2015: an Ugly Year for Healthcare Fraudsters

STETH WALLET BIOPSY

As the year 2015 came to a close, we thought it might be interesting to take a look back. We want you as a Medical Miscreant reader, to appreciate just how nasty the juggernaut of fraud really is, as it burrows itself right into your wallet. We didn’t have to look very hard to find a jaw-dropping number of physicians, clinic owners, hospital executives and drug cartel CEOs, handcuffed weekly, for ripping off insurance companies and patients alike.

Fortunately, not all of the money is lost. Government investigators recovered an astounding $6,000,000,000 from medical thieves in 2014 – $2,000,000,000 more than they got back in fiscal year 2013.*

2015 was witness to a host of major fraud cases, involving hundreds of so-called ‘healthcare professionals’, amounting to millions in abuse, often related to Medicare billing schemes. What follows is a sampling of health fraud cases. There are thousands of others.

So the next time you feel yourself about to erupt over insurance costs? Blame the scamsters who have been stealing them blind for 50 years.

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The owner of 8 drug stores in Miami will spend the next 9 years in federal prison, for his role in a scam that paid for luxury cars for himself and his family. Daniel Suarez stole $20,000,000 from Medicare, then bought several Rolls Royce cars,  a Mercedes Benz S63 and a Range Rover.

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In Long Beach California, two orthopedic surgeons; a chiropractor and a hospital chief financial officer, have all changed their “not guilty” pleas to “guilty” in what investigators say is a $600,000,000 spinal surgery scam – probably the most egregious healthcare scam in California History.

Hospital executive James L. Canedo; Doctor Philip Sobol; Doctor Mitchell Cohen, as well as Doctor Alan Ivar of Las Vegas, were discovered to be involved in illegal referrals of thousands of patients for spinal surgeries at  Pacific Hospital in Long Beach and Tri-City Regional Medical Center in Hawaiian Gardens.

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Drug cartel Warner Chilcott has also confessed their guilt in an illegal kickback scam to doctors, and must pay $125,000,000. They admitted they routinely paid cash and gifts under the table to physicians, who then prescribed their drugs, such as Actonel, Asacol, Atelvia, Doryx, Enablex and  Loestrin, instead of similar meds manufactured by competitors.

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CEG Dike Ajiri of Chicago-based Mobile Doctors, confessed in court to charges that he falsified Medicare billing for in-home patient care. He stole just under $2,000,000.

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In Georgia, Guardian Hospice will pay back the $3,000,000 they stole from Medicare. It seems they thought it would be cool to make Medicare believe their patients were at deaths door. So they billed for hospice patients who were not terminally ill at all.  Guardian Hospice and its subsidiaries, Guardian Home Care Holdings and AccentCare, operate in Atlanta.

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In Texas a former Army doctor has been sentenced to 3 years in federal prison for his role in a $7,300,000 healthcare scam, according to the U.S. Department of Justice, Western Texas. Former Army Lt. Colonel Richard Craig Rooney, age 46, of Medina Washington, was also fined $15,000 and ordered to return $4,300,000.

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In Detroit a home health company owner will spend 6 years in prison for scamming Medicare out of  $12,000,000. Mohammed Sadiq, age 67 of Oakland County, Michigan, admitted that he joined with co-conspirators to bill Medicare for home health services that were not provided. Sadiq also admitted to paying kickbacks to patient recruiters, to obtain medical information of Medicare beneficiaries, which he then used to bill Medicare for services that ften were not provided at all.

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In Denver a kidney care outfit called DaVita HealthCare will repay the government a half-billion dollars which it over-billed for dialysis drugs. Investigators say this may be the largest settlement for a False Claims Act case brought about without government intervention. DaVita reports it will cost them another $45,000,000 in legal fees.

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And finally . . .

In a nationwide sweep that is believed to be the largest healthcare fraud takedown in history, the Medicare Strike Force has targeted fraudsters in 17 counties in the states of Florida, Texas, California, Louisiana, New York and Michigan. The strike force brought criminal charges against 243 doctors, nurses, licensed medical professionals and health care company owners, for submitting over $700,000,000 in falsified billings.

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And so it goes. Any guesses that 2016 will evolve, to become the “year of honesty” in modern medicine?

Stranger things have happened. We’ll be right here next year to let you know. In the meantime, here’s a New Year’s tip: don’t bet your paycheck on honesty in healthcare.

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  •  (According to a recent study by Bass, Berry & Sims of Nashville, Tennessee)
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