National health care fraud takedown results in charges against over 412
individuals responsible for over $1.3 billion in fraud losses
Largest health care fraud enforcement action in Department of Justice history
LOUISVILLE, Ky. -United States Attorney John E. Kuhn, Jr. today announced the results of a health care fraud sweep in the Western District of Kentucky as part of the national health care fraud takedown led by the Justice Department. The takedown, in the Western District of Kentucky, resulted in charges against two businesses, and nine individuals, for their alleged participation in health care fraud schemes.
“We trust the medical community to do no harm - certainly no intentional harm," stated United States Attorney John Kuhn. “Unfortunately, health care fraud harms our health insurers, public agencies, and ultimately patients and taxpayers. Alarmingly, we often see health care fraud combined with other crimes such as unlawful dispensing of opioids, which does even more harm. Today we announce the cooperative efforts of multiple agencies, working to stop the illegal practices by a small segment of the medical community in an effort to restore safety for patients. Investigating and prosecuting health care fraud is one of the Department of Justice’s highest priorities."
U.S. Attorney Kuhn was joined in the announcement by:
Amy Hess, Special Agent in Charge, Louisville Division, Federal Bureau of Investigation. “To those prioritizing profit over their oath to honestly provide for the public health, the message should be clear that the collective resources of local, state and federal law enforcement will identify your illegal activity and bring you to justice."
“Healthcare providers that prescribe controlled substances illegally will continue to be a DEA priority," said Chicago Field Division Special Agent in Charge Dennis A. Wichern. “Too many lives have been lost and too many families forever scarred due to prescription drug abuse."
“We expect doctors and other medical professionals who bill Medicare and Medicaid to provide quality services to those served by the programs, not rip off scarce government health care funds," said Special Agent in Charge Derrick L. Jackson, of the U.S. Department of Health and Human Services, Office of Inspector General. “Coordinating with our law enforcement partners, our agents work hard to ensure those who steal from federal health care programs are brought to justice."
Office of Kentucky Attorney General, General Andy Beshear. “The single greatest threat to Kentucky is our drug epidemic, and as attorney general, I am committed to holding accountable any individual or company that carelessly overprescribes opioids to our citizens, many of them battling addiction," Beshear said. “This national takedown is a critical step to stop this activity and stop fraud to our Medicaid program to better protect our most vulnerable senior citizens and children. I appreciate the efforts of the task force and my Office of Medicaid Fraud and Abuse to hold providers accountable."
“This coordinated enforcement effort emphasizes the seriousness of healthcare fraud and the detrimental impact it has on our community. We will continue to partner with other state and federal law enforcement agencies to investigate those who perpetrate fraud against federal and state governments, private insurance companies and individual citizens," said Tracey D. Montaño, Special Agent in Charge of the Nashville Field Office of IRS, Criminal Investigation."
Office of Indiana Attorney General, General Curtis Hill. “Medicaid fraud is not a victimless crime," said Indiana Attorney General Curtis Hill. “When licensed professionals and organizations target those who rely on Medicaid, they’re also putting taxpayers on the hook. These actions truly impact all of us. The culmination of these investigations is extremely rewarding for the investigators and lawyers in our Medicaid Fraud Control Unit who work tirelessly to bring these offenders to justice. I applaud their efforts."
Anthony S. Gooden, Senior Supervisory Agent, Louisville Division, U.S. Postal Inspection Service. “Today’s challenging economy makes it critical that we safeguard the nation’s mail stream against criminal misuse and protect USPS customers from criminal attack through use of the mails. We as Postal Inspectors are dedicated to protecting the public and helping them guard their hard-earned money from fraudulent activity."
Gregory C. Burns, Jr. Lt. Colonel with LMPD. “With the scourge of opioid addiction going on across America today, it is more important than ever that local law enforcement and federal law enforcement continue to engage in collaborative partnerships together to fight this epidemic on all levels. A multi-faceted approach must also be maintained in order to sustain long term success in this effort."
In the Western District of Kentucky, three separate cases were indicted on June 27, 2017, and an additional case was charged in a superseding indictment that was unsealed yesterday. The charges included unlawful distribution and dispensing of controlled substances, health care fraud, money laundering, and aggravated identity theft.
Specifically, in United States v. Jeffrey Campbell, Mark Dyer, Dawn Antle and Physicians Primary Care, PLLC, the defendants, from Jefferson County, Kentucky, were charged with one count unlawful distribution and dispensing of controlled substances-conspiracy, four counts of unlawful distribution and dispensing of controlled substances-schedule II, two counts of unlawful distribution and dispensing of controlled substances-hydrocodone, one count health care fraud conspiracy, 11 counts health care fraud - fraudulent coding, one count health care fraud-physical therapy, and one count health care fraud Proove biosciences. The charges stem from the defendant’s intentionally distributing and dispensing controlled substances to patients allegedly without a legitimate medical purpose and outside of the usual course of professional medical practice. Further, the defendants allegedly fraudulently billed various health care benefit programs by coding physical therapy, counseling and exercise services, using evaluation and management codes in order to obtain a higher rate of reimbursement and fraudulently billing various health care benefit programs for physical therapy services, using evaluation and management codes as if a physician performed a service on the patients, but in reality, a non-physician and non-physical therapist performed the services on patients. Also the defendants caused Proove Bioscience, Inc. to falsely and fraudulently bill various health care benefit programs for genetic tests administered to Physicians Primary Care patients that were not medically necessary and never interpreted.
In United States v. Claudia Lopez, defendant Lopez, of Jefferson County, Kentucky, was charged by grand jury indictment with one count health care fraud-fraudulent billings, and three counts of mail theft. The charges stem from the defendant’s role in a scheme while operating the Top Care Chiropractic and Wellness Center Corporation, fraudulently billing United Health Care for medical services never provided.
In United States v. Janice Patterson, Tanesha Washington, and Katerrell Kennedy, the defendants, from Jefferson County, Kentucky, were charged with one count unlawful distribution-conspiracy, fifteen counts health care fraud, two counts health care fraud-conspiracy, eight counts money laundering, and three counts aggravated identity theft. The charges stem from their alleged role in a scheme to knowingly and intentionally distribute and dispense scheduled and controlled substances. Defendant Patterson, while operating the JM Autism Foundation Trust is charged with falsely and fraudulently billing Anthem, Inc. for autism services never performed. Further defendants Patterson and Kennedy, while operating Total Spectrum Autism Services, LLC, falsely and fraudulently billed Anthem, Inc. for autism services never performed. Further, Patterson is charged with aggravated identity theft and money laundering. Patterson allegedly used the identification of providers and created accounts and fraudulently billed for services. The money laundering counts total over $150,000.
In United States v. Med1st of Evansville, P.C., Karen Poeling, and Mitchel Stukey the named defendants were charged in a superseding indictment. They are charged with conspiracy to commit health care fraud, two counts of conspiracy to violate the controlled substance act, and conspiracy to commit money laundering. The charges stem from the defendants’ role in a scheme to defraud health care benefit programs, in connection with the delivery of or payment for benefits, services by causing the submission of false and fraudulent claims to Medicaid, Medicare, Anthem and other insurance carriers. Med1st is alleged to have directed staff to falsely bill for medically unnecessary facet block injections, billing for conscious sedation, which was never performed, providing back braces which were not medically necessary and performing unnecessary tests. Further defendant Stukey conspired with others to illegally distribute and dispense controlled substances. Conspirator A signed blank prescription pads and permitted individuals acting at the direction of Stukey, to conduct evaluations of patients and to use pre-signed pads to prescribe medication to patients. Further, all defendants are charged with committing money.
These cases are being handled by Assistant United States Attorneys, Joe Ansari, Lettricea Jefferson-Webb, and Jessica Malloy. U.S. Attorney Kuhn acknowledged and credited the law enforcement agencies investigating these cases: Federal Bureau of Investigation (FBI), the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG), the U.S. Drug Enforcement Administration (DEA), the United States Postal Inspection Service, the Internal Revenue Service Criminal Investigation, Indiana and Kentucky Medicaid Fraud Control Units, the Department of Defense Criminal Investigative Service and the Louisville Metro Police Department.
Earlier today, Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D., announced the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving over 412 charged defendants across 41 federal districts, including over 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving over $1.3 billion in false billings. Of those charged, today’s action also involved charges against over 120 defendants, including doctors, for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, the HHS Centers for Medicare & Medicaid Services (CMS) is suspending payment to 295 providers, including doctors, nurses and pharmacists.
The indictment of a person by a Grand Jury is an accusation only and that person is presumed innocent until and unless proven guilty.
Source: U.S. Department of Justice, Office of the United States Attorneys
