Another Week: Another Ugly Medical Scam. How Embarrassed is Healthcare? Not as Much as They Should be

These so-called medical professionals played with patients’ lives, buying and selling them for profit without regard to patient safety. Patients have the right to expect treatment decisions by health care professionals are based on medical need and not unadulterated greed. The magnitude of this alleged crime is an affront to ethical medical professionals.” (Dave Jones, California Insurance Commissioner)

The California State Insurance Commissioner’s office has joined the Orange County’s chief prosecutor in bringing what appears to be a monster medical fraud case against at least 21 physicians and 5 others.

 

Christopher and Tanya King

Christopher and Tanya King, back when the money was rolling in

The case involves a cash kick-back scam of what may be as much as $40,000,000 stolen from at least 27 insurance carriers, and more than 13,000 patients billed by Monarch Medical Group, One Source Laboratories and King Medical Management.

Investigators are focusing on the key players in the scheme – Christopher King, age 38 and his wife Tanya, age 37 of Beverly Hills, as well as the operators of Steven’s Pharmacy in Costa Mesa – Charles Bonner and Mervyn Miller, who are residents of Irvine.

Tanya King faces more than 100 years in prison. The two pharmacists could get 28 years and the doctors each face 25 year terms. Christopher King’s possible sentence, if convicted, was not announced.

Tony Rackaukas

Orange County District Attorney Tony Rackaukas addresses the media regarding the arrests

Prosecutors believe they can prove that the Kings were at the center of a long-running insurance fraud ring that operated between 2011-2015, recruiting unethical physicians and pharmacists. The evidence shows that the scam involved unnecessary treatments of Workers Compensation insurance patients. The Kings are also believed to have conspired with Steven’s Pharmacy owners to sell ointments and creams that offered no medical benefit whatsoever.

We must have ethical doctors who abide by their Hippocratic Oath to ‘do no harm.’ The intent of many of the laws surrounding the insurance industry is to keep the three Ps–physician, patients and profit—separate. We have a track record of putting these types of fraudsters behind bars for a long time and we intend to do just that again.”(Orange County District Attorney Tony Rackauckas)

The California State Department of Insurance is leading the investigation, with assistance of the Orange County DA’s Bureau of Investigation, National Insurance Crime Bureau and the FBI.

Is YOUR doctor being investigated in this case?

  • Dr. Duke Ahn, 49, Los Alamitos
  • Dr. John Casey Jr., 65, Modesto
  • Dr. Robert E. Caton, 65, Modesto
  • Dr. Chris Chen, 55, Pleasanton
  • Dr. Jonathan Cohen, 57, Modesto
  • Dr. Parvez Fatteh, 46, Pleasanton
  • Dr. Robert Fenton, 68, Ranchos Palos Verdes
  • Dr. Michael Henry, 61, Granite Bay
  • Dr. Mohamed Ibrahim, 40, Danville
  • Dr. Mannie Joel, 67, Pleasanton
  • Dr. Paul Kaplan, 76, Folsom
  • Dr. Howard Oliver, 70, Long Beach
  • Dr. Ismael Geli Silva, 38, Huntington Beach
  • Dr. Ismael Silva, 63, Newport Coast
  • Dr. Jerome Robson, 68, Modesto
  • Dr. Eric Schmidt, 63, Santa Rosa
  • Dr. Eduardo T. Lin I, 55, Pleasanton
  • Dr. Paul A. Stanton, 54, Victorville
  • Dr. William Pistel, 53, Modesto
  • Dr. Kevin Park, 49, Buena Park
  • Dr. Kourosh Shamlou, 49, Newport Coast

Here’s another look:

http://www.latimes.com/local/lanow/la-me-ln-medical-kickbacks-charges-20170420-story.html

“Biggest U.S. Doctor-Crime-Scam” Ever

 

DR CUFFED CASH ART

No other profession steals more money from the citizenry

“Patients should come before profits.” (Scott J. Lampert, Special Agent in Charge, Office of Inspector General, U.S. Department of Health and Human Services)

A jaw-dropping 27 New Jersey and New York physicians have now been found guilty in what is being called a “bribe-for-blood” scam that raked in more than $100,000,000 of taxpayers money, according to the U.S. Attorney’s Office in Manhattan.

U.S. Attorney Paul J. Fishman described the conspiracy to commit medical fraud as a long-running and elaborate scheme operated by Biodiagnostic Laboratory Services, a Parsippany New Jersey lab which has since been shut down by federal agents. A full 13 non-physicians, most of whom were employed BLS, have also been found guilty.

As of yesterday 39 lab coat criminals – 26 of them doctors – have confessed their roles in the conspiracy, which its organizers admitted involved millions of dollars in bribes and resulted in more than $100,000,000 in payments to BLS from Medicare and other insurance carriers.

caduceus-art

We’re guessing you didn’t know that.

Fishman added that many of the doctors engaged in elaborate versions of the kickback scheme, such as getting under-the-table tickets to concerts by Justin Bieber and Katy Perry, worth thousands of dollars.

Here is the litany of New Jersey physicians alone,  who secretly tucked cash into their floppy lab coat pockets:

  • Doctor Bernard Greenspan, of Saddle Brook
  • Doctor Frank Santangelo, of Wayne and Montville
  • Doctor Gary Safier, of Randolph
  • Doctor Angelo Calabrese, of North Arlington
  • Doctor Dennis Aponte, of Cedar Grove
  • Doctor Dana Fortunato, of Montclair
  • Doctor Claudio Dicovsky, of Paterson
  • Doctor Paul Ostergaard, of Pompton Plains
  • Doctor Wayne Lajewski, of Madison
  • Doctor Glenn Leslie, of Ramsey
  • Doctor John Vitali, of Howell and Wall
  • Doctor Douglas Beinstock, of Hawthorne
  • Doctor Anthony DeLuca, of Point Pleasant
  • Doctor Franz Goyzueta, of Secaucus
  • Doctor Eugene DeSimone, of Secaucus
  • Doctor Anthony Delpiano, of Jersey City
  • Doctor Ralph Messo, of Colts Neck

This case is believed to be the largest number of medical professionals ever prosecuted in a single American bribery case.

Second Michigan MD Confesses Guilt in $17,000,000 Health Fraud Scam

 

medi-fraud-art

No profession steals more taxpayer money than the errant doctor population

Another Detroit-area doctor changed his “not guilty” plea to “guilty” in March for his part in an appalling scheme which defrauded Medicare of more than $17,000,000. The theft involved fraudulent physician exams and unnecessary prescriptions. 

Doctor Leonard Van Gelder, age 69, admitted in U.S. District Court Eastern Michigan, to Conspiracy to Commit Healthcare Fraud, as he stood before Judge Avern Cohn.

Van Gelder, a resident of Caledonia Michigan, was an MD for a company called Lake Michigan Mobile Doctors, a service which provided home-bound citizens with medical visitations. Their office was located in Southfield. Van Gelder confessed in court that he would routinely visit patients who did not require physician-level care, but were charged via Medicare for the highest possible billing codes.  The criminal physician also admitted that he routinely prescribed patients wholly unneeded narcotics, such as Vicodin, which provided illegal indications that the patients were in serious pain. 

DR CUFFED CASH ART

Investigators discovered that Mobile Doctors illegally charged Medicare $17,100,000 over several years.

Last December, Van Gelder’s co-conspirator, Stephen Mason, age 46, of Zionsville Indiana, pleaded guilty to Conspiracy to Commit Healthcare Fraud. And another doctor, Gerald Daneshvar, age 41 of West Bloomfield, is awaiting his own trial.  

Van Gelder has not yet been sentenced.  

 

Which Profession Generates the Most Crime? Are You Ready to Face the Short Answer?

Here is a smidgeon of the news we receive daily:

Little Rock doctor pleads guilty to writing fraudulent oxycodone prescriptions

Arkansas Doctor Admits Illegally Distributing Pain Pills

 

 

 

 

 

 

 

 

 

 

 

Richmond-area doctor charged with running oxycodone ‘pill mill’

The Legacy of Hospital Greed

“This illegal conduct was unacceptable, victimizing both taxpayers and patients. Treatment decisions motivated by financial gain undermine public confidence in our health care system and threaten vital federal programs upon which so many of our citizens rely. We will not relent in our efforts to protect the public from this sort of systematic misconduct.” (U.S. Attorney Kerry B. Harvey)

kings-daughters

They all look ethical from the outside

 

In the city of Ashland Kentucky there exists a well-known hospital called King’s Daughters Medical Center. Unfortunately for them, it is a hospital that is even more famous now, than it was before they were caught up in some seriously unethical, highly dangerous, doctoring doo-doo, 3 years ago.

And simply because of this hospital’s lack of a moral compass, they are now paying off a $41,000,000 fine. Why? Well, it seems they had a secret scam going on: falsely billing federal health care programs for millions, by performing heart procedures on patients who did not need them.

Cutting innocent people open for fun and profit. Does that sound like “healthcare” to you? It sounds like assault with a deadly weapon to us. Repeatedly.

Investigators learned that over a 6-year period that began in 2006, King’s Daughters inflated reimbursements from Medicare and Kentucky Medicaid, by billing for many unnecessary coronary stents and cardiac catheterizations performed by their surgeons.

The prosecution revealed that surgeons would routinely falsify patient records in order to justify unnecessary procedures.

“This type of conduct deceives individuals when they are seeking medical treatment and are vulnerable. The level of funds involved in this matter is staggering. This money has been stolen from the patients and the taxpayers.” (Perrye K. Turner, Special Agent in Charge, FBI, Louisville Field Division) 

Here’s another look at this case, which we originally covered 3 years ago:

UPDATE: Doctor who performed unnecessary procedures wants new trial

New Jersey MD Now on Trial for . . . Guess What? Massive Fraud/Scam

“Blood is not a commodity that doctors are allowed to sell.” (Assistant U.S. Attorney Danielle A Walsman)

In the city of Newark Federal Court, a 79-year-old doctor is now on trial. Lord knows he isn’t the only doctor on trial this week – there are at least 10 dozen others. But this fellow appears to have been throat-deep in a massive healthcare wealth-building scam that featured all the aspects of a made-for-TV movie: secret envelopes stuffed with cash; luxurious private jet trips world-wide; physician mistresses and dressed-to-the-nines call-girls.

“Some doctors frolicked with prostitutes or received $50,000 monthly cash payments stuffed in envelopes.”

Doctor Bernard Greenspan – at least according to federal prosecutors – was perfectly willing to rake in $200,000 in bribe money from a now-closed scam-lab called Biodiagnostic Laboratory Services, in Parsippany, in exchange for sending his patients’ blood samples exclusively there.

Greenspan’s attorney is Mr. Damian Conforti, and he argues that the doctor did nothing illegal, that he even cooperated with law enforcement 4 years before Biodiagnostic Laboratory Services was charged.

More than 40 people, including 27 New York and New Jersey doctors, have already confessed their guilt over the last 4 years.

Investigators believe $3,000,000 was raked in by the lab, by its illegal arrangement with Greenspan, who is charged with Conspiracy, violating federal Anti-Kickback laws and Honest Services Fraud.

U.S. Attorney Paul Fishman says Medicare was defrauded out of tens of millions of dollars.

David Nicoll, the company president and a former pharmaceutical salesman; his brother, Scott, who previously sold concert tickets for a living; and Craig Nordman, David Nicoll’s cousin, are among those who have pleaded guilty.

Nicoll is now testifying against Greenspan, and already faces 25 years in prison. Authorities have proven he spent $390,000 on tickets to sporting events and $300,000 on a Ferrari – all out of illegal company profits.

The investigation of Biodiagnostic Laboratory Services underscored federal officials’ increased focus on health care fraud over the last 10 years. According to a Department of Health and Human Services and the Department of Justice annual report, the federal government was able to recover $2,500,000 in stolen health fraud money.

Since the beginning of Medicare fraud strike force teams nationwide, beginning in 2007, charges have been brought against more than 3,000 defendants who illegally billed Medicare more than $10,000,000.

California Physician Fraud: When Will They Ever Learn? Not Any Time Soon

(What follows is an update of a story we originally published 2 years ago this month):

medi-fraud-artDoctor Emilio Louis Cruz, age 61 of Carson California, was sentenced by United States District Judge Morrison England to 3 years in prison. He was also ordered to pay $600,000 in restitution, for his role in a Medicare Fraud Conspiracy. This, according to U.S. Attorney Benjamin B. Wagner.

Court records show that Cruz, a neurology specialist, acquired his medical degree at Yale University. He held medical licenses in 3 states. According to his testimony at the trial of Cruz’s co-defendants – Doctors Ramanathan Prakash, Alexander Popov, and Lana LeChabrier – a man named Vardges Egiazarian owned 3 health care clinics in Sacramento, Richmond, and Carmichael California. Cruz operated the Carmichael clinic. He established a Medicare provider number for the clinic and set up a bank account into which Medicare funds were deposited. Hundreds of medical bills were submitted to Medicare seeking reimbursement for services. The FBI found this extremely interesting, since Cruz never treated a single patient.

During most of the time that the Carmichael clinic operated, Cruz was living and working in North Dakota. A similar pattern was followed at the other two clinics operated by Egiazarian, and not one of the physicians submitting bills to Medicare ever treated a single patient.

The clinics’ patients were primarily Hispanic who spoke no English. They were recruited and transported to the clinics by van drivers who were paid according to the number of patients they brought in. Rather than being charged a co-payment, the patients were paid for their time – generally $100 per visit – in exchange for their Medicare number. Fake medical charts were created, stating that each patient received comprehensive exams and a broad array of diagnostic tests. Few of these tests were ever performed, and none were performed based on any medical need. Clinic staff filled out other portions of the charts using imaginary information. Some clinic employees admitted to performing various tests on themselves, and placing the results into patient files.

In all, the 3 clinics billed more than $5,000,000 in fraudulent claims to Medicare – $1,700,000 of which was actually paid. With respect to claims submitted for services by Cruz at the Carmichael clinic, Medicare paid $601,581 based upon fake billing by him.

Doctors Prakash, Popov, and LeChabrier, were also found guilty by a jury on July 8, 2011, of Conspiracy to Commit Healthcare Fraud and various other charges of Healthcare Fraud.

Here is a list of those involved in this massive medical system theft case:

  • Doctor Ramanathan Prakash – currently serving 10 years in federal prison
  • Doctor Lana LeChabrier – currently serving 6 years in prison
  • Doctor Alexander Popov – currently serving 8 years
  • Doctor Derrick Johnson – pleaded guilty and is awaiting sentencing
  • Nazaret Salmanyan, an unlicensed ultrasound technician – sentenced to 20 months
  • Zoya Belov, a nurse licensed in Russia but not here – pleaded guilty and is awaiting sentencing
  • Jenny Saechao, recruited patients, pleaded guilty, and is awaiting sentencing
  • Migran Petrosyan, a co-owner of the Richmond clinic –pleaded guilty and was sentenced to 27 months
  • Shushanik Martirosyan, a medical biller who submitted fake claims to Medicare for all 3 clinics – pleaded guilty and was sentenced to 18 months

Incidentally, all of the above felons except one are criminal immigrants.

Here’s another look:

https://archives.fbi.gov/archives/sacramento/press-releases/2012/physician-sentenced-to-eight-years-in-federal-prison-for-role-in-massive-medicare-fraud-scam