Articles Posted in Los Angeles Medicare Fraud

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Even “straightforward” Los Angeles Medicare fraud schemes often become surprisingly dynamic.staged-accident-los-angeles-insurance-fraud.jpg

Perhaps you and an associate billed the state or federal government for wheelchairs that you never delivered to patients. Or maybe you constructed a scheme to collect Social Security numbers and patient data and then use that information to purchase pharmaceuticals to sell to a third market supplier.

Even the most carefully wrought, well-protected plans have a funny way of coming undone and leading to surprises not only for investigators but also for defendants themselves.

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A new study shows that the federal government’s vigorous campaign against Medicare fraud in Los Angeles and beyond is paying off — big time. medicare-fraud-los-angeles-dermotologist.jpg

Over the last three years, the government has returned $7.90 for every $1 invested into the anti-fraud mission. This marks the highest ever return for the Health Care Fraud and Abuse Control Program, a nearly two decade old program, and federal officials are crowing about the numbers. Kathleen Sebelius, the secretary of Health & Human Services, said “our historic effort to take on the criminals who steal from Medicare and Medicaid is paying off. We are gaining the upper hand in our fight against healthcare fraud.”

The antifraud initiative is a collaboration between the Department of Justice and HHS. The Obama administration has lent lots of help to soup up this program and deliver more results. Over the past four years, federal officials recovered nearly $15 billion from scam artists, executives, doctors, pharmaceutical companies, vendors, and others who masterminded or acted complicit with fraudulent schemes. That’s nearly double the amount recovered over the previous four-year period.

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As a defendant (or soon-to-be defendant) in a Los Angeles Medicare fraud case, you’re deeply confused and concerned about how your situation will play out.Healthcare_Fraud_los-angeles.jpg

Maybe the government will overwhelm you with powerful evidence and testimonies. Or maybe surprising witnesses will come forward to “blow the whistle” on your activities.

Sometimes, blowing the whistle can pay off significantly. Consider a case out of Tampa, Florida, where a local physician, Dr. Alan Freedman, just collected $4 million for his part in blowing the whistle on an illicit kickback arrangement between Florida Pathology Laboratory and a dermatologist. The scheme apparently ran for over 15 years. Dr. Steven Wasserman, the dermatologist implicated, settled his case by paying over $26 million.

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Whether you’ve been charged with Medicare or Medi-Cal fraud in Los Angeles — or any other fraud or white collar crime in Southern California — you’re at high risk of making a vital mistake that could complicate your case before you begin. clarity-in-los-angeles-medicare-fraud-case.jpg

That mistake is this: You might fail to identify, with crystalline clarity, exactly what you and your associates did before, during and after the federal or state investigation.

That sounds like a bit strange.

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A raid on the clinic of Dr. Salomon Melgen — the culmination of a long Medicare fraud investigation — has roiled the political world. Melgen-los-angeles-health-care-fraud.jpg

Dr. Melgen is a close friend of New Jersey Sen. Robert Menendez, who flew on the eye doctor’s private jet to the Dominican Republic on three separate occasions. Those acts earned Menendez a slap on the wrist from the Senate Ethics Committee. (Menendez responded by reimbursing the doctor $50,000 for the trips.)

A right wing website, The Daily Caller, has accused Menendez of having relationships with under-aged prostitutes during those trips to the Dominican Republic, allegations the senator strongly denies. According to a spokesperson for his office “all those allegations… of engaging in prostitution are absolutely false… Senator [Menendez] has known Melgen for years, and his travel on Melgen’s plane on three occasions has been reported and reimbursed required by the rules.”

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As a doctor, chiropractor, dentist, or other health provider who has come under investigation for Los Angeles Medicare Fraud, you may be embarrassed by what you did… or by what authorities allege that you did.los-angeles-california-medicare-fraud.jpg

But you also likely resent being classified as a criminal. For instance, you probably don’t want to be thought of in the same company as 55-year-old Richard Alan Behnan, a Michigan area podiatrist recently sentenced to 55 months behind bars.

Behnan recently pled guilty in U.S. District Court to masterminding and executing a $1.6 million scam to fraudulently bill Blue Cross Blue Shield and Medicare.

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Getting charged with Los Angeles Medicare fraud can change your life — and not in a good way (but not necessarily in a totally bad way, either!) los-angeles-medicare-fraud-defense-overwhelmed.jpg

Defendants often go through a period of epiphany or powerful reflection after being accused. This can be disconcerting. If you’ve recently been arrested — or if you know or care about someone who has been charged — you probably recognize symptoms, such as:

• Sudden dismay and regret regarding years of actions;

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Last Monday, Charles Agbu, a 58-year pastor based in Carson, pled guilty to an $11 million Los Angeles Medicare fraud scam. 11-million-los-angeles-Medicare-fraud.jpg

The Department of Justice accused Agbu of masterminding the reimbursement fraud. Agbu faces the specter of a 20-year prison sentence on top of a fine of $500,000. He will be sentenced in May.

Agbu’s company, Bonfee Inc., marketed itself as a medical equipment supply business. In reality, Bonfee paid people to offer beneficiaries power wheelchairs in exchange for their Medicare information. Once Agbu and his crew had this info, they billed Medicare for the wheelchairs but never delivered them to clients. Bonfee and Agbu also falsified prescriptions and other documents to bill Medicare illegally. Agbu paid his co-conspirators, including Dr. Juan Tomas Van Putten, hundreds of dollars for batch orders of these fake prescriptions.

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Blockbuster charges face DaVita Inc., one of the largest dialysis companies in United States, including charges of Medicare fraud in Los Angeles and beyond. los-angeles-medicare-fraud-davita-.jpg

DaVita is a $7 billion company that operates 2,000 dialysis clinics in the United States. The CEO alone receives $15 million annually, much of that paid for ultimately by taxpayers. The Denver-based company may have engaged in a massively complex, hugely scaled scam to steal money from Medicare and Medicaid. One of the whistleblowers, Dr. Alon Vainer of Georgia, said “We are talking in the hundreds of millions, easily …the profit this company made from those two [Medicare and Medicaid] schemes… was hundreds of millions of dollars.”

Dr. Vainer and a nurse, Daniel Barbir, allege that DaVita engaged in a massive fraud scheme from 2003 through 2010, leveraging tens of thousands of patients to fraudulently boost their revenue from the Federal Government’s programs.

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Odds are that your Los Angeles Medicare fraud charges are slightly “less intense” than 50-year old Yuri Khandrius’ charges. The Brooklyn resident just pled guilty to a massive fraud scheme — a plan to pilfer over $71 million from Medicare’s coffers.

Last Monday, Khandrius pled guilty before U.S. District Judge Nina Gershon to a slate of charges, including conspiracy to pay kickbacks, healthcare fraud, and conspiracy to commit healthcare fraud. Khandrius and others billed the federal government’s Medicare program for an array of never-provided services, tests, therapies, and office visits. They paid co-conspirators in a place that was literally called the “Kickback Room” – offering up more than 1,000 kickbacks totaling over a half a million dollars, between April and June, 2010. When Khandrius gets sentenced on March 11th, he could face up to 25 years behind bars. If the 50-year old serves his full sentence, that means he would not be released again until the age of 75.

Khandrius did not operate this “Bay Medical” scheme himself. The 15 other defendants include five money launderers, two doctors, and nine employees/owners operators of clinics. Judge Gershon will try five more defendants in January.

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