. This shrinkage in the brain has been shown to result in several damaging conditions, including:

• Memory loss
• Alcoholic blackouts
• Damage to brain cells
• Loss of cognitive thinking skills
• Strokes
• Dementia

3. Your Digestive System

Excessive drinking stemming from alcohol abuse or alcoholism has also been shown to damage all parts of the digestive system. If you consume several alcoholic beverages each day, you are at a higher risk for digestive system problems, such as:

• Chronic inflammation of the esophagus
• Pancreatitis
• Gastritis (inflammation of the stomach)
• Stomach ulcers
• Cancer (in esophagus, mouth, throat, colon and rectum)

4. Your Heart

Another damaging effect of alcoholism is heart problems and diseases. At high concentrations, alcohol has been shown to interfere with the pumping action of the heart. It has also been linked to a number of other cardiovascular problems, listed below.

• Loss of heart's ability to beat properly
• High blood pressure
• Coronary artery disease (the leading cause of death in Western society)
• Heart attacks
• Increased risk of stroke

5. Your Immune System

Alcoholics and people who drink heavily suffer from far more infectious diseases than people who drink moderately or not at all. One study found that alcohol abusers were 15 to 200 times more likely to get tuberculosis than nonusers. In extreme cases, the body can cease to accurately distinguish self from non-self, causing the immune system to actually attack your own body.

In addition to all of the health complications of high concentrations of alcohol, the University of Maryland Medical Center estimates that alcoholism can reduce your life expectancy by 10 to 12 years.

But there is hope. When alcoholics enter recovery, many of the affected vital organs begin to repair themselves and the overall health of the patient improves.

Entering into recovery can be a frightening, painful, even dangerous process. To guard the alcoholic's safety and increase the rate of long-term recovery, the first short-term goal is often a proven detoxification program to help alleviate withdrawal symptoms and ease the detox phase. Then the next phase of rehabilitation and recovery can proceed with a better prognosis for success.

Beaumont Orthodontist Sentenced for Health Care Fraud Violations

BEAUMONT, TX—A 70-year-old Beaumont orthodontist has been sentenced to federal prison for health care fraud violations in the Eastern District of Texas, announced U.S. Attorney John M. Bales today.
Terrence Ewing Syler pleaded guilty on June 18, 2013, to health care fraud and was sentenced to 22 months in federal prison today by U.S. District Judge Thad Heartfield. Syler was also ordered to submit to forfeiture of $829,000 and pay a $6,000 fine.
According to the information presented in court, Syler owned and operated Syler Orthodontics in Beaumont. From January 2007 to October 2012, Syler carried out a scheme to defraud Medicaid by submitting claims for palatal expanders that were never provided to his patients. As a result of the scheme, Syler received $829,333 to which he was not entitled. As part of his plea agreement, Syler has agreed to forfeiture of several bank accounts totaling just over $829,000.
The Texas Medical Assistance Program (Medicaid) is a health care benefit program, jointly funded by the state of Texas and the federal government, and helps pay for reasonable and necessary medical procedures and services provided to individuals who are deemed eligible under state low-income programs.
This case was investigated by Federal Bureau of Investigation, the U.S. Department of Health and Human Services-Office of the Inspector General (HHS-OIG), and the Texas Office of the Attorney General-Medicaid Fraud Control Unit (OAG-MFCU). Assistant U.S. Attorney Christopher T. Tortorice prosecuted this case.
Any individuals with knowledge of these or other health care fraud violations are encouraged to contact the Department of Health and Human Services’ fraud hotline at 1-800-HHS-TIPS (447-8477).

Patient Broker of South Florida Psychiatric Hospital Sentenced for Role in $67 Million Health Care Fraud Scheme

WASHINGTON—A patient broker of a South Florida psychiatric hospital was sentenced today to serve 24 months in prison, followed by three years of supervised release, for her participation in a $67 million Medicare fraud scheme.
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 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.
Gloria Himmons, 54, of Union Springs, Alabama, was sentenced by U.S. District Judge Jose E. Martinez in the Southern District of Florida. In March 2013, Himmons pleaded guilty to one count of conspiracy to receive health care kickbacks and one count of receiving a health care kickback. In addition to her prison term, Himmons was ordered to pay $14 million in restitution, jointly and severally with her co-defendants.
According to court documents, Himmons was a patient broker at Hollywood Pavilion LLC (HP), a state-licensed psychiatric hospital in South Florida that purported to offer both inpatient and outpatient mental health services. Himmons would provide Medicare beneficiaries to HP in exchange for bribes and kickbacks, and she knew that the patients she provided to HP were not appropriate for inpatient psychiatric hospitalization or for outpatient mental health treatment. The patients she provided to HP included those who were not severely mentally ill, as well as substance abusers looking for rehabilitation programs. The patients did not have legitimate referrals from hospitals or doctors who had been treating acute-phase, severe mental illness.
From at least 2005 through September 2012, in exchange for bribes and kickbacks, Himmons knowingly and willfully provided to HP Medicare beneficiaries who did not need inpatient or outpatient psychiatric treatment. As a result of Himmons’s participation in this scheme, HP was improperly paid more than $7 million by Medicare. From at least 2003 through at least August 2012, HP billed Medicare approximately $67 million for services that were not properly rendered, for patients that did not qualify for the services being billed, and for claims for patients who were procured through bribes and kickbacks. Medicare reimbursed HP on approximately $40 million of those claims.
On September 10, 2013, co-defendants Karen Kallen-Zury, Daisy Miller, and Christian Coloma were sentenced on their June 2013 jury convictions. Kallen-Zury, the chief executive officer of HP, and Miller and Coloma were convicted on all counts at trial and sentenced to 300 months, 180 months, and 144 months, respectively. Kallen-Zury and Miller were ordered to pay, jointly and severally with their co-defendants, nearly $40 million in restitution. Coloma was ordered to pay, jointly and severally, more than $20 million in restitution.
This case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Miami. This case is being prosecuted by Assistant Chief Robert A. Zink and Trial Attorneys Andrew H. Warren and Anne McNamara of the Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,500 defendants who collectively have falsely billed the Medicare program for more than $5 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are 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.

Drug and Alcohol Denial and Intervention

Denial and Intervention

Denial and family intervention is often an essential part of the recovery process. Denial plays a common role with drug addiction and what's called tough love can be very persuasive. because an individual's life has become unmanageable as a result of drug addiction and/or alcoholism, no matter what the drug being abused, along with the abuse comes a lack of willingness and/or ability to confront the true nature of one's own problem with drugs and alcohol and to take any kind of action to better their lives. This is called denial, and it comes in many forms - blaming, playing the victim, anger, fear etc. Along with denial, an addict must deal with pride and ego, two of the worst enemies of addiction, as they will in no doubt keep an addict or alcoholic using until one of three inevitable ends - jails, institutions, or death. This is where a type of addiction professional called an interventionist becomes important. Interventionists play an essential role in the treatment process.

A family Intervention or Interventionist's job is to break down denial. Denial is a very strong defense mechanism used by addicts that enables them to justify continuing their destructive behavior. Often they blame their usage on family members, jobs, and stress, anything that allows them not to accept responsibility for their addictive actions and continue the substance abuse. Breaking through these barriers and gaining commitment to receive care is essential to begin the healing process.

The purpose of an interventionist is to coordinate with the family and/or other professionals in selecting a proper detoxification and treatment facility to suit the need. Advanced arrangements must be made as the expectation is immediate admittance upon the completion of the intervention. Experienced interventionists will counsel the family with understanding an answer any questions they may have and to resolve any bad feelings to ease the situation keeping in mind the goal of getting the addict to drug or alcohol detox treatment program immediately. The intention is clear, the tone is hopeful and the resolve is unwavering. This process is born out of love and concern interventions and interventionists are successful in 90%-95%+ of all cases.

In the event that the drug addict or alcoholic chooses not to agree to treatment, the family, friends, and employers must be prepared for the next step. This involves of all enabling behaviors by the parties involved needs to cease.

Typically the only reason this process may not be effective is that in the past, consequences of the drug addicts have been so minimal that the addict doesn't think that anything will change. The family must be prepared to set strong boundaries and not waver at the time of intervention. The addict is once again told he/she is loved and that the family and interventionist are willing to get them effective drug or alcohol treatment. It must be made clear, however, that the family (with the guidance of the interventionist as a mediator) will no longer accept this behavior and watch the addict slowly kill themselves. The drug addict or alcoholic is expected to accept the gift that is being offered and get help at a drug or alcohol detox and treatment program. Intervention can be a very painful process, because it is a time during which a family often gets to see the true strength of the addictive minds. Intervention is a serious undertaking and it is imperative that it be done effectively, safely and with confidentiality. No intervention should be done without at least being researched and discussed with a knowledgeable counselor or interventionist.