Ugly American Reality: Doctor-Managed Fraud is Out-of-Control

We thought it might be illuminating to review a handful of fraud cases we have been tracking over the past year. Here are “13 for 2013” that adequately represent how out-of-control U.S. health care scams are, on the large facility level:

1. Health Alliance of Greater Cincinnati/Christ Hospital Physician Scam Case

Health Alliance of Greater Cincinnati and The Christ Hospital in Mount Auburn, Ohio, have been fined $108,000,000 to settle claims they violated the Anti-Kickback Statute and the False Claims Act. Both health care programs were found guilty of illegally paying doctors in exchange for bringing in cardiac patients. Heart doctors were rewarded for their contributions to the hospital’s yearly financial revenues, and these physicians could earn additional income for treating patients at the facility. The government proved their kickback scheme violated the False Claims Act.

Who do YOU trust in a lab coat?

Who do YOU trust in a lab coat?

http://www.justice.gov/opa/pr/2010/January/10-civ-082.html

2. Tuomey Hospital Guilty verdict

In Sumter, South Carolina a federal court has convicted the Tuomey Health System, of violating the Stark Act, by providing kickbacks to 18 different doctors, for sending patients to the hospital in a “money=for-patients” scam. Tuomey was ordered in June to pay the federal government $45,000,000 and still faces a new trial on False Claims violations.

http://www.fiercehealthfinance.com/story/stark-violations-tuomey-healthcare-s-c-ordered-pay-50-million/2010-06-09

3. Los Angeles’ City of Angels Medicare fraud judgement

Intercare Health Systems, formerly doing business as Los Angeles’ City of Angels Medical Center, is paying a $16,000,000 judgment to resolve a civil lawsuit, by the United States and the state of California, for a Medicare and Medi-Cal fraud scheme, according to a U.S. Department of Justice news release. City of Angels was accused of violating the False Claims Act and Anti-Kickback Statute by paying illegal kickbacks to recruiters employed at Los Angeles homeless shelters to deliver homeless patients by ambulance to the hospital for medical treatment regardless of whether their clients in fact needed or requested such treatment.

City of Angels Hospital

City of Angels Hospital Stole $16m from Medicare & MediCal

City of Angels would then bill the Medicare and MediCal programs for a variety of medical services allegedly rendered to the homeless patients, many of which were not medically necessary.

http://articles.latimes.com/2012/aug/24/local/la-me-0824-homeless-recruits-20120824

4. 14 Hospitals found guilty in Kyphoplasty procedure scams

Fourteen hospitals in seven states have been ordered to repay the United States more than $12,000,000 to settle false claims to Medicare related to kyphoplasty procedures, performed between 2000 and 2008, according to a U.S. Department of Justice news release. The hospitals were accused of performing kyphoplasty, a procedure used to treat certain spinal fractures, as an inpatient procedure, in order to increase Medicare billings when many of the cases could have been performed on a less-costly outpatient basis. The top-paying hospitals were Ball Memorial Hospital in Muncie, Ind., which paid $1,900,000; Huntsville (Ala.) Hospital, which paid $1,992,000 and Palmetto Health in Columbia, S.C., which paid $1,860,000. Others are:

The U.S. Department of Justice reports the following hospitals will share in the restitution:

  • Plainview Hospital, Plainview, N.Y.: $2.3 million
  • North Mississippi Medical Center, Tupelo, Miss.: $1.9 million
  • Mission Hospital, Asheville, N.C.: $1.5 million
  • Wenatchee Valley Medical Center, Wenatchee, Wash.: $1.2 million
  • Community Hospital Anderson, Anderson, Ind.: $501,000
  • St. John’s Mercy Hospital, Creve Coeur, Mo.: $365,000
  • North Shore Syosset Hospital, Syosset, N.Y.: $193,000
  • Gulf Coast Hospital, Fort Myers, Fla.: $173,000
  • Lee Memorial Hospital, Fort Myers, Fla.: $160,000
  • Cape Coral Hospital, Cape Coral, Fla.: $73,000Four Florida hospitals affiliated with Adventist Health System/Sunbelt, Inc., will jointly pay $3.9 million:
  • Florida Hospital Orlando
  • Florida Hospital-Oceanside
  • Florida Hospital Fish Memorial
  • Florida Hospital Heartland Medical Center

http://www.floridasecuritiesfraudlawyerblog.com/2012/02/14-hospitals-settle-false-clai.html

 

5. Robert Wood Johnson University Hospital Hamilton Medicare fraud settlement

Robert Wood Johnson University Hospital Hamilton (N.J.) is repaying a $6,350,000  settlement in March to resolve allegations that it inflated charges to Medicare patients to obtain higher reimbursements from the federal program. Medicare provides supplemental outlier payments for cases that involve unusually high costs to providers. Two whistleblower lawsuits against the Hamilton hospital alleged it inflated charges to obtain these supplemental outlier payments for cases that were not overly costly and that should not have been eligible for outlier payments. The federal government intervened in the lawsuits in January, 2008. The whistleblowers received $1,100,000 of the settlement amount.

http://www.justice.gov/opa/pr/2010/March/10-civ-293.html

6. Five California Physicians charges in Medicare fraud scheme

Five doctors and six others were indicted by a grand jury in June for their roles in running an alleged $5,000,000 Medicare fraud scheme. From February. 2006 through August, 2008, doctors and staff at three clinics in Sacramento, Ca. are believed to have billed Medicare more than $5,000,000 in fraudulent claims for treating patients who were not sick. Vardges Egiazarian, MD, the apparent leader of the scam, admitted healthy patients were paid $100 per visit in exchange for allowing the clinic to bill for its services. In some cases, the clinics would bill Medicare for patients who were dead. Doctors Egiazarian and Derrick Johnson, pleaded guilty last year. Dr. Egiazarian was sentenced in November to six years in prison and was ordered to pay $1,500,000 in restitution. A grand jury extended healthcare fraud charges to five additional physicians and six others who knowingly committed healthcare fraud”

United States Attorney Benjamin B. Wagner announced today that on May 20, 2010, a federal grand jury returned a 20-count superseding indictment charging five doctors and six others with conspiracy to commit health care fraud. The defendants are as follows:

Dr. Alexander Popov, 44, of Los Angeles
Dr. Ramanathan Prakash, 63, of Northridge
Dr. Emilio Cruz III, 57, of Los Angeles
Dr. Lana Le Chabrier, 62, of Santa Barbara
Dr. Sol Teitelbaum, 82, of Los Angeles

http://www.news10.net/news/local/story.aspx?storyid=82107

7. Christiana Care whistleblower  claims settlement

Christiana Care Health System in Wilmington, Delaware has been ordered to pay $3,000,000 to settle claims made by a whistleblower that they paid kickbacks to nerve doctors, for sending patients to its Wilmington hospital. According to the prosecution, Christiana Care overpaid physicians at Neurology Associates for in-hospital readings of EEGs allegedly as a “reward” for referring patients to the hospital.

http://www.quitamhelp.com/index.php?/weblog/comments/christiana_care_health_system_pays_33_million_in_false_claims_act_settlemen/

8. Brookhaven Memorial Hospital Medical Center Medicare fraud case

Brookhaven Memorial Hospital Medical Center, on Long Island, New York, was ordered to pay $2,900,000 to settle allegations that the hospital inflated charges to obtain supplemental payments. The U.S. Justice Department intervened in the suit and discovered the hospital defrauded Medicare by inflating its charges to Medicare patients.

http://elearning.nextgenrcm.com/new-york-hospital-to-pay-2-92-million-settlement-concerning-outliers

9.
New York’s Oswego Hospital Stark violations

Oswego (N.Y.) Hospital was ordered to pay $2,000,000 to the Office of Inspector General, United States Department of Health and Human Services, and the New York State Office of the Medicaid Inspector General, to settle violations of the Stark Law. Oswego Hospital voluntarily contacted HHS and the state Medicaid program in March 2008 when it was discovered that a number of the hospital’s business transactions from 2002 to 2007 may not have complied with Stark Law. The hospital has since implemented policies and procedures to ensure that all hospital transactions comply with Stark Law.

http://www.syracuse.com/news/index.ssf/2009/12/oswego_hospital_pays_21_millio.html

10. Former Massachusetts Hospital executive $500,000 kickback scheme

Former Beverly Hospital vice president Paul Galzerano was indicted in July in a bribery and kickback scheme that brought him nearly $500,000 in profits. Prosecutors said that Galzerano solicited and received kickbacks and bribes from contractors on a $50,000,000 expansion project.

http://www.salemnews.com/local/x1221403196/Former-hospital-VP-gets-18-months-in-jail

11. Texas state representative’s Medicaid fraud scam

Texas State Representative Doctor Tara R. Rios Ybarra; Doctor Diana Woo Paparelli; and Doctor Colbert J. Glenn, were indicted in June on charges that they illegally referred Medicaid beneficiaries to a Gary Morgan Schwarz, DDS, MSD, a McAllen, Texas dentist. The three dentists were charged together on a 22-count indictment. State Sen. Rios Ybarra was charged with three of the counts, which allege that she referred Medicaid beneficiaries to Dr. Schwarz in return for 15 percent of all Medicaid payments made to him for the referred beneficiaries. Dr. Paparelli and Dr. Glenn were charged similarly with three counts of the indictment. All three defendants surrendered themselves to U.S. Marshals and each currently faces prison time and a fine of up to $25,000 for each count if convicted. In late June, Sen. Ybarra was in federal custody awaiting an initial court hearing.

http://www.fbi.gov/sanantonio/press-releases/2010/sa062310.htm

Sometimes, the best care, is NO care. Use common sense

Sometimes, the best care, is NO care. Use common sense

12. Michigan Neurologist false diagnosis scam

Yasser Awaad MD, a Dearborn Michigan child neurologist, was accused in June of diagnosing patients with epilepsy, when in fact the patients were healthy, in order to increase the volume of tests he performed at Oakwood Hospital & Medical Center in Dearborn. A lawsuit by seven patients against Dr. Awaad and Oakwood accused Dr. Awaad of misdiagnosing patients because his earnings were tied to procedure volume. Patients diagnosed with epilepsy undergo regular testing to monitor their condition. The hospital denied tying Dr. Awaad’s compensation to volume.

http://www.people.com/people/archive/article/0,,20446975,00.html

13. Federal intervention in lawsuit against Georgia’s Satialla Regional Medical Center

The U.S. Attorney General’s office intervened in a False Claims Act lawsuit in April after discovering that Satilla Regional Medical Center in Waycross, Georgia, and Najam Azmat, MD, were routinely submitting bills for medically substandard and unnecessary services to Medicare and Medicaid. Specifically, the complaint alleges, among other things, that the defendants submitted claims for medical procedures performed by Dr. Azmat in Satilla’s Heart Center that the doctor was not qualified to perform.

Dr Najam Azmat

Dr Najam Azmat

As a result, at least one patient died, and others were seriously injured. The complaint states that Satilla hired Najam Azmat even after learning that the hospital where he previously worked had restricted his privileges because of a high-surgical complication rate. The complaint also states that after Dr. Azmat joined the Satilla staff, the hospital management allowed him to perform endovascular procedures in the hospital’s Heart Center, even though he lacked experience in performing such procedures and did not have privileges to perform them.

http://jacksonville.com/news/crime/2012-01-19/story/waycross-hospital-pays-840000-lawsuit-over-unqualified-physician

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Sad to say, these 13 outrageous cases are merely 1% of the total of ongoing fraud cases continuing into the new year. They are an ugly reflection of the jaw-dropping volume of physician-generated, medical fraud in America.

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San Jose-Area Children’s Doctor Indicted on Drug Charges

The former medical director of the Valley Health & Hospital System in Santa Clara, California has been arrested and charged with 18 drug-related felonies.

Dr Marvin Bonham & attorney

Dr Marvin Bonham & attorney in court

Doctor Marvin Bonham, age 61 of Los Gatos, is believed to have been writing bogus prescriptions for  OxyContin to drug dealers in exchange for cash and methamphetamine, according to police documents.

The district attorney’s office reports Bonham would customarily write  “substantial volume of prescriptions for narcotics and other painkillers” to more than two dozen individuals over a two-year period. At least half of the “patients” had criminal histories of drug abuse and drug sales.

According to Deputy District Attorney James Sibley, a Santa Clara county task force began investigating Bonham after unusual police reports involving the doctor, his car, his home and a storage facility started coming in.

Court records show that a search of Bonham’s home in Los Gatos revealed weapons, methamphetamine and ecstasy. Detectives uncovered a marijuana plant green room in a hidden area below the house.

“Substantial quantities” of drying marijuana were found hanging in the garage, and the home was littered with burnt foil and hollowed pens that appeared to have been used to smoke drugs.

His Felony charges include possession of methamphetamine and marijuana for sale; prescribing narcotics without legitimate medical purpose; prescribing to known drug addicts; and possession of psilocybin mushrooms and ecstasy.

Bonham has previously served in an administrative role as medical director of a county-run health care system that includes the public health and mental health departments and its parent hospital, Santa Clara Valley Medical Center in San Jose.

He is a graduate of Tulane University School of Medicine.

Doctor Marvin Bonham was released on a $1,000,000 bond.

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American ‘Health Care’ and the Most Prolific Drug Cartels on Earth: a Lethal Combination

Opinion:

As a 32-year emergency medical professional who has treated well over 20,000 patients, I proffer this: Our society has developed no habit more inherently insane, than allowing its entire healthy population to be gleefully drugged.

That’s what a mentally sluggish society gets you.

Worst-kept secret in 'health care"

Worst-kept secret in ‘health care”

The legal drug cartels churn legal poisons out at an astonishing rate; the FDA approves them; and otherwise ethical MDs become pill-pushers, just as surely as the pimp on the street corner. The unethical MDs? This “all drugs, all the time” mantra is like bowling for dollars.

The pharmaceutical giants are the monsters of the Midway, amassing an army 80,000 strong to overpower physician doubt – a well-equipped battalion of ground-troops armed with the deadliest, most effective weapons known to mankind – spray-on tans & the world’s greatest legs. Do they hire the brightest minds? Why would they?

Who do drug companies hire, to convince MDs to use their products?

Who do drug companies hire, to convince doctors  to use their products?

http://query.nytimes.com/gst/fullpage.html?res=9B03E6DD1431F93BA15752C1A9639C8B63&pagewanted=all

These peppy drug pros have their banter down so well they effectively lecture physicians on what ‘new diseases’ ought to be, and how they should be treated. As for our Daffy Docs? Well, more often than not, they buy the sales pitch, hook, line & sinker.

No need to take our word for it.

Dr. Thomas Carli of the University of Michigan. ”You’ll never meet an ugly drug rep in health care. It’s sexual salesmanship all the way.”

Yes, we now live in a true “tail-wagging-the-dog” society, do we not? We live in an era where “you might get sick” has become the disease de jour. Nobody in health care makes any money from a healthy population. So it’s essential that you believe you aren’t quite well.

How long before we discover – wonder of wonders – that our treatment juggernaut itself is far more devastating than the maladies?

My guess is, we have a few more decades of insanity, before we get to the weird science punch-line anyway. At least, not until the very, very end of the Twilight Zone.

Cue Rod Serling.

http://www.drugwarfacts.org/cms/Causes_of_Death

http://www.vaccineriskawareness.com/Your-Immune-System-How-It-Works-And-How-Vaccines-Damage-It

For the health of your loved ones, you might want to take a peek at this excellent study by a very, very bright fellow::

This book saves lives

This book saves lives

http://www.amazon.com/Death-Medicine-Gary-Null/dp/1607660067

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N.Y. Doctor: “I didn’t commit those crimes. One of my mischievous personalities did.”

A Manhattan physician once praised for her work in AIDS treatment, has claimed in court that one of her 12 other personalities – and not her real self – was responsible for bilking Medicaid out of nearly a million dollars.

Dr Diana Williamson

Dr Diana Williamson

Investigators determined that Doctor Diana Williamson defrauded Medicaid out of almost exactly $1,000,000, at least $300,000 of which was her take, in a conspiracy to scam the program. Prosecutors proved that Williamson wrote bogus prescriptions for about 10,000 doses of narcotics that were bought with Medicaid benefits at pharmacies, and then peddled on the street.

Authorities said the ring dealt primarily in oxycodone, a highly addictive pain medication commonly sold on the black market for $20-40 per pill, as a heroin substitute.

U.S.rapidly becoming the most drug-dependent society on earth

U.S. rapidly becoming the most drug-dependent society on earth

At trial, the prosecution recommended an 11-year sentence for Williamson, age 50, and she was was scheduled to be sentenced Monday by U.S. District Judge Loretta Preska. But the judge decided to delay a final determination, until prison authorities could report on their ability to treat the doctor’s illnesses.

Defense attorney Jonathan Marks argued that any prison time would be a death sentence, due to the doctor’s medical issues that, “cannot be adequately managed in prison.”

Williamson’s lawyer also told the court that his client deserved leniency because, “she didn’t know she was the one carrying out crimes.” According to the doctor, the crimes were actually done by “Nala,” one of her multiple personalities. He said Nala was “mischievous, irresponsible, reckless and, as we have just discovered, criminal.”

However, things are really looking up in the funeral industry

However, things are really looking up in the funeral industry

The judge did not buy the multiple personality argument.

“I guess I’m having trouble understanding that with the defendant’s medical career, she didn’t know she was stealing money.”

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Before she turned to crime, Williamson was once named to Crane’s Business Magazine’s annual, exceptional young professionals in New York list 40 under 40, for her work at the Harlem United Community AIDS Center.

http://www.nypost.com/p/news/local/manhattan/me_myselves_AMKZBZsseisM5nimRPUNhL

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Jailed MD Who Lied to Patients About Non-existant Cancers . . . Has Cancer

A Grand Rapids, Michigan skin specialist who once made millions by scaring his patients into believing they needed cancer surgeries, has undergone radical surgery for prostate cancer while in federal prison.

Dr Robert Stokes

Dr Robert Stokes

Disgraced physician Robert Stokes, now in custody in the California State Corrections system, was found guilty of 31 counts of insurance fraud, in December 2007. He was sentenced to 10 years in prison.

According to court records, the doctor would customarily remove simple skin blemishes and even freckles, of his patients, for no medically necessary reasons. He would then bill for procedures that should never have been done, and in hundreds of other cases, bill for services he hadn’t performed.

Bob May, mayor of the city of Hastings, Michigan and a victim of Stokes’ medical fraud himself, testified that he underwent dozens of unnecessary surgeries that left him scarred for life. “The man is a monster.”

What can medical fraud buy? Well, a mansion for one

What can medical fraud buy? Well, a mansion for one

According to the Coalition Against Insurance Fraud, Stokes robbed Medicare and Blue Cross/Blue Shield of just under $2,000,000.

http://www.insurancefraud.org/article.htm

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Kentucky Court Finds Florida Doctor Guilty in ‘Pill-Mill’ Operation

Dr Clara Rodriguez-Iznaga

In Ashland, Kentucky federal court, a 57-year old internal medicine specialist has been convicted for her part in a conspiracy that funneled hundreds of thousands of doses of narcotics across state lines.

Dr. Clara Rodriguez-Iznaga was found guilty in a jury trial Tuesday of Conspiracy to distribute drugs, as well as Money Laundering.

Rodriguez-Iznaga worked at a Miami-area pain clinic, Florida Global Medical. Prosecutors were able to prove that hundreds of “patients” from as far away as West Virginia, Kentucky and Ohio would regularly travel to the clinic to get easy prescriptions for narcotics, according to U.S. Attorney Kerry B. Harvey.

During the trial, witnesses testified that they stopped drug-shopping at other clinics because it was far easier to get prescriptions from Rodriguez-Iznaga than from other doctors.

According to investigators, Rodriguez-Iznaga would customarily “see” as many as three dozen people a day, most of whom paid $150 cash at a time. According to U.S. Attorney Harvy, she gave patients prescriptions with no real medical exam. And because she was also supervising the clinic pharmacy, where the typical 0prescriptions cost $1,000 or more, Rodriguez-Iznaga’s drug-pushing brought in more than $600,000 per year.

Rodriguez-Iznaga, who faces 20-year prison terms for each count, will be sentenced next year

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Observation:

Florida Global Medical Care was a limited liability corporation, located at 4367 W Sunrise Boulevard in Plantation, Florida. The “clinic” was a typical example of physician-run, pill-mill traffickers that funnel narcotics throughout the U.S. In this particular case, the eastern coastline and Appalachia. Both addicts and peddlers find their drug of choice – Oxycodone – is readily available from unscrupulous doctors. Regretfully, there are thousands of them.

For her part, Rodriguez-Iznaga was marching in step with her Third World Assassin counterparts. She was born and raised in the Dominican Republic, attended medical school at University Cetec, School of Medicine, Santa Domingo; emigrated to the U.S. with the plan to get rich at the expense of the American public. And had she not gotten so greedy as to peddle 1,000 pills per day, she would very likely have never been caught.

We find it pertinent that this doctor’s medical school closed not long after she graduated, as it failed to be recognized as a legitimate medical training program.

http://dailyindependent.com/local/x1149575915/Fla-doctor-will-be-arraigned-for-drug-conspiracy/print

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Fugitive Indiana Surgeon Found Living in a Tent in Italy

In Hammond Indiana, a doctor who had been sought by authorities for five years, has finally been convicted in one of the worst patient-billing fraud cases in U.S. history.

Dr Mark Weinberger

Dr Mark Weinberger

Dr. Mark Weinberger of Merrillville was sentenced to seven years in state prison for defrauding patients and insurers, a theft of more than $30,000,000 over a three-year period, according to court records.

Weinberger was finally caught when he was found by Italian authorities living in a tent on a snowy mountainside. He had been hiding from investigators for five years. During that time investigators say Weinberger never contacted his wife, Michelle Kramer, nor any members of his family. He instead settled into a new secret life in the village Courmayeur, Italy with a new girlfriend.

Fugitive MD's home on an Italian mountainside

Fugitive MD’s home on an Italian mountainside

During sentencing, U.S. District Judge Philip Simon said that before Weinberger disappeared, he had operated his medical office like a “factory,” hustling patients as quickly as possible through thousands of procedures, which allowed him to amass nearly a quarter-million dollars per month before he fled the country.

Court records state that Weinberger, now 49, defrauded countless patients, possibly as many as a thousand. And now more than 350 of them are suing him for totally unnecessary sinus operations.

Wife Michelle had no idea what happened to her daffy doctor husband

Wife Michelle had no idea what happened to her daffy doctor husband

For more on the strange sage of this medical maniac, read investigative reporter Buzz Bissinger’s excellent account of the Weinberger case:

http://www.vanityfair.com/society/features/2011/01/missing-doctor-201101

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