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.

Alternative Drug Addiction Therapies - Narconon

There are almost as many treatments for drug addiction as causes for it. One of the so called "alternative therapies" is Narconon.

This treatment looks at handling the causes of the addiction, as well as the addicition itself. It is controversial inasmuch as it is based upon the writings and beliefs of Ron L. Hubbard. One time science fiction author and founder of the "religion" of scientology.

The basic premise is to try and look at an individual's own position as a start to treating the actual addicition. This program does not make use of any drugs to combat withdrawal symptoms. Rather using education and rehabilitation. The program is widely used in schools as preventative education, along with the schools own program, if they have one.

Advocates of the program commonly claim a 70% success rate with it in combatting drug abuse. As opposed to the more usual figure of around 30% for most other treatments. Narconon claims that addicts can resume normal life as a healthy, productive member of society, when they work with the program and stick with it.

Narconon have their own facilities, where drug addicts can be treated "in-house", or they can be treated as an out patient. Depending upon their level of drug abuse, and of course the wishes of the patient themselves, or more usually their partners/relatives.

The usual amount of time taken for the Narconon program to work effectively is between four to six months. During which time addicts are said to be "going back to school" to be re-educated on drugs, their use and abuse, the dangers of drugs and drug addiction, and of course eventual recovery. All done without the use of other pharmaceuticals to dull the pain of withdrawal.

Narconon has it's adversaries, just as Scientology itself. These opponents say the information used is not scientifically sound, and results are manipulated to show the program in a good light. They also say that the program is in effect brainwashing. Which of course it is, as are most programs designed to wean the brain off the effects of various substances.

Another point brought up is that the educational materials used in the Narconon program are not geared to the capabilities of the students involved. That the same materials are used for elementary level to high school level, and use many scientific terms without sufficient, or even any, explanation. This can make understanding quite hard for the younger students.

This being the case, it is still a fact that drug abuse is a massive problem worldwide, and it's causes and treatments are many. Narconon probably does have it's place in the scheme of things, and there is no doubt that many addicts have benefited from the program. Whether those people would have benefited equally from any other program is of course a matter for conjecture.

Two Plead Guilty to Money Laundering Conspiracy in $10.5 Million Medicare Fraud Scheme

WASHINGTON—Two men from Miami have pleaded guilty to laundering millions of dollars obtained through a $10.5 million Medicare fraud scheme using shell companies they controlled.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, Acting U.S. Attorney for the Middle District of Florida A. Lee Bentley III, Special Agent in Charge Paul Wysopal of the FBI’s Tampa Field Office, and Special Agent in Charge Christopher B. Dennis of the U.S. Health and Human Services Office of Inspector General (HHS-OIG) region including all of Florida made the announcement.
Rafael Roche, 43, and Alain Remy, 35, pleaded guilty on October 24, 2013, and October 23, 2013, respectively, in the U.S. District Court for the Middle District of Florida to an indictment charging them with conspiracy to commit money laundering involving the proceeds of a health care fraud scheme. Remy is scheduled for sentencing on January 16, 2014; Roche’s sentencing date has yet to be scheduled. They each face a maximum penalty of 20 years in prison.
According to documents filed in the case, Roche, Remy, and others conspired to engage in financial and monetary transactions of health care fraud proceeds from Renew Therapy Center of Port St. Lucie LLC (Renew Therapy), a comprehensive outpatient rehabilitation facility. From November 2007 through August 2009, Renew Therapy submitted approximately $10,549,361 in fraudulent claims for reimbursement to Medicare for therapy services that were not legitimately prescribed and not legitimately provided to Medicare beneficiaries. As a result of those fraudulent claims, Medicare deposited approximately $6,248,056 into a Renew Therapy bank account. The fraud proceeds in that account were subsequently disbursed to various entities, including a combined total of $1,847,222 to Ariguanabo Investment Group Inc. and IRE Diagnostic Center Inc., shell companies that Roche and Remy controlled.
Court records indicate that more than $1.2 million was laundered through Ariguanabo Investment Group between February 5, 2009 and September 22, 2009. The money was subsequently removed from the Ariguanabo Investment Group bank account to various individuals and entities, including to Ibiza Future Planning Inc., a shell company that Remy established and controlled.
More than $600,000 was laundered through IRE Diagnostic Center from August 7, 2008 and January 29, 2009. The money was subsequently removed from the IRE Diagnostic Center bank account to various individuals and entities, including to A&R Medical Services of South Florida Inc., another shell company that Roche and Remy established and controlled.
This case is being 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 U.S. Attorney’s Office for the Middle District of Florida. This case is being prosecuted by Trial Attorney Christopher J. Hunter of the Criminal Division’s Fraud Section.
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, 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 Team (HEAT), go to: www.stopmedicarefraud.gov.

Owner, Executives, and Physicians at Closed Sacred Heart Hospital Indicted in Alleged Medicare Referral Kickback Conspiracy

CHICAGO―The owner and three other executives of the now-closed Sacred Heart Hospital and four physicians affiliated with the former west side facility were indicted on federal charges alleging that they collectively paid and received hundreds of thousands of dollars in illegal kickbacks in exchange for the referral of hospital patients who were insured by Medicare and Medicaid. Sacred Heart allegedly paid physicians bribes and kickbacks to induce patient referrals and increase the patient census, which, in turn, increased hospital revenue.
Sacred Heart Hospital was a 119-bed acute care facility located at 3240 West Franklin Blvd. in Chicago. The hospital closed and filed for bankruptcy this summer after Medicare payments were suspended in the aftermath of criminal charges that were first filed in April. The indictment charges only conduct involved in the alleged kickback conspiracy while a broader investigation that was outlined in the earlier criminal complaint continues.
The eight defendants were charged in a 17-count indictment that was returned by a federal grand jury late yesterday and announced today by Zachary T. Fardon, United States Attorney for the Northern District of Illinois. Five of the eight defendants were charged and arrested on April 16 this year, while three new defendants were charged in the indictment for the first time. A fifth physician associated with Sacred Heart was indicted separately for illegally prescribing prescription medications. No new arrests occurred in connection with the indictments.
Mr. Fardon announced the charges with Lamont Pugh, III, Special Agent in Charge of the Chicago Region of the U.S. Department of Health and Human Service Office of Inspector General, and Robert J. Shields, Jr., Acting Special Agent in Charge of the Chicago Office of the Federal Bureau of investigation.
The five defendants charged previously in the conspiracy case are: Edward J. Novak, 58, of Park Ridge, Sacred Heart’s owner and chief executive officer; Roy M. Payawal, 64, of Burr Ridge, executive vice president and chief financial officer; and Drs. Percy Conrad May, Jr., 75, of Chicago, Subir Maitra, 73, of Chicago, and Shanin Moshiri, also known as “Shawni Moshiri,” 58, of Chicago. All five of these defendants remain free on various bonds after they were arrested in April.
The three new defendants are: Dr. Rajiv Kandala, 41, of Chicago; Anthony J. Puorro, 57, formerly of Chicago, who was Sacred Heart’s chief operating officer; and Noemi Velgara, 64, of Chicago, who was Sacred Heart’s vice president of geriatric services and was responsible for overseeing the Golden L.I.G.H.T. medical clinics, including managing employees responsible for marketing, and recruiting and transporting patients.
All eight defendants will be ordered to appear for arraignment in U.S. District Court.
Four defendants―Novak, Payawal, Puorro, and Velgara―were each charged with one count of conspiracy to violate the federal healthcare anti-kickback statute by offering and paying kickbacks and bribes, directly and indirectly, from Sacred Heart to Drs. May, Maitra, Moshiri, and Kandala and other physicians to induce them to refer patients to the hospital for services that would be reimbursed by Medicare and Medicaid. Sacred Heart’s chief operating officer before Puorro, identified as “Administrator A,” is named as an unindicted co-conspirator.
In addition, Novak and Payawal were each charged with eight substantive counts of paying kickbacks for patients, while Drs. May, Maitra, Moshiri, and Kandala were charged with two counts each of accepting kickbacks for patient referrals. The indictment also seeks forfeiture of illegal proceeds from Novak, Payawal, and the four physicians, including the unspecified total amount of Medicare and Medicaid reimbursements made on claims submitted on behalf of hospital patients whose referral involved kickbacks and the total amount of kickbacks paid to the four physicians.
According to the indictment, Sacred Heart’s owner, executives, and administrators conspired between 2004 and April 2013 to pay physicians bribes concealed as consulting, employment, and personal services compensation, rent, and instructional stipends in return for referrals of Medicare and Medicaid patients. Although styled as payments for legitimate services, the payments actually contained disguised bribes paid to and for the benefit of Drs. May, Maitra, Moshiri, and Kandala in exchange for patient referrals.
The indictment alleges that Novak, Payawal, Puorro, and Administrator A caused Sacred Heart to pay May hundreds of thousands of dollars in bribes disguised as rent and Moshiri more than $150,000 in bribes disguised as payments for purportedly teaching podiatric surgery residents. Novak, Payawal, and Puorro allegedly caused Sacred Heart to pay Maitra at least $68,000 in bribes disguised as payments for purportedly teaching medical students at the hospital; and Kandala at least $32,000 in bribes disguised as compensation for consulting and instructional services purportedly provided to the hospital and its staff.
Payawal, Puorro, and Velgara allegedly agreed to have Sacred Heart offer to pay bribes to the hospital’s transportation staff to recruit and refer patients to the hospital, and those three defendants, together with Novak, also caused Sacred Heart to pay individuals employed as “marketers” to recruit patients.
As part of the same investigation, a fifth physician associated with Sacred Heart was indicted separately this month for allegedly illegally prescribing hydrocodone or lorazepam to four different patients without having a valid license and registration to prescribe controlled substances. The defendant, Dr. Kenneth S. Nave, 51, of Chicago, who also was arrested and charged last April, allegedly illegally used the Drug Enforcement Administration registration number of another physician when he prescribed the prescription narcotics between October and December 2012. Nave pleaded not guilty at his arraignment this week.
Each count in the eight-defendant Novak indictment carries a maximum penalty of five years in prison and a $250,000 fine and restitution is mandatory. Each count in the Nave indictment carries a maximum penalty of four years in prison and a $250,000 fine. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The government is being represented by Assistant U.S. Attorneys Joel Hammerman, Ryan Hedges, and Terra Reynolds.
The public is reminded that an indictment is not evidence of guilt. The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.
The case falls under the umbrella of the Medicare Fraud Strike Force, which expanded operations to Chicago in February 2011 and is part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Justice Department and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Dozens of defendants have been charged in health care fraud cases since the strike force began operating in Chicago.
To report health care fraud to learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

Man Who Posed as Wellsville Doctor Sentenced for Health Care Fraud

BUFFALO, NY—U.S. Attorney William J. Hochul, Jr. announced today that Fitzgerald Anthony Hudson, 53, formerly of Western New York, who was convicted of health care fraud for lying about his qualifications to practice medicine, was sentenced to 24 months in prison and three years’ supervised release by Chief U.S. District Chief Judge William M. Skretny. The defendant was also ordered to pay restitution in the amount of $227,548.35.
Assistant U.S. Attorney Aaron J. Mango, who handled the case, stated that in August 2008, the defendant submitted an application and was later accepted to work as a doctor in the Emergency Department at Jones Memorial Hospital in Wellsville, New York. In his August application, the defendant stated that (1) he had earned a degree from York University in Ontario, Canada; (2) he had never voluntarily withdrawn or resigned any employment or privileges at any healthcare facility in order to avoid the imposition of disciplinary measures; and (3) he had never been denied or suspended from any health care facility. In fact, the defendant did not have a degree from York; had been suspended from his duties as a resident and dismissed from the residency program due to academic incompetence at the Warren Hospital Family Practice Residency Program in Phillipsburg, New Jersey; and had resigned from the Claxton-Hepburn Medical Center in Ogdensburg, New York, after being told he would be terminated for poor performance.
During the course of this prosecution, the government presented evidence that while employed at Jones Memorial Hospital, Hudson treated a 5-year-old child who subsequently died shortly after being treated by the defendant. That case is now the subject of an ongoing wrongful death civil suit in state court. The government further introduced a New York State Board of Professional Medical Conduct investigation that concluded that the defendant obtained his medical license by fraud and while practicing medicine and engaged in gross negligence and gross incompetence with at least five patients.
“Each and every day, people across this country place their lives and their health—as well as the lives and health of their families—into the hands of those they believe to be trained medical professionals,” said U.S. Attorney Hochul. “Such medical visits are always accompanied by the highest level of trust and hope that the person we are seeing is actually qualified to provide the care for which we are seeking treatment. It is difficult to imagine a more egregious case of health care fraud than this—where a person lies in order to become an emergency room physician, had been twice previously cited for incompetence and poor performance, and in fact was not a legitimate doctor at all. This office will continue to crack down on all types of health care fraud and will vigorously prosecute those who lie about their qualifications to practice medicine.”
As for the defendant’s offense of conviction, the government established that once the defendant illegally obtained his medical staff appointment, Delphi Healthcare, Hudson’s employer, billed and received approximately $227,548.35 from Medicare, BlueCross BlueShield of Western New York, Univera Healthcare, and Independent Health for services rendered by the defendant.
The sentencing is the culmination of an investigation on the part of special agents of the Federal Bureau of Investigation, under the direction of Brian P. Boetig, Special Agent in Charge; special agents of the U.S. Department of Health and Human Services, Office of Inspector General, Office of Investigations, under the direction of Thomas O'Donnell, Special Agent in Charge; and investigators with the Medicaid Fraud Control Unit of the New York State Attorney General’s Office.