• Attorney General Ford Announces Felony Convictions of Medicaid Healthcare Providers

    Justice 010

     

    Las Vegas, NV – Today, Nevada Attorney General Aaron D. Ford announced that April Lynn Brown, 47, of Las Vegas, and Dynamic Minds Family Services, LLC (Dynamic Minds), were sentenced in a Medicaid fraud case involving billing for services that were not provided to Medicaid recipients. The fraud occurred between January 2017 and May 2018.

    Eighth Judicial District Court Judge Ronald J. Israel sentenced April Lynn Brown and Dynamic Minds for a category “D” felony offense of Submitting False Claims, Medicaid Fraud. Judge Israel sentenced Brown to 12 to 24 months in prison, suspended, and placed her on probation for two years. As part of the sentence, Dynamic Minds was also ordered to pay $499,848 in restitution, and Brown was ordered to perform 150 hours of community service. Persons convicted of Medicaid fraud may also be administratively excluded from future Medicaid and Medicare participation.

    “Overbilling and false billing of Medicaid hurts taxpayers and puts this important healthcare program at risk,” said AG Ford. “My office will hold healthcare providers accountable when they don’t conduct business honestly with Nevada’s healthcare programs.”

    The investigation of this case began after the Attorney General’s Medicaid Fraud Control Unit (MFCU) received information that April Lynn Brown, a licensed Qualified Mental Health Professional and owner of Dynamic Minds, had billed Nevada Medicaid for excessive Rehabilitative Mental Health (RMH) services. The investigation revealed that Dynamic Minds, through Brown as its owner and service provider, submitted claims to Nevada Medicaid purporting to have provided in excess of 24 hours of RMH services each day over a period of several months. In fact, Brown had neither provided nor could have provided the services in such quantities.    

    The MFCU investigates and prosecutes financial fraud by those providing healthcare services or goods to Medicaid patients. The MFCU also investigates and prosecutes instances of elder abuse or neglect. The Nevada MFCU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award. The remaining 25 percent is funded by the State of Nevada, MFCU. Anyone wishing to report suspicions regarding any of these concerns may contact the MFCU at 702-486-3420 or 775-684-1100.

    This case was investigated by the Attorney General’s Medicaid Fraud Control Unit and prosecuted by Senior Deputy Attorney General Steve Sidhu.

    To view the criminal information of April Lynn Brown, click here. To view the criminal information of Dynamic Minds Family Service, LLC, click here.

    Source

    {jcomments on}

  • Carterville Nurse Sentenced on Felony Drug and Health Care Fraud Charges

    Justice 059

     

    BENTON, Ill. – A Carterville man was sentenced on Thursday, September 16 to four years of probation for drug diversion and health care fraud charges. Joseph M. Mattingly, 42, was also ordered to pay a $500 fine along with a $200 special assessment.

    According to court documents, Mattingly diverted Schedule II controlled substance (Hydrocodone) pills from a patient and defrauded the Medicare program of the cost of the pills.

    In 2018, Mattingly was employed as a nurse with Progress Port, a center for adults with intellectual disabilities in Williamson County. Between August 20, 2018 and October 30, 2018, Mattingly obtained possession of 25 Hydrocodone pills he falsely claimed he dispended to a Progress Port resident, which he diverted for his own personal use.

    Mattingly took three Hydrocodone pills intended for the same Progress Port resident and replaced those pills with Tylenol, an over-the-counter medication at three separate locations.

    The investigation was conducted by the United States Department of Health and Human Services, Office of Inspector General - Office of Investigations and the Illinois State Police Medicaid Fraud Control Bureau.

    If you suspect or know of an individual or company that is not complying with healthcare laws or public aid programs, you may report this activity to the local office of the U.S. Department of Health and Human Services, Office of Inspector General, or you may call 1.800.447.8477.

    Source

    {jcomments on}

  • Former Evansville Mental Health Counselor Sentenced

    Justice 008

     

    Submitted over 2,000 materially false and fraudulent claims to Medicaid and Medicare

    Evansville – Acting U.S. Attorney John Childress announced today that Barbara B. Witte, 74, of Evansville, Indiana, was convicted of felony health care fraud and sentenced to two years of federal probation by U.S. District Judge Richard L. Young. Witte was also ordered to pay $186,347.55 in restitution and a $50,000 fine.

    “Health care fraud harms the entire healthcare system and those that need the care from it,” said Childress. “This office will continue to work with our law enforcement partners to investigate and prosecute those who do their best to undermine that system.”

    Witte was a licensed mental health counselor. She provided counseling services for patients in Evansville and Vanderburgh County through her business, B-One Counseling. She billed health care benefit programs, including Medicaid and Medicare, for medical services she provided.

    Between January 2014 and July 2018, Witte submitted over 2,000 materially false and fraudulent claims to Medicaid and Medicare. The claims were fraudulent because Witte had not actually provided services to the patients identified in the claims.

    Medicaid and Medicare processed Witte’s false claims and paid her for services she never provided. Witte’s conduct caused a loss of $146,334.51 to the Medicaid program, and $40,013.04 to the Medicare program.

    This investigation was a collaborative effort between the FBI, Indiana Medicaid Fraud Control Unit, Office of Attorney General, and the U.S. Department of Health and Human Services, Office of Inspector General.

    "This sentence should put others on notice that exploiting federally funded health care programs will not be tolerated and those who engage in this type of crime will be identified and held accountable,” said FBI Indianapolis Special Agent in Charge Paul Keenan. “We will continue to work with our partners to protect taxpayer’s resources from those who would take advantage of such programs for their own greed.”

    “Fighting fraud and protecting Hoosiers is our top priority. This criminal conviction is a win for all Indiana residents, as every dollar returned to Indiana Medicaid through this restitution is another taxpayer dollar that will go toward services for our most vulnerable,” said Indiana Attorney General Todd Rokita. “I am proud of the diligent work of our team and our federal partners to bring this case to justice.”

    “Medical professionals are entrusted to provide only medically necessary services and bill for only for the services that they provide. Billing for services not rendered is fraud, pure and simple,” said Lamont Pugh III, Special Agent in Charge, U.S. Department of Health & Human Services, Office of Inspector General – Chicago Region. “The OIG will continue to work with our partners to ensure that those who choose to submit fraudulent claims to the Medicare and Medicaid programs are held accountable.”

    According to Assistant U.S. Attorney Matthew B. Miller, who prosecuted this case for the government, Witte must pay restitution in full within thirty days.

    In November of 2020, Acting United States Attorney John E. Childress renewed a Strategic Plan designed to shape and strengthen the District’s response to its most significant public safety challenges. This prosecution demonstrates the Office’s enduring commitment to investigating and prosecuting those who engage in fraud and abuse that harm the public and the healthcare system. See U.S. Attorney’s Office, Southern District of Indiana Strategic Plan Section 5.2.

    Source

    {jcomments on}

  • Pharmacy Owner and Pharmacist Employee, a Previously Convicted Felon, Agree to Pay $250,000 to Resolve Alleged False Claims Act Liability

    Justice 046

     

    The government alleges that the employee, who was previously convicted of a state-controlled substance offense, improperly filled prescriptions and managed pharmacies

    PHILADELPHIA – Acting United States Attorney Jennifer Arbittier Williams announced that Mark Zulewski, Kaushal Patel, Patel’s company Kass Management & Consulting, LLC, and Patel-owned pharmacies Belmont Pharmacy, LLC; Bensalem Pharmacy; Big Oak Pharmacy, Inc.; Doylestown Drugs, LLC; Family One Pharmacy; Penndel Drugs, Inc.; Penlar Pharmacy; and Medical Plaza Pharmacy have agreed to pay $250,000 to resolve potential liability under the False Claims Act.

    Zulewski was a pharmacist licensed in Pennsylvania when, in 2010, he was convicted by the Commonwealth of Pennsylvania of a felony-controlled substance offense. As a result of the conviction, Zulewski’s pharmacy license was suspended and in 2011 he was excluded from participation in federal health care programs by the U.S. Department of Health and Human Services.

    The United States contends that Patel hired Zulewski to work in Patel’s pharmacies even though Patel knew that Zulewski had been convicted of a controlled substance offense, and that Patel allowed Zulewski to continue working in his pharmacies even after learning Zulewski was excluded from participating in federal health care programs as a result of his conviction. The United States further contends that, from August 2010 until March 2017, Patel gave Zulewski broad administrative authority as well as his pharmacist log-in credential so that Zulewski could manage Patel’s pharmacies and, on occasion, fill prescriptions as needed when pharmacists-in-charge at certain of the Kass pharmacies were unavailable.

    The United States further contends that Zulewski, Patel, Kass Management, and the Patel-owned pharmacies knowingly and willfully disregarded Zulewski’s exclusion, resulting in the presentation of false or fraudulent claims for payment to the federal programs, including Medicare, Medicaid, and the Federal Employee Health Benefits Program.

    The Office of the Inspector General of the U.S. Department of Health and Human Services excludes people from participating in federal health care programs upon their conviction of certain crimes, including a controlled substance offense. A federal health care exclusion is intended to keep individuals who have violated the law out of Medicare, Medicaid, and Federal Employee Health Benefits programs to protect program beneficiaries and the integrity of federal health care programs.

    The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act statute. Under these provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The suit was filed in the Eastern District of Pennsylvania and is captioned United States of America, ex rel. LaGrossa v. Kass Management & Consulting, LLC, et al., Civil Action No. 15-6844. The whistleblower’s attorneys are Gavin Lentz and Peter Bryant of Bochetto & Lentz, PC.  

    “The United States will pursue those who violate a federal health care exclusion and those who knowingly allow excluded individuals to provide goods or services to federal program beneficiaries.” said Acting U.S. Attorney Williams. “An individual convicted of a controlled substances offense, as Zulewski was, must not be allowed behind the pharmacy counter during his exclusion to handle prescription drugs, including narcotics, and dispense them to federal program beneficiaries.”

    “Civil enforcement is an important tool in our ongoing battle against health care fraud,” said Maureen R. Dixon, Special Agent in Charge of the Office of the Inspector General for the U.S. Department of Health and Human Services. “We will continue to work closely with the United States Attorney’s Office to ensure the integrity of taxpayer funds and protect beneficiaries of federal healthcare programs.”

    “Exclusions protect Medicare and Medicaid patients and safeguard the integrity of these vital programs,” stated Gregory Demske, Chief Counsel to the Inspector General for the U.S. Department of Health and Human Services. “Anyone who circumvents an exclusion undermines the goal of ensuring Medicare and Medicaid patients receive safe, appropriate, and high-quality, services.”

    The government’s resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).

    This matter was investigated by the U.S. Department of Health and Human Services’ Office of Inspector General, the U.S. Office of Personnel Management’s Office of Inspector General, and the U.S. Attorney’s Office for the Eastern District of Pennsylvania. This matter was handled by Assistant U.S. Attorney Judith A.K. Amorosa and Fraud Investigator Jeffrey Braun.

    Source