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OIG Enforcement Actions on Therapy Practices

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  • Florida Business Owners Plead Guilty for their Role in Durable Medical Equipment Fraud Scheme

    13 Nov 2023 10:38 AM | Zachary Edgar (Administrator)

    ATLANTA - Brett Weiner and Valerie Desalvo have pled guilty to federal conspiracy charges for their role in buying and selling fake doctors’ orders used to obtain over $1.5 million in fraudulent payments from Medicare.

    “Durable Medical Equipment fraud schemes involve much more than simply bilking the Medicare system,” said U.S. Attorney Ryan K. Buchanan. “These schemes exploit our most vulnerable citizens in the name of personal greed, and our office is committed to finding and prosecuting those involved.”

    “Health care fraud is all about the money,” said Keri Farley, Special Agent in Charge of FBI Atlanta. “Hopefully this case and the work of our special agents with their financial expertise will be a deterrent to anyone thinking about abusing federal healthcare programs to line their own pockets.”

    “Kickbacks can corrupt medical decision-making, resulting in medically unnecessary durable medical equipment and services. Such schemes can affect the availability of medically needed services and drive up the cost of health care for everyone,” stated Special Agent in Charge Tamala Miles with the U.S. Department of Health and Human Services Office of Inspector General. “Individuals and entities that participate in the federal health care system are required to obey the laws meant to preserve the integrity of program funds and the provision of appropriate, quality services to patients.”

    According to U.S. Attorney Buchanan, the charges and other information presented in court: Brett Weiner and Valerie Desalvo owned and operated Laboratory Marketing Services, LLC (“LMS”), a business in Boca Raton, Florida. LMS was in the business of, among other things, receiving kickback payments in exchange for patient “leads,” consisting of billable Medicare beneficiaries’ personal identifying information. Defendants Weiner and Desalvo received bribes from DME companies such as Medihealth Medical Solutions, LLC, located in Amory, Mississippi, and Liberty Medical DME, LLC, in Atlanta, Georgia, in exchange for the leads. These “leads” included, among other information, each Medicare beneficiary’s name, Medicare number, diagnoses, pain level, and primary care physician.

    Through LMS, Weiner and Desalvo also bought and sold signed doctors’ orders from Nagaindra Srivastav and his company B2B Apps Solutions, LLC in Tampa, Florida, which they sold to DME companies. A substantial portion of the doctors’ orders that Weiner and Desalvo purchased from Srivastav and B2B contained forged signatures or purported approvals of physicians or other health care providers whose names and professional identifying information were used without their authorization or knowledge.

    In total, Weiner and Desalvo, through LMS, caused the submission of more than $.15 million in false and fraudulent claims to Medicare, which generated approximately $715,000 in payments, for braces that were procured through the payment of illegal kickbacks and bribes and were ineligible for Medicare reimbursement.

    Brett Weiner, 61, of Atlanta, Georgia, and Valerie Desalvo, 58, of Boca Raton, Florida, each pleaded guilty to one count of conspiracy to pay health care kickbacks. Sentencing is scheduled for February 8, 2024, at 10:00 a.m. before U.S. District Judge Steve C. Jones.

    Reference

    Department of Health and Human Services

    Office of Inspector General


  • Attorney General Moody Announces Arrest of Speech-Language Pathologist Defrauding Florida Medicaid

    8 Nov 2023 10:37 AM | Zachary Edgar (Administrator)

    TALLAHASSEE, Fla.—Attorney General Ashley Moody’s Medicaid Fraud Control Unit is announcing the arrest of a speech-language pathologist for defrauding Florida Medicaid. Kristin Marie Stiggleman, a therapy provider in Hillsborough County, inflated hours by billing for services not provided and misappropriating more than $5,000 from the taxpayer-funded program. The Hillsborough County Sheriff’s Office assisted in arresting Stiggleman who is charged with Medicaid provider fraud and grand theft. 

    Attorney General Ashley Moody said, “This speech-language pathologist was trusted to provide care for vulnerable children and abused that trust to line her own pockets. She inflated her hours spent treating children, billed for sessions she personally canceled, and even billed for services when children were unavailable due to hospitalization. Thanks to our Medicaid Fraud Control Unit, her scheme is shut down and she will now face our Statewide Prosecutors.”

    Stiggleman worked as a licensed speech-language pathologist, tasked with the assessment and treatment of children with speech, language, voice and fluency disorders. An investigation by Attorney General Moody’s MFCU revealed that between March 2020 and September 2021, Stiggleman inflated hours by billing for services not provided on numerous occasions. Stiggleman billed for services even when personally canceling sessions, when children discontinued services, or when children were unavailable for services due to hospitalization—stealing more than $5,700 of public funds in the process. 

    Stiggleman faces one count of Medicaid-provider fraud and one count of grand theft, both third-degree felonies. Assistant Attorney General Joseph Kelly, through the Attorney General’s Office of Statewide Prosecution, will prosecute the case.

    Reference

    Florida Medicaid Fraud Unit


  • Bay Area Doctor Convicted Of Health Care Fraud And Kickback Scheme For Referrals To Medicare-Funded Home Health Services

    1 Nov 2023 10:36 AM | Zachary Edgar (Administrator)

    Dr. Henry Geoffrey Watson Referred Patients to Expensive and Unneeded Home Health Services Billed to Medicare After Sham Visits with Victims in Retirement Homes

    SAN FRANCISCO – Henry Geoffrey Watson, a medical doctor residing in Oakland, California, was convicted by a federal jury today of charges that included accepting kickbacks for patient referrals to home health agencies, health care fraud, and false statements relating to a health care matter, announced Attorney for the United States Thomas A. Colthurst, Robert K. Tripp, Federal Bureau of Investigation Special Agent in Charge, and Steven J. Ryan, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG).

    The jury found that Watson, 67, engaged in three health care kickback schemes from 2013 to 2019, using his position as a licensed medical doctor. The first scheme involved a conspiracy in which Watson agreed to refer patients to home health agency Amity Home Health Care in exchange for illegal kickback payments. The evidence at trial proved that Watson and employees of Amity and its CEO, Amanda Singh, conspired to pay Watson regular and recurring amounts, sometimes in the form of cash payments of $3,000 a month, to ensure that Watson referred Medicare patients to Amity each month.

    Title 42, United States Code, Section 1320a-7b, the Anti-Kickback Statute, makes it a crime for any person to knowingly solicit, offer, or pay a kickback, bribe, or rebate for furnishing services under a Federal health care program including Medicare.

    In the second scheme proved at trial, Watson accepted kickback payments from an undercover FBI agent posing as a home health agency representative seeking Watson’s agreement to refer his patients to a particular Bay Area home health agency. The evidence at trial included video recordings of Watson accepting envelopes of cash, for a total of more than $10,000, at four meetings in 2017. The jury heard evidence that Watson also suggested other doctors who he believed would be willing to accept illegal payments for referrals from the undercover agent.

    The third scheme proved at trial involved a conspiracy between Watson and others to repeatedly and falsely certify individuals for Medicare-funded home health services that the individuals did not seek and did not need. The evidence at trial showed that Watson and co-conspirators arranged for Watson to briefly meet large numbers of unwitting elderly residents of Bay Area retirement homes. After these meetings, held in common areas or recreation rooms, Watson certified that each and every resident he met was homebound, meaning they had a normal inability to leave the home. In fact, according to the evidence and the jury’s verdict, Watson knew that the patients were not homebound and did not need the services he prescribed. Watson did not conduct any tests or conduct any inquiry about whether they were homebound, according to trial evidence, but he nevertheless made fraudulent referrals to the three home health agencies. During time periods that Watson repeatedly certified that certain individuals were homebound, testimony from these individuals and their regular primary care doctors showed that the individuals were generally healthy and active, engaging in activities such as traveling internationally, shopping, walking stairs, and jogging. The evidence proved Watson falsely billed Medicare for certifying these individuals for home health and for supervising their home health care, despite the fact that the individuals did not need that care. As part of the conspiracy, Watson was paid illegal kickbacks of $100 per patient referral by a co-conspirator working for the three home health agencies.

    “Henry Watson engaged in a scheme to enrich himself and his co-conspirators by falsely certifying patients needed expensive home health care services, causing Medicare to pay millions in unnecessary and fraudulent claims,” said FBI Special Agent in Charge Robert K. Tripp. “The FBI and its law enforcement partners will continue to pursue and prosecute medical professionals who cheat our critical healthcare programs like Medicare.”

    HHS-OIG Special Agent in Charge Steven J. Ryan said: “Violations of the Anti-Kickback Statute harm patients by taking away their choice and by depriving them of a doctor committed to doing what is best for them. Kickbacks also can result in medically unnecessary services billed to Medicare, which can affect the availability of services and drive up the cost of health care for everyone. Individuals and entities that participate in the federal health care system must obey the laws meant to preserve the integrity of those programs.”

    Reference

    Department of Health and Human Services

    Office of Inspector General


  • Physical Therapist Convicted for Paying Health Care Kickbacks

    15 Sep 2023 10:35 AM | Zachary Edgar (Administrator)

    A federal jury in the Southern District of Florida convicted a Florida woman for paying kickbacks in exchange for Medicare patient referrals.

    According to court documents and evidence presented at trial, Nelly Anderson, 58, of Bay Harbor Islands, was the owner of Dial 4 Care, a business that provided home health services to Medicare beneficiaries. She hired multiple marketers and paid them kickbacks in exchange for patient referrals. Anderson then caused the submission of claims to Medicare for home health services that were procured through the payment of illegal kickbacks.  

    The jury convicted Anderson of conspiracy to defraud the United States and pay health care kickbacks, and two counts of paying kickbacks in connection with a federal health care program. She is scheduled to be sentenced on Dec. 5 and faces a maximum penalty of five years in prison for the conspiracy count and 10 years in prison for each of the kickback offenses. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

    Reference

    Department of Health and Human Services

    Office of Inspector General

  • U.S. Attorney Announces Charges Against Five Individuals for Over $20 Million Health Care Fraud, Money Laundering, And Kickbacks Scheme

    13 Sep 2023 10:35 AM | Zachary Edgar (Administrator)

    Damian Williams, the United States Attorney for the Southern District of New York, and Naomi Gruchacz, the Special Agent in Charge of the New York Office of the U.S. Department of Health and Human Services, Office of Inspector General (“HHS-OIG”), announced the unsealing today of a Superseding Indictment charging acupuncturists JUNYI LIU, a/k/a “Jenny,” and HONGXING WANG, as well as physical therapists JONATHAN LAQUI and MITZY BALDOVINO and insurance company employee VICTOR MAN, a/k/a “Mr. Wen,” with operating an over $20 million health care fraud scheme at medical offices in Manhattan, Brooklyn, and Queens (the “Offices”).  As part of the fraud scheme, MAN referred patients to the Offices in exchange for kickbacks and also assisted in paying kickbacks to the patients (the “Paid Patients”), who were insured by Medicare and/or other insurance providers (collectively, the “Insurance Providers”).  The defendants and their co-conspirators then billed the Insurance Providers for physical therapy and acupuncture services that were unnecessary or never performed.  LIU was additionally charged with unlawfully enriching herself and a family member through a COVID-19 unemployment benefit scheme.

    LIU and WANG were previously indicted and arrested on these charges in September 2021.  LAQUI, BALDOVINO, and MAN were arrested earlier today and presented and arraigned this afternoon before U.S. Magistrate Judge Sarah L. Cave.  The case is assigned to U.S. District Judge Laura Taylor Swain.

    HHS-OIG Special Agent in Charge Naomi Gruchacz said: “Health care providers who submit fraudulent claims to federally funded insurance plans and bribe patients to participate in kickback schemes put health care benefits for older people and vulnerable populations at risk.  HHS-OIG will continue to hold accountable individuals who exploit federal health care programs for their own greed.”

    Between 2018 and 2021, JUNYI LIU, a licensed acupuncturist, operated the Offices from which LIU and her partners fraudulently billed the Insurance Providers for physical therapy and acupuncture services that were not rendered in the manner represented or not rendered at all.  LIU partnered with other licensed medical professionals, including JONATHAN LAQUI and MITZY BALDOVINO, both of whom were licensed physical therapists, and HONGXING WANG, who was a licensed acupuncturist (collectively, the “Partners”).  The Partners’ roles in the scheme typically included: (i) allowing the Offices to use their enrollments with the Insurance Providers to submit to the Insurance Providers materially false and fraudulent claims for reimbursement for physical therapy and acupuncture services; (ii) creating materially false medical documentation, which stated that certain physical therapy and acupuncture services had been rendered, when such services in fact were not rendered in the manner represented or were not rendered at all; and (iii) contributing financing for the Offices, including for the payment of cash kickbacks to the Paid Patients to induce those patients to provide their insurance information and receive medically unnecessary and/or non-existent services at the Offices. 

    In furtherance of the scheme, LIU paid cash kickbacks to MAN and others in exchange for recruiting and referring the Paid Patients, all beneficiaries of the Insurance Providers, to the Offices.  The beneficiaries also received cash kickbacks, paid by MAN and others, in exchange for their insurance information and their signatures on sign-in sheets and other documents.  In some instances, these Paid Patients visited the Offices, signed in, and received unnecessary physical therapy and acupuncture services.  In other instances, the Paid Patients visited the Offices, signed a sign-in sheet and other documents, and then left without receiving any services at all.  In yet other instances, the Paid Patients did not visit the Offices at all and instead signed sign-in sheets and other documents brought to them elsewhere by MAN and others.  Regardless of whether the Paid Patients received any services or even visited the Offices at all, LIU and her co-conspirators used the Paid Patients’ insurance information to fraudulently bill the Insurance Providers for unnecessary and/or never rendered services.  

    While LIU and her co-conspirators were defrauding the Insurance Providers of millions of dollars, from April 2020 through September 2021, LIU also engaged in a scheme to obtain COVID-19 unemployment benefits for herself and a family member (the “Family Member”) by fraudulently submitting and causing to be submitted to the New York Department of Labor materially false online applications and certifications for COVID-19 benefits.  Among other things, the applications and/or certifications represented that LIU was unemployed when, in fact, she continued to operate the Offices for all or nearly all of this period, and the applications and/or certifications represented that the Family Member was unable to work because of COVID-19 during a five-month period when the Family Member was in China. 

    Reference

    Department of Health and Human Services

    Office of Inspector General


  • Greenville ABA Therapist Pleads Guilty to Making Fraudulent Statements to Medicaid in Connection with the Delivery of Autism Spectrum Disorder Services

    25 Aug 2023 10:34 AM | Zachary Edgar (Administrator)

    COLUMBIA, SOUTH CAROLINA —Nina Bourret, 41, of Greenville, pleaded guilty in federal court to making false and fraudulent statements on claims submitted to Medicaid. 

    Evidence obtained in the investigation revealed that Bourret was an owner of Agapi Behavior Consultants, Inc., which provided Applied Behavior Analysis therapy to treat Autism Spectrum Disorder.  From February 2021 to December 2022, Bourret submitted electronic claims to Medicaid on behalf of Agapi falsely and fraudulently certifying that services had been rendered and/or certifying that services had been rendered in excess of what was actually provided to the beneficiary.

    The investigation has revealed Bourret and Agapi submitted claims to Medicaid that contained false and fraudulent statements in excess of $900,000.00.

    Bourret faces a maximum penalty of 5 years in federal prison. She also faces a fine of up to $250,000, restitution, and 3 years of supervision to follow the term of imprisonment.  Senior United States District Judge Henry Michael Herlong, Jr. accepted the guilty plea and will sentence Bourret after receiving and reviewing a sentencing report prepared by the U.S. Probation Office.

    Reference

    Department of Health and Human Services

    Office of Inspector General


  • Operators of Physical Therapy Chain Charged in Fraud Scheme

    24 Aug 2023 10:28 AM | Zachary Edgar (Administrator)

    McALLEN, Texas – Two individuals involved in a state-wide chain of physical therapy clinics have been charged with defrauding a federal worker’s compensation program, announced U.S. Attorney Alamdar S. Hamdani.

    Authorities took Ricardo Cano, 46, McAllen, and Rosita Cano Meeks, 56, Edinburg, into custody today. They are expected to make their initial appearances before U.S. Magistrate Judge J. Scott Hacker at 1 p.m.

    The 18-count indictment charges Cano and Meeks with conspiracy to commit health care fraud and 10 counts of health care fraud. Cano is also charged with seven counts of money laundering. 

    The indictment alleges between 2014 and 2019, the clinics operated under the name Texas Federal Wellness Center. During that time, they allegedly billed more than $80 million to the Department of Labor – (DOL) Office of Worker’s Compensation Program for physical therapy services provided to injured federal employees. 

    According to the indictment, Cano and Meeks allegedly caused the clinics to submit inflated claims for therapy, fictional medical visits, excessive therapy and fraudulent durable medical equipment. The charges allege Cano and Meeks directed clinic employees to falsify patient checkout times on medical records to conceal the inflated therapy claims. Meeks was in charge of, and oversaw, the fraudulent billing, according to the indictment.

    The charges also allege Cano is not a physician. He was only a physician’s assistant and allegedly instructed employees to refer to him as Dr. Cano.

    According to the indictment, Cano entered into an arrangement with a physician  to falsely give the appearance a licensed doctor oversaw, managed and controlled the clinics, as Texas law requires. The charges allege Cano is, in fact, the true owner of the enterprise which he managed and controlled.  

    As part of the scheme, Cano allegedly coordinated with that physician to obstruct a Texas Medical Board inquiry into a complaint about Cano’s role in operating the clinics and submitting false corporate records. The indictment also alleges Cano transferred approximately $43 million from the Texas Federal Wellness Center clinics to various bank accounts in Cano’s name or in the name of clinics Cano controlled. 

    If convicted, they each face up to 10 years in prison for conspiracy to commit health care fraud and substantive counts of health care fraud. Cano also faces up to 10 years for each conviction of money laundering.

    The U.S. Postal Service-Office of Inspector General (OIG), FBI, Department of Homeland Security-OIG and DOL-OIG conducted the investigation.

    Assistant U.S. Attorney Andrew Swartz is prosecuting the case.



  • Team Rehabilitation Services Agreed to Pay $12.2 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Services that Were Not Reimbursable and Services that Did Not Meet the Requirements of Time-Based Codes

    21 Jul 2023 10:32 AM | Zachary Edgar (Administrator)

    After it self-disclosed conduct to OIG, Team Rehabilitation Services (TRS), Michigan, agreed to pay $12,256,518.14 for allegedly violating the Civil Monetary Penalties Law. OIG alleged that TRS improperly billed certain Medicare Part C plans for time-based CPT codes for Physical Therapy (PT) therapy services by improper calculation of 15-minute units when a therapist had not treated a patient for at least 8 minutes. OIG also alleged that TRS improperly billed Federal health care programs for routinely performing PT reevaluations under CPT code 97164, when routine, continuous assessment of a patient’s expected progress in accordance with a therapy plan of care is not considered to be a medically necessary service and is not separately reimbursable as a reevaluation.



  • Diversicare And Two Occupational Therapy Assistants To Pay Over $1.3 Million To Resolve False Claims Act Allegations

    12 Jul 2023 10:32 AM | Zachary Edgar (Administrator)

    MONTGOMERY, ALABAMA – Diversicare Healthcare Services, LLC, with related subsidiary Diversicare entities (Diversicare), along with Certified Occupational Therapy Assistants Kellie S. Lemons and Charles M. James, have agreed to pay the United States $1,377,696.00 to resolve allegations that they violated the False Claims Act (FCA) by submitting claims to Medicare for occupational therapy services that they did not provide, announced United States Attorney Sandra J. Stewart.

    Read more on www.justice.gov


  • Two Therapists Arrested for Falsifying Information And Defrauding Florida Medicaid Out Of More Than $76,000

    10 May 2023 10:33 AM | Zachary Edgar (Administrator)

    TALLAHASSEE, Fla.—Attorney General Ashley Moody’s Medicaid Fraud Control Unit announced the arrest of two therapists for defrauding the Florida Medicaid program out of more than $76,000.

    https://www.myfloridalegal.com/newsrelease/two-therapists-arrested-falsifying-information-and-defrauding-florida-medicaid-out-more



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