Dr. Ashish Pal, a cardiologist based in Orlando, Florida, has paid $6.75 million to resolve allegations that he violated the False Claims Act by performing medically unnecessary ablations and vein stent procedures.

The settlement resolves allegations that, from Jan. 1, 2013 to Dec. 31, 2019, Dr. Pal knowingly submitted false claims to federal health care programs for medically unnecessary ablations and vein stent procedures. The government alleged that Dr. Pal performed the ablations and stent procedures on veins that did not qualify for treatment under accepted standards of medical practice. Additionally, the government alleged that Dr. Pal made misrepresentations in patient medical records to justify the procedures, including overstating the degree of reflux and diameter of veins, and falsely documenting patient symptoms. The United States also alleged that, in many instances, the ablations were performed either exclusively or primarily by one or more ultrasound technicians outside their scope of practice.

“Physicians are expected to perform procedures only when they have a legitimate medical basis to do so,” said Acting Assistant Attorney General Brian M. Boynton for Justice Department’s Civil Division. “The department will pursue those who waste taxpayer funds and subject patients to unwarranted medical care.”

“Our office is committed to protecting vulnerable patients from those who put financial gain ahead of patients’ needs,” said Acting U.S. Attorney Karin Hoppmann of the Middle District of Florida. “We will continue to hold accountable those who abuse the nation’s healthcare programs at the expense of the taxpayers.”

“The Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS) will continue to lead the way in the dogged pursuit of unethical providers who risk patient health for profit,” said Acting Inspector General Sean O’Donnell for the Department of Defense Office of Inspector General. “Ensuring Force readiness and proper care of our military members and their families are among our top priorities.”

“When physicians enrich themselves by performing medically unnecessary procedures on Medicare and Medicaid beneficiaries, they threaten their patients’ health and divert taxpayer funds meant to pay for necessary care,” said Special Agent in Charge Omar Pérez Aybar of U.S. Department of Health & Human Services Office of Inspector General (HHS-OIG). “We will continue to work hard with our law enforcement partners to ensure that health care providers who engage in such abusive behavior are held accountable.”

“The healthcare providers within the Military Health System are committed to patient satisfaction and take seriously their obligation to ensure great outcomes by providing the highest-quality care,” said Director Lt. Gen. Ronald J. Place, M.D. of the Defense Health Agency (DHA). “We are grateful to the U.S. Department of Justice for working to maintain that trust by ensuring medical providers continue to put their patients’ needs and safety first.”

“The Office of Personnel Management’s Office of the Inspector General (OPM-OIG) is dedicated to investigating providers that prioritize profits over patient well-being,” said Deputy Inspector General Performing the Duties of the Inspector General Norbert E. Vint for the OPM-OIG. “We will continue to work with our law enforcement partners and colleagues at the Department of Justice to safeguard the federal health care programs from fraud.”

To help ensure the alleged abuses outlined in this case do not reoccur, Dr. Pal and Interventional Cardiology & Vascular Consultants, PLC entered a detailed, multi-year integrity agreement with HHS-OIG. This integrity agreement contains training and reporting requirements as well as a quarterly claims review conducted by an Independent Review Organization, with the requirement that the review team includes at least one interventional cardiologist who is board certified. It also contains provisions for stipulated penalties and, possibly, the exclusion from federal health programs such as Medicare and Medicaid in the event of a breach of its terms.

The resolution obtained in this matter was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section and the U.S. Attorney’s Office for the Middle District of Florida, with assistance from the Department of Defense Office of Inspector General - DCIS, the FBI, the U.S. Department of Health & Human Services Office of Inspector General and the Office of Personnel Management Office of Inspector General.

The government’s pursuit of this matter illustrates its 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 handled by Nicholas C. Perros of the Civil Division’s Commercial Litigation Branch, Fraud Section, and Assistant U.S. Attorney Michael R. Kenneth of the U.S. Attorney’s Office for the Middle District of Florida.

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About 41,500 patients in the Department of Veterans Affairs are receiving letters notifying them their care may have been delayed because of issues with the VA's beleaguered new electronic health records system, the agency's top health official told reporters Wednesday.

The number of potentially affected Veterans comes after the department announced last week it was delaying further rollout of the system until summer 2023 over flaws that watchdog reports have found posed risks to patient safety. The number was first reported by The Spokesman-Review newspaper in Spokane, Washington.

In a roundtable with reporters, Shereef Elnahal, the VA's under secretary for health, stressed that not all of the 41,500 Veterans receiving letters definitely had care delayed. But a review of the system suggested they may have been among a group where glitches resulted in clinicians failing to contact them with information about medications, lab tests or follow-up appointments.

The VA is notifying those patients "out of an abundance of caution," Elnahal said. The agency has a call center dedicated to the issue, and he vowed that the VA would assist Veteran by Veteran to solve any problems.

"What we asked Veterans to do in this letter... is to check their appointments, check their medications, check to make sure they have that next step in their care scheduled and confirmed, and reach out to us if they haven't heard from us about that next step," he said.

The Oracle Cerner Millennium electronic health records system has faced numerous issues since it was first launched at the Mann-Grandstaff VA Medical Center in Spokane in November 2020, including cost overruns and incidents that have sparked patient safety concerns. The system has also been rolled out in Walla Walla, Washington; Columbus, Ohio; and Roseburg and White City, Oregon.

The Cerner system is meant to replace a decades-old program called the Veterans Health Information Systems and Technology Architecture, or VistA, and is aimed at providing Veterans a more seamless health record that could follow them from their military career to their post-military life.

The VA officially estimates the Cerner system will cost $16.1 billion, but a report from the Institute for Defense Analyses earlier this year estimated the cost could actually top $50 billion. The system has also crashed repeatedly.

Meanwhile, several inspector general reports have identified issues with patient safety, including a report released in July that found at least 149 patients at Mann-Grandstaff were harmed by a glitch that put some orders and referrals into an overflow folder clinicians weren't aware of, effectively making them vanish from the system.

The issues sparked concern from Congress and calls from lawmakers, particularly those representing Washington state, to delay rolling out the system more widely.

But the VA pressed ahead until the July inspector general report that found patients were harmed by a system glitch. After that was released, the VA announced it was delaying further deployment of the system until at least January to investigate the issues.

It's that investigation that turned up the 41,500 patients potentially affected by glitches, Elnahal said. In addition to the so-called "unknown queue" issue identified in the July inspector general report, the department found "several" other examples of flaws that meant important medical information was ultimately not getting to its destination, Elnahal said.

The department started sending out the letters last week, he said.

The investigation also prompted the VA to announce last week the rollout is now being delayed until June 2023. Among the issues the VA cited in a news release last week were latency and slowness, problems with patient scheduling, referrals, medication management and other types of medical orders.

The announcement was welcomed by lawmakers in both parties who have been deeply frustrated by the issues with the system.

"Patient safety should be the guiding principle for this program. However, it is clear this program was not given a foundation for success," House Veterans Affairs Committee Chairman Mark Takano, D-Calif., said in a statement last week. "Congress needs a clear analysis of continuing with the Cerner program, the risks and costs associated with delaying modernization and continuing to rely on VistA, or the potential use of other [electronic health records] to meet VA's clinical and interoperability needs."

Asked Wednesday whether the VA has a backup plan beyond Cerner, Elnahal said the department believes the best path forward is to fix the Cerner program.

"The Veterans who are getting care at the five facilities where this system exists now need a resolution to the configuration issues that have led to this disclosure," he said. "We've determined that the fastest way to address those risks is to work on the system and reconfigure it and fix those issues where that system exists. I believe that by extension, if we do that, this will be a system that will be ready to deploy elsewhere."

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The Veterans Affairs disability claims backlog has dropped by almost 25% in the last four months, indicating that hiring and overtime efforts are making a significant dent in the pending workload, department officials said.

As of June 21, the total number of backlogged files — claims that have been pending for more than four months — was at 187,540. The figure had been as low as 70,000 claims before the start of the American coronavirus pandemic in early 2020.

Since then, partial closures of benefits offices slowed processing of the disability claims. At the same time, the volume of new claims (particularly ones in recent years tied to the expansion of illnesses related to Agent Orange exposure during the Vietnam War) increased, putting additional pressure on the system.

The backlog reached as high as 264,000 last October.

Last week’s totals are 29% lower than that mark. Despite the rapid progress, officials have said it may take until mid-2024 to get the figure below the 100,000 case level again.

VA officials credited new hirings and employee overtime with much of the recent improvement.

Last fall, VA Secretary Denis McDonough said the Veterans Benefits Administration would hire and train 2,000 employees to assist with the increasing volume of disability benefits claims processing. As of last week, about 82% of those new workers have started working.

Officials said they have paid for about $100 million worth of overtime for existing employees through American Rescue Plan funds awarded by Congress in early 2021.

In a statement, department leaders also credited new automated claims processing systems with helping streamline the work, leading to additional decreases in the backlog.

“Through these efforts, the claims development and decision making portion of the claims process is more efficient and improves decision accuracy,” the statement said. “VBA continues to improve and expand this automated decision support process.”

The claims backlog has been a source of frustration and concern in past years, particularly before the department’s processing systems were shifted to fully electronic files. It peaked in spring 2013 at more than 610,000 cases, prompting calls from lawmakers and advocates for wholesale changes in how the claims are handled.

From late 2015 to early 2020, the backlog hovered around 75,000 cases, a figure that department officials said was realistically the lowest level possible without forcing complex claims through the system too quickly, risking mistakes.

Reducing the caseload of overdue claims has been a priority for advocates as Congress considers sweeping toxic exposure legislation that could add hundreds of thousands of new claims to the benefits system, potentially driving the backlog even higher.

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Foreign agitators continue to target American Veterans through a complex network of fraudulent social media pages mimicking well-known service groups and brands, officials from Vietnam Veterans of America warned in a new report released Tuesday.

“Their goals are to perpetrate financial fraud, spread anti-American propaganda, manipulate the online public community spaces and sow discord by exploiting and inflaming national divisions,” the VVA analysis states.

“While their objectives also include election interference, their activities and their effects continue without interruption year-round and are not limited to political elections.”

The findings are part of a wide-ranging report on the influence of foreign groups on the U.S. Veterans community, the culmination of more than two years of work by the group. Author Kris Goldsmith, chief investigator and associate director for policy and government affairs at VVA, said the report should serve as a wake-up call for law enforcement and the American public.

“We ought to be looking outside the country at this problem,” he said. “If someone stole technology from a defense contractor and used it to attack America, we’d be going after the people who did the attack. But here, we seem to expect Facebook to be policing all of this and taking these sites down.”

Goldsmith first got involved in tracking the problem after discovering an unauthorized “Vietnam Vets of America” Facebook page using the VVA logo and branding in 2017.

The site, run by a Bulgarian “troll farm” active in U.S. election destabilization efforts in 2016, grew to nearly 200,000 followers in less than a year and mixed legitimate news stories with faked reports and inflammatory commentary, all under the guise of representing an official Veteran service organization’s views.

After refusing to censor the page for several weeks, Facebook officials eventually relented and shut it down. Since then, VVA investigators have tracked more than 150 other similar overseas-based efforts on Facebook, Instagram, Snapchat and other social media and blogging platforms. Most are connected to well-known Russian and Eastern European agitators and criminals.

In some cases, the sites appear to be scams designed to peddle unauthorized merchandise, a long-standing problem within the Veterans community. But others seem focused less on direct financial gain and more on creating confusion and division within the Veterans’ community.

Investigators found one Facebook page titled “Vietnam Veterans” and using pictures of VVA leadership officials alongside the group’s logo was being used by foreign administrators to sell merchandise supporting the election of Donald Trump. Another, titled “Vietnam Veterans Advocacy,” used similar tactics to promote anti-Trump memes and stories.

In both cases, the pages drew followings of tens of thousands of followers, many of them real American Veterans who may have confused the postings with official messages and group positions.

“(U.S. Veterans) have a higher propensity than other subgroups of Americans to be politically engaged — they are more likely to vote and serve in public office — and they tend to wield greater political influence on those around them,” the report states.

“Additionally, nearly one-third of the federal workforce is composed of Veterans. This makes the targeting of the MilVets population a means to jeopardize federal agencies ranging from law enforcement and defense to healthcare and food safety.”

Goldsmith said social media companies thus far have been open to working with Veterans groups on the issue, but shutting down sites only temporarily disrupts the scammers’ work. He wants to see more involvement from the FBI and U.S. law enforcement in tracking and prosecuting the foreign troublemakers.

VVA is also pushing the White House to issue an executive order “to protect troops and Veterans from exploitation by foreign actors and to strengthen American cybersecurity.”

The full report is available on the VVA website.

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CAMDEN, N.J. – The president and CEO of a commercial diving school was sentenced today to 27 months in prison for fraudulently obtaining funding from the U.S. Department of Education (DOE) and the U.S. Department of Veterans Affairs (VA) for the school and its students, U.S. Attorney Philip R. Sellinger announced.

Tamara Brown, 58, of Haddon Heights, New Jersey, previously pleaded guilty by videoconference before U.S. District Judge Joseph H. Rodriguez to an information charging her with one count of wire fraud. Judge Rodriguez imposed the sentence today by videoconference.

According to documents filed in this case and statements made in court:

From January 2012 through July 2018, Brown owned a private, for-profit commercial diving school, which offered educational programs in commercial diving and underwater welding and salvage. As a for-profit institution, the diving school was required to be accredited through an approved accreditation body to be eligible to receive tuition funds from the DOE’s Higher Education Act’s programs. The VA also relies upon the accreditation in evaluating the eligibility of Veteran students to receive student aid funding. Given that more than 80 percent of the diving school’s students received financial assistance from the Department of Education, the school stood to lose its largest source of tuition funding for its students if it lost its accreditation.

Prior to 2012, the diving school had been properly accredited. However, when renewing the diving school’s accreditation that year, Brown submitted fraudulent information to the accrediting authority. For example, Brown reported rates of employment of the school’s graduates of between 81 to 84 percent, when the employment rates were closer to 50 to 60 percent, significantly lower than the rate required to maintain accreditation. Brown also provided fraudulent information pertaining to the school’s holding of “advisory board” meetings required for accreditation to ensure that the school’s curriculum would educate students to meet the current demands of the industry and prospective employers. In the school’s accreditation application, Brown reported holding advisory board meetings on various dates and also submitted what purported to be minutes of nine such board meetings. The diving school did not have a formal advisory board and did not regularly conduct meetings as required. Brown submitted wholly fabricated meeting minutes for at least six of the nine dates listed in the school’s accreditation application and, therefore, did not satisfy the minimum accreditation requirements. The diving school nonetheless continued to regularly receive DOE funds via wire transfers, including a wire transfer which occurred on Jan. 18, 2017.

In addition to the prison term, Judge Rodriguez sentenced Brown to three years of supervised release, fined her $50,000 and ordered restitution of $1.1 million.

U.S. Attorney Sellinger credited agents of the FBI’s South Jersey Resident Agency, under the direction of Special Agent in Charge Jacqueline Maguire in Philadelphia; the Philadelphia Resident Agency of the U.S. Department of Education, Office of Inspector General, under the direction of Special Agent in Charge Terry V. Harris, and the Northeast Field Office of the U.S. Department of Veterans Affairs Office of Inspector General, under the direction of Special Agent in Charge Christopher F. Algieri, with the investigation leading to today’s sentencing.

Students who can show that their school misled them or engaged in other misconduct in violation of certain state laws may be eligible for the discharge of some or all federal student loan debt under certain circumstances pursuant to the Borrower Defense Loan Discharge program. Former students of Divers Academy International who wish to seek federal loan forgiveness may apply at http://www.studentaid.gov/borrower-defense/.

The government is represented by Assistant U.S. Attorney Diana Vondra Carrig of the U.S Attorney’s Office in Camden.

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Leonard C Boyle, Acting United States Attorney for the District of Connecticut, announced that WALI MUHAMMAD, 46, of Branford, was sentenced today by U.S. District Judge Vanessa L. Bryant in Hartford to 24 months of imprisonment, followed by three years of supervised release, for defrauding Connecticut’s Medicaid Program.

According to court documents and statements made in court, from 2010 to 2019 Muhammad owned and operated Happy Family Clinical Services LLC (“Happy Family”), a mental health and social services agency. At various times, Happy Family’s office was located in East Haven and Branford, before moving to New Haven in 2014.

From 2013 through 2019, Muhammad engaged in a scheme to defraud the Connecticut Medicaid Program by submitting fraudulent claims for psychotherapy services that were purportedly provided to Medicaid clients. The claims were for occasions and dates of service when no psychotherapy services of any kind had been provided to the Medicaid clients identified in the claims. The claims also were submitted using the names and identities of licensed clinical social workers and other licensed health care providers who purportedly worked for Happy Family, and represented that the psychotherapy services were personally rendered by the licensed providers, when, in fact, the licensed providers had not personally rendered the services, had not supervised the services that were billed, and were unaware that Muhammad was billing or causing the services to be billed as if the providers had personally rendered the services. When services were provided, they were usually rendered by unlicensed individuals and billed as licensed psychotherapy.

Judge Bryant ordered Muhammad to pay $527,034 in restitution to Medicaid.

On March 11, 2021, Muhammad pleaded guilty today to one count of health care fraud.

Muhammad, who is released on bond, is required to report to prison on September 27, 2021.

This case was investigated by U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), and the Medicaid Fraud Control Unit (MFCU) of the Connecticut Chief State’s Attorney’s Office. Acting U.S. Attorney Boyle also thanked the Connecticut Attorney General’s Office, the Connecticut Department of Social Services, and the Connecticut Department of Mental Health and Addiction Services for their assistance in the investigation.

The matter was prosecuted by Assistant U.S. Attorney David J. Sheldon and Auditor Susan Spiegel.

The U.S. Attorney’s Office, Chief State’s Attorney’s Office, and Attorney General’s Office meet regularly as part of The Medicaid Fraud Working Group. The Working Group also includes representatives from the Connecticut Department of Social Services; the Connecticut Department of Public Health; the Drug Control Division of the Connecticut Department of Consumer Protection; the Office of the Inspector General of the U.S. Department of Health and Human Services, and the Federal Bureau of Investigation. The Working Group reviews pending issues and cases, identifies trends that might indicate fraudulent activity, and coordinates efforts for maximum results.

People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS.

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SACRAMENTO, Calif. — Akop Atoyan, 48, of Glendale, pleaded guilty today to one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive health care kickbacks, Acting U.S. Attorney Phillip A. Talbert announced.

According to court documents, Atoyan and his wife, Liana Karapetyan, owned and controlled home health care and hospice agencies in the greater Sacramento area: ANG Health Care Inc., Excel Home Healthcare Inc., and Excel Hospice Inc. On behalf of the agencies, Atoyan and Karapetyan certified to Medicare that they would not pay kickbacks in exchange for Medicare beneficiary referrals to the agencies.

Despite their certifications, from at least July 2015 through April 2019, Atoyan and Karapetyan paid and directed others to pay kickbacks to multiple individuals for beneficiary referrals, including employees of health care facilities, as well as employees’ spouses. The kickback recipients included John Eby, a registered nurse who worked for a hospital in Sacramento; Anita Vijay, the director of social services at a skilled nursing and assisted living facility in Sacramento; Jai Vijay, Anita Vijay’s husband; and Mariela Panganiban, the director of social services at a skilled nursing facility in Roseville.

In total, Atoyan, Karapetyan, and others caused the agencies to submit over 8,000 claims to Medicare for the cost of home health care and hospice services. Based on those claims, Medicare paid the agencies approximately $31 million. Of that amount, Medicare paid the agencies over $2 million for services purportedly provided to beneficiaries, but these beneficiaries were referred in exchange for kickbacks paid to, among others, Eby, Anita Vijay, Jai Vijay, and Panganiban. Because the agencies obtained the beneficiary referrals by paying kickbacks, the agencies should not have received any Medicare reimbursement.

This case is a product of an investigation by the Federal Bureau of Investigation and the U.S. Department of Health and Human Services’ Office of Inspector General. Assistant U.S. Attorney Matthew Thuesen is prosecuting the case.

As part of his guilty plea, Atoyan agreed to pay $2,525,363 in restitution to the U.S. Department of Health and Human Services. He also agreed to forfeit that same amount to the United States.

U.S. District Judge Morrison C. England Jr. is scheduled to sentence Atoyan on Oct. 7, 2021. Atoyan faces maximum statutory penalties of 10 years in prison for the health care fraud conspiracy charge and five years in prison for the kickback conspiracy charge. He also faces a maximum fine of $250,000 or twice the gross gain or loss for each charge. The actual sentence, however, will be determined at the discretion of the court after consideration of any applicable statutory factors and the Federal Sentencing Guidelines, which take into account a number of variables.

In separate cases, Karapetyan, Eby, Jai Vijay, Anita Vijay, and Panganiban pleaded guilty for their roles in the kickback scheme. They await sentencing.

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Conspired with Owner of Tennessee Genetic Testing Laboratory, Marketing Companies, and Physicians to Defraud the United States

NASHVILLE – A Kentucky woman pleaded guilty yesterday in U.S. District Court in Nashville, to conspiracy to pay and receive health care kickbacks, announced Acting U.S. Attorney Mark H. Wildasin for the Middle District of Tennessee.

Elizabeth Turner, 34 of Glenview, Kentucky, was charged by criminal Information in November with conspiring with Fadel Alshalabi, the owner of Crestar Labs, LLC, based in Spring Hill, Tennessee, Melissa Lynn “Lisa” Chastain, the owner of marketing company Genetix, LLC, located in Belton, South Carolina, as well as other marketers and physicians, to offer, pay, solicit and receive illegal kickbacks and to defraud the Medicare and Medicaid Programs.

Between approximately February 2018 and ending around August 2019, Turner was the owner of telemedicine company Advanced Tele-Genetic Counseling (“ATGC”), which received kickback payments from marketers in exchange for providing signed doctors’ orders for Cancer genomic (“CGx”) testing. CGx testing uses DNA sequencing to detect mutations in genes that could indicate a higher risk of developing certain types of cancers in the future. CGx testing is not a method of diagnosing whether an individual presently has cancer. The marketers targeted Medicare and Medicaid patients through door-to-door marketing, at senior citizen fairs, at nursing homes, and at other locations, and convinced patients to provide their genetic material via a mouth swab kit. The marketers then provided the swab kits to Crestar Labs for CGx testing in exchange for kickbacks paid by Crestar Labs. Crestar Labs billed Medicare and Medicaid for the tests.

Turner, through ATGC, paid kickbacks to doctors for signed orders for CGx tests, without regard for the medical necessity of the tests. Turner knew the doctors were not the patients’ treating physicians, were not treating the patients for any specific medical problem, symptom, illness, or diagnosis, and were not using the results in the care of the patients. Turner was aware that the doctors often never contacted the patients at all.

As a result of Turner’s involvement in the conspiracy, ATGC received approximately $234,730 in illegal kickback payments from marketing company co-conspirators, including Genetix, LLC. As a result of the conspiracy, Medicare and Medicaid paid laboratories, including Crestar Labs, LLC millions of dollars in reimbursements they were not entitled to receive because the CGx tests had been procured through the payment of kickbacks, and were otherwise ineligible for reimbursement.

Turner faces up to five years in prison when she is sentenced on May 2, 2022, and a fine of up to $250,000; restitution to the Medicare and Medicaid programs; and forfeiture of the ill-gotten proceeds.

This case was investigated by the U.S. Department of Health and Human Services - Office of the Inspector General, and the Federal Bureau of Investigation. Assistant U.S. Attorneys Sarah K. Bogni and Robert S. Levine are prosecuting the case.

United States v. Elizabeth Turner is docketed at Criminal Case No. 3:21-cr-00280.

United States v. Fadel Alshalabi, Edward Klapp, and Melissa Lynn Chastain is docketed at Criminal Case No. 3:21-cr-00171. The charges contained in that Superseding Indictment are merely accusations. The defendants are presumed innocent until proven guilty in a court of law.

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WACO – U.S. Attorney Ashley C. Hoff of the Western District of Texas announced today that Integrated Pain Associates, PLLC (“IPA”), a pain clinic headquartered in Killeen, and Central Texas Day Surgery Center, LLC (“CTDSC”), an affiliated ambulatory surgery center, have agreed to pay the United States and the State of Texas $836,702.88 to resolve allegations they violated the False Claims Act by overbilling federal healthcare programs.

The United States’ allegations arise from IPA and CTDSC’s submission of claims to Medicare, Medicaid, and TRICARE for facet joint injections, transforaminal injections, and radiofrequency ablation procedures. The United States contends that the defendants billed for more units or levels of these procedures than they performed. For example, the United States alleges that even when a patient received only a single injection, IPA and CTDSC would sometimes bill the government as though the patient had received two or three injections, thereby increasing the amount paid for the procedure.

“We will not allow health care providers to enrich themselves at taxpayer expense,” said U.S. Attorney Hoff. “We are grateful to our partners at the Department of Health and Human Services Office of Inspector General, the Defense Criminal Investigative Service, and the Civil Medicaid Fraud Division of the Office of the Attorney General of Texas for their assistance in obtaining this significant recovery.”

“Health care providers who try to boost their profits by overbilling federal health care programs will be held accountable for their actions,” said Special Agent in Charge Miranda L. Bennett of the Department of Health and Human Services Office of the Inspector General. “In coordination with our law enforcement partners, our agency will continue to safeguard critical health care programs from such schemes.”

“The Department of Defense Office of Inspector General, Defense Criminal Investigative Service (‘DCIS’) and our law enforcement partners diligently investigate allegations of fraud against individuals or companies attempting to take advantage of the military healthcare system, known as TRICARE,” said Special Agent in Charge Michael Mentavlos, DCIS Southwest Field Office. “Today’s outcome reflects DCIS’s steadfast commitment to protect our Warfighters and their families and hold accountable those who perpetrate the fraud.”

The civil settlement of these allegations includes the resolution of claims brought under the qui tam provisions of the False Claims Act by Susan Edwards. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam case is captioned United States and Texas ex rel. Edwards v. Integrated Pain Associates, et al., 5:15-cv-00315-FB (W.D. Tex.).

Assistant U.S. Attorney Thomas Parnham represented the United States in this matter.

The claims resolved by the settlement are allegations only. There has been no determination of liability.

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A federal jury convicted a Tennessee physician and his wife yesterday in the Northern District of Alabama for unlawfully distributing opioids, providing unnecessary services and defrauding insurers from their now-shuttered Alabama clinics.  

According to court documents and evidence presented at trial, Mark Murphy, 65, and his wife, Jennifer Murphy, 65, both of Lewisburg, owned and operated North Alabama Pain Services (NAPS), which closed its Decatur and Madison offices in early 2017. Over the approximately five-year period leading up to the clinic closing its Alabama locations, Murphy and his wife, who was the office manager, caused over $50 million in fraudulent or unnecessary medical services to be charged to Medicare, TRICARE, Blue Cross Blue Shield of Alabama and others. Evidence at trial showed that NAPS provided pre-signed prescriptions to thousands of patients a month, including prescriptions written outside the usual course of professional practice without a legitimate medical purpose. The Murphys also solicited and received unlawful payments for referring fraudulent or unnecessary services to patients. Jennifer Murphy was also convicted of tax-related charges for underreporting clinic income.

Both defendants were convicted of conspiracy to unlawfully distribute controlled substances and conspiracy to commit health care fraud, along with various substantive counts related to the same. They were also convicted of conspiring to defraud the United States and receiving kickbacks. The Murphys face a maximum of 20 years in prison for the drug charges and a maximum of 10 years in prison for the health care fraud charges. Both defendants face a maximum of five years in prison for charges stemming from violations of the Anti-Kickback Statute, and Jennifer Murphy faces up to three years in prison for the tax charges. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors. Sentencing is scheduled for June 30.

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division; U.S. Attorney Prim F. Escalona for the Northern District of Alabama; Special Agent in Charge Bradford L. Byerly of the Drug Enforcement Administration (DEA) New Orleans Field Division; Special Agent in Charge Johnnie Sharp Jr. of the FBI Birmingham Division; Special Agent in Charge James E. Dorsey of IRS Criminal Investigation (IRS-CI) Atlanta Field Office; and Special Agent in Charge Tamala E. Miles of the Department of Health and Human Service Office of the Inspector General (HHS-OIG) Atlanta Region made the announcement.

FBI, HHS-OIG, IRS-CI and DEA investigated the case.

Assistant Chief Jillian Willis and Trial Attorney Emily Gurskis of the Criminal Division’s Fraud Section and Assistant U.S. Attorney J.B. Ward of the Northern District of Alabama are prosecuting the case.

The Fraud Section leads the Appalachian Regional Prescription Opioid (ARPO) Strike Force. Since its inception in October 2018, the ARPO Strike Force, which operates in 10 districts, has charged more than 90 defendants who are collectively responsible for distributing more than 105 million pills. The ARPO Strike Force is part of the Health Care Fraud Strike Force Program, which since March 2007 has charged more than 4,200 defendants who collectively have billed the Medicare program for more than $19 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at:https://www.justice.gov/criminal-fraud/health-care-fraud-unit.

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A federal jury in the Eastern District of Michigan convicted a Michigan doctor today for his role in masterminding and executing a complex scheme to defraud Medicare and other health insurance programs by administering medically unnecessary spinal injections in exchange for prescriptions of high doses of opioids to patients.

According to court documents and evidence presented at trial, Francisco Patino, 66, of Wayne County, excessively prescribed highly addictive opioids to his patients at his medical clinic in Livonia. In exchange for opioids, these patients would receive (or be billed as if they had received) facet joint or nerve block injections, both lucrative spinal injections. Although these spinal injections were purportedly intended to treat chronic pain, evidence at trial demonstrated that Patino injected patients without regard to medical necessity. Evidence also revealed that if patients refused to accept the injections, Patino would withhold their prescriptions for opioids. From January 2012 through July 2017, Patino billed Medicare for more of these injections than any provider in the country. The evidence at trial also showed that in 2016 and 2017, Patino prescribed more 30-milligram Oxycodone pills than every other provider in the state of Michigan.

Patino also developed illegal kickback relationships with at least one diagnostic laboratory, under which he was paid in exchange for referring his patients’ samples to that lab. The evidence showed that the labs funneled money into bank accounts held by others, who then distributed the money to Patino or spent it on his behalf. Patino also spent funds he derived from these various schemes on jewelry, cars, and vacations. A sizable portion of Patino’s fraud proceeds were devoted toward the promotion of Patino’s specialized diet program and lifestyle and wellness book. Patino paid Ultimate Fighting Championship and other mixed martial arts fighters to promote the Patino Diet.

Patino was convicted of one count of conspiracy to commit health care fraud and wire fraud, two counts of health care fraud, one count of conspiracy to defraud the United States and pay and receive health care kickbacks, one count of conspiracy to commit money laundering, and one count of money laundering. He is scheduled to be sentenced on Jan. 20, 2022, and faces a maximum total penalty of life in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division; Assistant Director Calvin Shivers of the FBI’s Criminal Investigative Division; and Special Agent in Charge Lamont Pugh III of the Department of Health and Human Services, Office of Inspector General (HHS-OIG) made the announcement.

The FBI’s Detroit Field Office and HHS-OIG investigated the case.

Trial Attorneys Steven Scott and Kathleen Cooperstein of the Criminal Division’s Fraud Section are prosecuting the case.

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LAREDO, Texas – A 44-year-old physician from Laredo has paid $340,437.68 to resolve allegations he falsely billed Medicare for the use of electro-acupuncture devices, announced Acting U.S. Attorney Jennifer B. Lowery.

Dr. Marte A. Martinez Jr. is an anesthesiologist and pain management physician who practices in Laredo. Marte A. Martinez M.D. PLLC is an entity Martinez used to conduct his medical practice.

From Aug. 23, 2019, to Feb. 12, 2020, Martinez billed Medicare for the implantation of neurostimulator electrodes. These are surgical procedures usually requiring use of an operating room. Medicare pays thousands of dollars per procedure.

Neither Martinez nor his staff performed surgery. Instead, patients received devices used for electro-acupuncture. This involves inserting needles into patients’ ears with the neurostimulator taped behind them with an adhesive.

To date, the Southern District of Texas has resolved four other settlements with a Katy anesthesiologist, a Houston pain doctor, a Rockport chiropractor and a Houston chiropractor involving similar allegations of false billing.

The FBI and Department of Health and Human Services – Office of Inspector General conducted the investigation with the assistance of Qlarant, the Unified Program Integrity Contractor for Medicare. Assistant U.S. Attorney Brad Gray handled the matter.

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SAN DIEGO – National Spine & Pain Center, LLC (“NSPC”), a physician management services organization headquartered in Rockville, Maryland, agreed this week to pay $5.1 million in restitution to Medicare as part of a criminal settlement for receiving payments in violation the Anti-Kickback Statute.

CLICK HERE for Non-Prosecution Agreement

As part of a non-prosecution agreement resolving criminal liability, NSPC admitted that the company and its affiliate Physical Medicine Associates, Ltd. (“PMA”) entered into an arrangement with Proove Biosciences, defunct genetics testing company formerly based in Irvine, California, in which Proove unlawfully compensated physicians under the guise of a clinical research program.

The federal Anti-Kickback Statute provides for criminal penalties for whoever knowingly and willfully offers, pays, solicits, or receives remuneration to induce or reward the referral of business that is reimbursable under any of the Federal health care programs, including Medicare. The statute covers the payers of kickbacks - those who offer or pay remuneration - as well as the recipients of kickbacks - those who solicit or receive remuneration.

NSPC admitted that certain NSPC and PMA physicians referred to the clinical research payments offered by Proove as being payments “per test” or “per patient,” and that as a part of the scheme physicians completed timesheets used by Proove to pay the physicians which overstated the time that the physicians spent conducting related clinical research. In some cases, the timesheets indicated that the physicians had performed certain tasks, which had, in fact, been performed by Proove’s own employees, resulting in payments from Proove to the physicians for tasks that they did not perform.

NSPC admitted that certain NSPC personnel communicated to Proove that the company would not offer Proove’s genetic tests at additional NSPC sites unless Proove was current on its payments to NSPC and PMA physicians. Conversely, Proove communicated to NSPC that Proove expected NSPC and PMA physicians to order a certain volume of tests from Proove. Proove’s genetic tests purportedly could determine a patient’s risk of abusing certain prescription opioids and how patients metabolized certain drugs.

PMA received a total of $1.1 million in payments from Proove. Medicare paid Proove approximately $4 million for claims submitted by Proove from referrals from NSPC and PMA physicians.

“Referring patients based on expectation of personal profit corrupts the health care system by encouraging medical providers to make decisions based on their own financial gain rather than a patient’s best interests,” said David Leshner, Attorney for the United States. “Kickback payments also unfairly generate business for dishonest providers at the expense of those who do not engage in illegal conduct. This office is committed to holding perpetrators accountable for these fraudulent schemes.” Leshner commended AUSA Joseph Green, the FBI and HHS-OIG for the diligent investigation and prosecution of this matter.

“The defendants bilked millions of dollars intended to fund services that promote and improve the health of Medicare beneficiaries, some of whom were their own patients,” stated Timothy DeFrancesca, Special Agent in Charge of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “They prioritized their own enrichment above their duties as health care providers. HHS-OIG is dedicated to protecting Federal health care beneficiaries and programs, so our work includes the pursuit of providers who cheat both.”

“This week's restitution order sends a strong message to healthcare providers that choose to put personal gain over professional responsibility,” said FBI Special Agent in Charge Suzanne Turner. “The FBI is proud to work with our federal partners at HHS-OIG to root out these schemes which further diminish trust in the health care system.”

The non-prosecution agreement cited NSPC’s new ownership group, its voluntary termination of its relationship with Proove prior to the company’s knowledge of the criminal investigation, its continuing cooperation with investigators, and the adoption of a robust compliance program, as factors that supported the resolution of the criminal investigation with a non-prosecution agreement.

On June 9, 2021, nine individuals were charged in connection with the scheme in United States v. Brian Meshkin, et al., 21CR0112-JLS, United States District Court, Central District of California. The case is presently pending.

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Impressive addition to new Women’s Clinic

There may be no greater honor for a Veteran than having her likeness displayed for hundreds to see. But it is a greater recognition when a permanent display is prominent for thousands to observe over time.

Painter and Korean War Veteran Broadway Swim honored four women Veterans recently when he unveiled his work of art before a crowd that had gathered at a local mall.

The large painting will find its home in the new Shreveport VA women Veterans clinic. The dedication ceremony is scheduled for late spring or early summer 2020. The presentation was the culmination of several weeks of gathering military photos, several tubes of oil paints and brushes of various sizes, and a creative artist’s mind blending a mix of patriotism and uniform accuracy.

In the photo above, Swim (right), stands with the four women Veterans featured in the artwork. Medical center director Richard Crockett (left) accepted the donated painting.

“I have a few touch-ups to include the eagle, globe and anchor on the Marine’s service cap,” said Swim. “But we wanted to present the painting to the VA hospital during November, National Veterans Month.”

Veteran supporter and mother of a U.S. Marine, Gwendolyn Hampton, approached Swim about painting a Veteran portrait.

“I’m involved with Veteran programs and I asked if he would paint something for women,” she said.

“I was glad to do it,” remarked Swim. “These women have gone far beyond the call of duty. It was a choice to serve, and service is one of the greatest things anyone can do in America.”

“I am proud to have painted these women Veterans”

Swim, a Veteran of the Army and Air Force, stated, “No one is greater than their source and we all came from a woman. I am proud to have painted these women Veterans.”

“We are so proud to display this women Veteran’s portrait,” said Crockett. “When I arrived to receive the donated painting, I was amazed at the artist’s ability to capture the personalities and likenesses of these women Veterans. They are heroic and they receive their care at the Shreveport VA.

“I am now even more excited about opening the new women’s clinic. We will display the painting proudly, prominently and appropriately for all Veterans to see.”

The women Veterans in the painting are (from left to right):

• Latrica Barnes, U.S. Navy (2000-2009)
• Kimberley Hill, U.S. Army (1987-1995)
• Sandy Franks, U.S. Air Force (1974-1997)
• Mary Huddleston, U.S. Marine Corps (2000-2002)

The new Women Veterans Clinic will expand from a current space that is around 1,500 square feet to an area of almost 7,000 square feet.

The women’s clinic allows for improved access, comprehensive primary care for Women Veterans and more exam room space, among many other modern features.

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A Pakistani man was sentenced today in the Northern District of Illinois for a health care fraud scheme and money laundering conspiracy.

Muhammad Ateeq, 33, of Rawalpindi, Pakistan, was sentenced to 12 years in prison and ordered to pay approximately $48 million in restitution. In addition, Judge Manish Shah ordered the forfeiture of a $2.4 million cashier’s check and over $1 million in cash.

According to court documents, Ateeq worked in the Islamabad office of Home Health Care Consulting, an entity that controlled Medicare billing and maintenance of electronic medical records for over 20 home health agencies located in Illinois, Indiana, Nevada and Texas. While working at Home Health Care Consulting, Ateeq used a variety of fake identities, including “Nilesh Patel,” “Sanjay Kapoor” and “Rajesh Desai,” to acquire and manage home health agencies in the United States. Once the agencies were under Ateeq’s control, Ateeq caused the agencies to submit fraudulent claims to Medicare for home health services, resulting in over $40 million in payments for services that were never rendered.

As part of the money laundering conspiracy, Ateeq directed his U.S. employees to deposit checks of fraud proceeds into U.S. bank accounts designated by overseas customers of overseas money transmitting businesses. The money transmitting businesses then issued cash payments to Ateeq in Pakistan, as well as deposits into bank accounts in Pakistan under Ateeq’s control. Ateeq also directed U.S. employees to use fraud proceeds to purchase expensive watches and other luxury items in the United States and then deliver the items to Ateeq’s associates in Dubai.

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division; U.S. Attorney John R. Lausch, Jr. for the Northern District of Illinois; Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division; Special Agent-in-Charge Emmerson Buie Jr. of the FBI Chicago Field Office; and Principal Deputy Inspector General Christi A. Grimm of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) made the announcement.

The FBI Chicago Field Office and HHS-OIG investigated the case.

Trial Attorney Sarah Wilson Rocha of the Criminal Division’s Fraud Section and Assistant U.S. Attorneys Jeremy Daniel and Patrick Mott of the Northern District of Illinois prosecuted the case.

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Attorneys who decide on Veterans’ benefits appeals struggled to meet caseload requirements during the upheaval of the COVID-19 pandemic, and women more often faced such challenges, a union officer explained to lawmakers July 13.

The Board of Veterans’ Appeals also is failing to reach targets to cut a backlog of legacy appeals cases because of pandemic complications, the House Veterans Affairs Committee learned.

Board attorneys who fall short of certain caseload expectations are often placed on performance improvement plans, and usually about two or three employees must follow such plans each year.

“Currently, there are 31 attorneys on PIPs, 20 of whom are women, and many whom are also parents of young children who did not have child care for all or part of the COVID-19 pandemic,” Gillian Slovick, second vice president of Local 17 for the American Federation of Government Employees.

“As a mother of a young child myself, I can assure you that having my child at home made a hard job requiring intense focus and concentration even more difficult.”

Of the 996 employees at the board listed under the “general attorney” classification, approximately 59 percent are women, but about 65 percent of the 31 employees placed on PIPs were women, indicating that female employees disproportionately struggled with performance metrics.

For all attorneys, the struggle stems in part from the transition to a new appeals system under the Appeals Modernization Act that passed in 2017.

“Prior to the implementation of the AMA, Board attorneys were expected to complete 125 cases a year, a pace that averaged 2.4 cases per week. Each case, regardless of the number of issues decided, carried the same weight towards an attorney’s production quota. In FY 2018, the Board increased its production standards from 125 to 169 cases per annum, (or 3.25 cases per week), a 35 percent increase in production requirements which was overwhelming for Board attorneys,” Slovick said at the hearing.

The union official described an alternative productivity measure the Board of Veterans’ Appeals created in fiscal 2019, evaluating the total number of issues within cases that an attorney resolves. The number has changed every year.

“AFGE supports the creation of this alternative metric as it better accounts for the amount of work required to complete each case. However, we caution that measuring the number of issues can also be manipulated to create unfair metrics. Unfortunately, this manipulation appeared in FY 2020, the first full year the AMA was fully implemented, because while the case quota remained at 169, the issue quota was raised to 566.”

This year, the number lowered to a “more manageable but still difficult” level of 156 cases or 491 issues, Slovick said.

The COVID-19 pandemic also threw a wrench into the board’s efforts to reduce its backlog of benefit appeals cases and transition more completely to a new, faster process under the Appeals Modernization Act.

As Rep. Elaine Luria, D-Va., noted at the hearing, the agency will fail to meet its goal of addressing all legacy cases that don’t fall under the AMA as “a direct result of impacts from the COVID-19 pandemic.”

But according to board Chairman Cheryl Mason, the agency is on track to hold a record number of hearings in FY 2021, leading to potentially larger caseloads for attorneys.

And caseloads may prove particularly challenging because from March 1, 2019, through June 23, 2021, a total of 148 board attorneys resigned or were removed, according to Slovick.

The Biden administration has begun to take steps to expand the workforce at the board, as Mason announced July 13 that the White House had approved 20 new Veterans law judges to join the agency.

“As we go forward, we will be announcing another cohort … for Veterans law judges once we get the FY22 funding,” said Mason. “One judge equals about 10 staff, both attorneys and administrative staff.”

But Slovick also suggested that the agency adjust requirements that a judge sign off on a case before it counts toward attorney totals, as that leaves a part of the attorneys’ performance metrics outside their control. She also recommended allowing certain attorneys to specialize exclusively in legacy cases while the backlog remains in place, so that employees don’t have to switch back and forth between two different systems for different cases.

Rep. Mike Bost, R-Ill., suggested that the board invest in machine learning performance management tools, similar to one used by the Social Security Administration to improve the accuracy of decisions and compliance with agency policy.

“I believe the VA should take its cues from SSA and make critical investments in the technology that will simplify the process. This would allow employees to focus on work that computers can’t do,” said Bost.

But SSA’s appeals employees are facing their own problems with caseload and performance expectations, as a recent Government Accountability Office study found that the agency had not provided clear rationale for its decision expectations, which many employees have struggled or failed to meet.

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Scientists find a way chemicals may contribute to Parkinson’s

What exactly causes Parkinson’s disease is far from figured out. But a clue has been lurking in cornfields for years.

The data confirm it: farmers are more prone to Parkinson’s than the general population. And pesticides could be to blame. Over a decade of evidence shows a clear association between pesticide exposure and a higher risk for the second most common neurodegenerative disease, after Alzheimer's. A new study published in Neurology proposes a potential mechanism by which at least some pesticides might contribute to Parkinson’s.

Regardless of inciting factors — and there appear to be many — Parkinson’s ultimately claims dopamine-releasing neurons in a small, central arc of brain called the “substantia nigra pars compacta.” The nigra normally supplies dopamine to the neighboring striatum to help coordinate movement. Through a series of complex connections, striatal signals then find their way to the motor cortex and voila, we move. But when nigral neurons die, motor function goes haywire and the classic symptoms set in, including namely tremors, slowed movements, and rigidity.

Pesticides first came under suspicion as potentially lethal to the nigra in the early 1980s following a tragic designer drug debacle straight out of Breaking Bad. Patients started showing up at Northern California ERs nearly unresponsive, rigid, and tremoring — in other words, severely Parkinsonian. Savvy detective work by neurologist Dr. William Langston and his colleagues, along with the Santa Clara County police, traced the mysterious outbreak to a rogue chemist and a bad batch. He’d been trying to synthesize a “synthetic heroin” — not the snow cone flavorings he claimed — however a powder sample from his garage lab contained traces of an impurity called MPTP. MPTP, it turned out, ravages dopaminergic neurons in the nigra and causes what looks like advanced Parkinson’s. All of the newly Parkinsonian patients were heroin users who had injected the tainted product. And MPTP, it also turned out, is awfully similar in structure to the widely used herbicide paraquat, leading some neurologists to turn their attention to farms and fields.

In 2000, a meta-analysis linked confirmed and presumed pesticide exposure with increased risk of Parkinson’s. Subsequent work supported this connection, including a large 2006 study that followed patients for nine years. The patients exposed to pesticides had a 70% higher incidence of Parkinson’s when the study ended; the risk was the same for exposed farmers and exposed non-farmers, hence some other farm-related factor wasn’t to blame. The study didn’t report on specific toxins, but more recent work out of The Parkinson’s Institute in Sunnyvale, CA, founded by Langston after the MPTP discovery, did. The authors took detailed occupational and exposure histories from farmers and their families. Paraquat upped Parkinson’s risk 2.5-fold. Rotenone was also red-flagged.

Pesticides exert their neurotoxicity in a number of ways. Both paraquat and rotenone appear to wither dopaminergic neurons via free radical production. Free radicals are atoms or molecules with an unpaired electron looking for a partner; they do major cellular damage by pilfering electrons from other molecules, impairing their function. Rotenone may also interfere with the normal neuronal clearance of damaged or degraded proteins. Faulty proteins accumulate, derailing various cellular processes.

The new study, from a team at UCLA, proposes yet another mechanism by which some pesticides might contribute to Parkinson’s. It might also provide a major lead in understanding the disease. The team had previously found that the fungicide benomyl was associated with increased Parkinson’s risk and damaged the brain by inhibiting an enzyme called ALDH that normally helps metabolize fats, proteins and toxins like alcohol (certain ALDH mutation carriers have to take it easy at the bar). ALDH also detoxifies the dopamine metabolite DOPAL. When the enzyme isn’t working properly, DOPAL builds up in neurons and may explain the loss of dopaminergic neurons in Parkinson’s. This time around the authors tested 26 pesticides, first for their influence on ALDH activity in rat neurons and next for any epidemiologic association with Parkinson’s. Eleven pesticides inhibited ALDH at the concentration tested, eight of which could be included in the study based on available histories from 360 rural Californian patients. All eight were associated with an increased Parkinson’s risk and genetic variation in the ALDH2 subtype of the enzyme increased the risk further in those exposed. The findings not only point to new culprit compounds, but reflect the growing appreciation of Parkinson’s as a multifactorial disease, in many cases due to the collusion of both genetic and environmental factors.

At least 10% of Parkinson’cases are now thought to be due primarily to specific gene variants, and estimates suggest that genetics may contribute to upwards of 20% to 50%. Patients with a few specific mutations — common in people of Mediterranean descent — carry a nearly 100% chance of developing the disease. Though, as lead author Dr. Jeff M. Brontstein commented to Scientific American, while a minority of cases might be primarily due to a specific genetic or environmental risk factor, ultimately many if not most cases are likely due to gene-environment interactions. This may explain why there isn’t an epidemic of Parkinson’s in rural areas. Despite the large number of people regularly exposed to pesticides, not everyone has a genetic susceptibility.

This gets incredibly complicated when you consider the possibility of multiple genetic and environmental risk factors working together. It's clear that pesticides wreak havoc on the brain through a variety of mechanisms. Hence farmers and others regularly exposed are at risk for a multipronged, possibly cumulative attack. Certain industrial solvents also appear to bump up Parkinson’s vulnerability. Head trauma, in combination with a particular mutation, does too. And diets high in omega-3 fatty acids, found in fish, plant and seed oils, appear to protect against the disease. The laundry list of risk factors and contributors could explain the varied symptoms experienced by Parkinson’s patients. Some present early in life, some late. For many the classic motor symptoms predominate; others present with non-motor findings like sleep disturbances, constipation and depression. No two cases are identical.

The confusion isn’t just clinical. Recent evidence positions Parkinson’s as one of a number of related neurodegenerative disorders marked by the accumulation of abnormal proteins in the brain, including Alzheimer’s disease and ALS. They all appear partially genetic, partially environmental and probably in many cases both. Neuronal protein accumulations called Lewy bodies — a pathologic hallmark of Parkinson’s — are also found in the brains of Alzheimer’s patients; PD-afflicted brains often contain the amyloid protein aggregates common to Alzheimer’s. It’s a Venn diagram of neurodegeneration.

The new findings further confirm that those whose livelihood relies on repelling pests should pay mind to their increased risk for Parkinson’s, particularly if they have other known risk factors, and take precautions. They can limit exposure and avoid the riskier compounds. They can wear masks, clean up spills and wash up vigorously. Moreover, implicating ALDH in Parkinson’s pathology could represent an important step toward determining a final common pathway on which the various risk factors converge, a potential holy grail for drug development, and ultimately for patients. Rarely are neurologic diseases straight forward, and Parkinson’s has proved no different. But a terribly unfortunate outcome for many in search of heartier, healthier crops may have brought medicine one notch closer to deciphering a frustratingly complex disease.

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A new study of individuals treated for Parkinson’s disease in Louisiana found a clear correlation between the disease and the use of two types of herbicide and one pesticide in rural areas dominated by forestry, woodlands and pastures.

The study also found that Parkinson’s disease has become less common in areas of the state where cotton, corn and soybean farmers have switched to the use of the herbicide glyphosate, sold under the brand name of Roundup — although that product has recently been linked to some forms of cancer, which the study did not examine. Roundup is manufactured in Luling by the Bayer subsidiary Monsanto.

The peer-reviewed, open-access study by three LSU researchers was published online in the International Journal of Environmental Research and Public Health on Feb. 29.

Parkinson’s disease involves the progressive degeneration of the nervous system, and its symptoms include tremors, muscular rigidity, and slow, imprecise movements. It mostly affects middle-aged and elderly people, and its onset can take six to 10 years before symptoms are recognized.

The study found that in the seven-year period ending in 2012, the areas at greatest risk included large portions of Allen and Evangeline parishes, where between 35 and 46 individuals per 10,000 residents were treated for Parkinson’s in hospitals. That band of high risk stretched across the lower middle of the state from Beauregard Parish to Iberville Parish, where farm pastures and timberland are dominant.

The second greatest risk area for that time period runs in a band from Sabine Parish — on the Sabine River along the Texas border — northeast to West Carroll Parish. Again, much of the area is dominated by timber and pastureland, with the exception of West Carroll, where cotton, soybeans and sorghum are grown.

Two smaller areas of higher risk are in the New Orleans region.

In the eastern Florida Parishes on the north shore, more cases were found in central Tangipahoa Parish, where strawberries are grown, and in St. Tammany and Washington parishes, where pastures and woodland dominate.

But the researchers said there is less connection to agriculture exposure in a higher-risk area that includes Kenner and parts of St. Charles and St. John the Baptist parishes. The study points out that those cases occur in an area dominated by petrochemical manufacturing, and suggests the high rate in Kenner may be because of its role as a “dormitory suburb” for the workers in the two petrochemical parishes.

However, the study also found that other areas along the Mississippi River that are also dominated by petrochemical manufacturing had much lower risk for Parkinson's. It's not clear why.

A similar map of Parkinson’s risk for the 1999-2005 period shows the risk of the disease was much greater in parishes in the northeast corner of the state, where cotton and other crops dominate. The study concludes the higher risk during that time period was because farmers were using 2,4-D, paraquat and other herbicides with links to the disease, rather than glyphosate, sold as Roundup.

Monsanto began selling genetically modified Roundup Ready soybean seed in 1996, followed by the release of similarly modified corn, cotton and other crops in the next few years. The plants grown from those seeds were resistant to damage when glyphosate-based weed killers were used, and their use was widely adopted by farmers in the northeastern part of the state.

The result was that the use of herbicides linked to Parkinson’s dropped dramatically in that area. But because of the lengthy time between the onset of the disease and when its effects caused a first hospital stay, the effects of the change didn’t become clear until the 2006-2012 time frame.

The second time period of the study also found a much lower risk of Parkinson’s in the area west of Alexandria that includes Fort Polk, where its younger population of soldiers would not be likely to be showing symptoms of the disease, if they were hospitalized.

The U.S. Environmental Protection Agency keeps track of studies like this one on Parkinson's disease, and is reviewing the rules for the use of both paraquat and 2,4-D. The agency is required to review the use of previously approved pesticides at least every 15 years. According to its website, as of July 2017, more than 700 reviews were underway.

The state Departments of Health and Hospitals and Environmental Quality and did not respond to requests for comments on the study. A spokeswoman for the Louisiana Department of Agriculture and Forestry said the agency follows the lead of the EPA, "but does not supersede it."

"Our role is to make sure that pesticides used in Louisiana are registered with the EPA and correctly applied by certified applicators," said Veronica Mosgrove.

The researchers used a database of patients admitted to 95 Louisiana hospitals between 1999 and 2012 to identify the ZIP code areas where 23,224 individuals diagnosed with Parkinson’s disease lived. The database was provided by the Louisiana Office of Public Health.

Data after 2012 has not been made available by the health department for this study, said Martin Hugh-Jones, lead author of the study and an emeritus professor of Veterinary epidemiology at LSU. Hugh-Jones is better known as a world-renowned expert on the use of anthrax in bioterrorism. The other study authors were Hampton Peele, a researcher with the Louisiana Geological Survey at LSU, and Vincent Wilson, an environmental sciences professor at LSU.

The patient information was divided into seven-year periods and used to map the risk – in cases per 10,000 people – of having the disease for each 7-year period. The risk estimates were then compared with maps identifying where land was used for agriculture or timber-growing operations, and then to information from four-year U.S. Geological Survey estimates of the use of herbicides and insecticides on farmland and timberland in Louisiana parishes between 1992 and 2004. The estimates are based on chemical use reported by farmers.

The study points out that the relationship between Parkinson’s disease and exposure to pesticides has been known since the 1980s.

Herbicides linked to the disease include paraquat, trifluralin, 2,4-dichlorophenoxyacetic acid (2,4-D), and 2,4,5-trichlorophenoxyacetic acid (2,4,5-TP, and better known as the main ingredient in Agent Orange). The latter has been banned for most uses in this country.

The disease has not been linked to more modern herbicides, including atrazine, dicambra, glyphosate and triazine.

Specific insecticides linked to the disease that have been used in Louisiana include chlorpyrifos, dieldrin and rotenone. The use of dieldrin is now banned by the EPA.

The disease has not been associated with a number of other commonly used insecticides, including carbamates, pyrethroids, diazinon, malathion and parathion.

The USGS data shows that in Allen Parish, as much as 15,818 pounds of 2,4-D herbicide, 130 pounds of paraquat herbicide and 149 pounds of chlorpyrifos insecticide were used in 1992, which could have exposed people who were later hospitalized.

Individuals could have been exposed to the chemicals in a variety of ways, including direct exposure through work, exposure through the air, or exposure through drinking water, especially from groundwater sources.

A separate map in the study outlines recharge areas for underground aquifers, where rainfall seeps into the soil – often through fields treated with herbicides and pesticides – and then into the aquifers, or where small streams or bayous that collect rainwater running off those fields connect with aquifers.

According to the study, areas with the highest risk of the disease occur where the potential for aquifer recharge is considered moderate or high.

The report points out that there have been several studies in other states linking herbicide and pesticide contamination of aquifers used for drinking water and Parkinson’s disease.

It also points out that state regulations require sampling of groundwater only on a single day once every three years, with repeat sampling conducted only when a pesticide is detected at a level of at least half the federal maximum content level allowed.

A review of state test data for both groundwater and surface water supplies from 1993 through 2016 found only a handful that were contaminated.

But the study pointed out that tests that occur on one day every three years are unlikely to find such contamination, “as any agricultural pesticide contamination is likely to be short (2 weeks).”

The study points to several issues involving the data. First, about 3% of Parkinson’s cases result from family genetic causes, rather than environmental exposures.

The hospital records also would not have captured individuals who were treated as outpatients, and since hospitalizations specifically for Parkinson’s typically occur only 10 to 15 years after onset, early-onset cases likely were missed unless the disease was spotted while patients were hospitalized for other reasons, like cancer or heart disease.

The statistics also likely capture more women than men because women are more likely to seek healthcare, the study said.

“Thus, these hospital records are not necessarily a measure of the true extent of PD in Louisiana, but currently, it is all that is available,” the study said.

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Of the roughly 1 million U.S. residents with Parkinson’s disease, some 110,000 are Veterans. To improve this population’s health, well-being, and quality of life, the U.S. Department ofVeterans Affairs (VA) has formed a partnership with the Parkinson’s Foundation.

The intent of the collaboration is to ensure that Veterans diagnosed with Parkinson’s have the information and resources needed to effectively manage their condition, which has an economic burden of Parkinson’s of nearly $52 billion annually, according to a recent study published by the Michael J. Fox Foundation with support from the Parkinson’s Foundation and others.

“We’ve found that Veterans are not always aware of the Parkinson’s-related resources and services available through the VA, which leads to them being underserved in terms of healthcare access,” Veronica “Ronnie” Todaro, executive vice president and chief operating officer, Parkinson’s Foundation, said in a press release.

“Our partnership with the VA is designed to improve our understanding of priorities so we can fill those gaps. We want to make sure Parkinson’s is identified early so that people can engage with providers who have experience with the disease, as well as have the information they need to best manage their PD,” said Todaro.

About half of Veterans are at least age 65, putting them at greater risk for Parkinson’s, which usually manifests in patients 50 and older. In addition, many Veterans have sustained traumatic head injury or have been exposed to environmental hazards, both of which are associated with Parkinson’s development. In particular, those who served from 1962 to 1975 are at an increased risk of the progressive disease due to the military’s tactical use of the herbicide Agent Orange.

Specifically, the partnership seeks to heighten access to Parkinson’s information, resources, and providers. It also wants to educate Veterans and healthcare professionals about best practices in Parkinson’s management, and to help Veterans navigate Parkinson’s-related health and social services.

Veterans and their families can start by learning more about the VA’s Parkinson’s Disease Research, Education and Clinical Centers. Located across the nation, these centers are staffed by leading movement disorder specialists, neurosurgeons, psychiatrists, scientists, social workers, and other Parkinson’s specialists.

The centers can help Veterans manage Parkinson’s and other movement disorders through VA pharmacy benefits, physical, occupational, and speech therapies, medical equipment, surgical services, and other resources.

For its part, the Parkinson’s Foundation offers information forVeterans, including new Parkinson’s patients. It also provides tools and resources for families and care partners.

“Multidisciplinary care is critically important to people with Parkinson’s and is a priority of both the VA and the Parkinson’s Foundation,” Todaro said, adding that apprising Veterans of available resources and benefits will help defray the disease’s overall cost.

“Veterans need to be aware of all their benefits, including those that come from having a service-related disability,” she said. “As a foundation, we are committed to addressing issues related to cost, including non-medical costs such as missed work, lost wages, forced early retirement, and family caregiver time.”

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Construction Firm Illegally Received Contracts Set Aside for Veterans, Minorities

KANSAS CITY, Mo. – A Parkville, Missouri, man who was charged in two federal cases pleaded guilty in federal court today to his role in a $335 million scheme to defraud federal programs that award contracts to firms owned by minorities, Veterans, and service-disabled Veterans, and in a separate case to filing false tax returns that cheated the government out of more than $615,000 in taxes owed.

Patrick Michael Dingle, 50, pleaded guilty before U.S. District Judge Roseann Ketchmark to the charges contained in both federal cases. Dingle pleaded guilty to one count of conspiracy to commit wire and major program fraud. Dingle also pleaded guilty, in a separate case, to one count of filing a false tax return.

$335 Million Fraud Conspiracy

By pleading guilty today, Dingle admitted that he conspired with Matthew C. McPherson, 45, of Olathe, Kansas, to fraudulently obtain contracts set aside by the federal government for award to small businesses owned and controlled by Veterans, service-disabled Veterans and certified minorities.

Dingle was the operations manager for Zieson Construction Company located in North Kansas City, Mo. Dingle and his co-conspirators controlled and operated Zieson, which was originally formed in 2009 with Stephon Ziegler – an African-American service-disabled Veteran – as the nominal owner. Zieson’s primary business was obtaining federal construction contracts set aside for award to small businesses owned and controlled by service-disabled Veterans or certified minorities. However, Ziegler did not control the day-to-day operations or the long-term decision making of Zieson. Dingle and his co-conspirators actually controlled and operated Zieson, and received most of the profits from Zieson.

Ziegler signed Zieson checks when requested to do so, signed bids for government jobs when requested to do so and served as a courier of checks and invoices when requested to do so. Ziegler did not participate in any way in the management and control of either day-to-day operations or long-term decision-making for Zieson.

Dingle and McPherson were not eligible for these set-aside contracts because they were not certified minorities or Veterans. Although Zieson was not eligible, the firm received approximately 199 federal contracts set aside for award to minority-owned small businesses and Veteran-owned small businesses between 2009 and 2018. The government paid Zieson approximately $335 million for those contracts. Several of the set-aside contracts awarded to Zieson were valued in excess of $1 million, including a contract at Topeka, Kan., awarded on July 13, 2012, valued at approximately $4,125,800.

Dingle, McPherson, and others submitted false and fraudulent Past Performance Questionnaires in support of Zieson bids for set aside contracts.

McPherson pleaded guilty on June 3, 2019, to one count of conspiracy to commit wire fraud and major program fraud and awaits sentencing.

False Tax Returns

Dingle also pleaded guilty, in a separate case, to filing a false tax return. Dingle admitted that he claimed $799,425 in fraudulent business expenses on his tax return for 2016. As a result of the false and fraudulent expenses offset on Dingle’s 2016 tax return, the government suffered a loss of approximately $349,784.

Dingle also admitted that he filed false tax returns over a four-year period from 2013 to 2016, which resulted in a total loss to the government of $615,847. Under the terms of today’s plea agreement, Dingle must pay restitution to the government in the total amount of federal tax loss as determined by the court at sentencing.

Under federal statutes, Dingle is subject to a sentence of up to eight years in federal prison without parole. The maximum statutory sentence is prescribed by Congress and is provided here for informational purposes, as the sentencing of the defendant will be determined by the court based on the advisory sentencing guidelines and other statutory factors. A sentencing hearing will be scheduled after the completion of a presentence investigation by the United States Probation Office.

This case is being prosecuted by Assistant U.S. Attorney Paul S. Becker. It was investigated by the Department of Veterans Affairs, Office of Inspector General; the Department of Defense Criminal Investigative Service; the U.S. General Services Administration, Office of Inspector General; the U.S. Small Business Administration, Office of Inspector General; the Army Criminal Investigation Command, Major Procurement Fraud Unit; the Department of Agriculture, Office of Inspector General; IRS-Criminal Investigation; the U.S. Secret Service; the Air Force Office of Special Investigations, Procurement Fraud; the Naval Criminal Investigative Service; the Defense Contract Audit Agency - Operations Investigative Support (OIS); the U.S. Department of Labor, Office of Inspector General; and the Department of Labor, Employee Benefits Security Administration (EBSA).

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A Florida man pleaded guilty today in the Southern District of Florida for a scheme to receive kickbacks and bribes in exchange for referring Medicare beneficiaries to five South Florida home health agencies for services that the patients did not need and, in many cases, never received.

Ernesto Espinosa, 71, of Miami, pleaded guilty to one count of conspiracy to commit health care fraud. According to court documents, from January 2010 to June 2015, Espinosa and his co-conspirators paid kickbacks to Medicare beneficiaries to recruit them for referral to home health agencies. Espinosa also coached the Medicare beneficiaries, who did not need home health services, on what to say to obtain home health prescriptions from doctors. In exchange for referring these beneficiaries, Espinosa solicited and received kickbacks and bribes from the home health agencies. Espinosa and the home health agencies attempted to disguise these kickbacks and bribes by routing them through shell companies controlled by Espinosa. The home health agencies then submitted false and fraudulent claims to Medicare for services that were not medically necessary and typically not even provided. As a result of this fraud, Espinosa and his co-conspirators caused Medicare to make payments of approximately $870,000 for the bogus claims. Espinosa personally netted approximately $630,000 from the scheme.

Espinosa is scheduled to be sentenced on May 24 and faces up to 10 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division; Special Agent in Charge Omar Pérez Aybar of the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Miami Regional Office; Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division; and Special Agent in Charge George L. Piro of the FBI’s Miami Field Office made the announcement.

The FBI and HHS-OIG investigated the case.

Trial Attorneys Kelly M. Lyons, Alexander Thor Pogozelski and Jamie De Boer of the Justice Department’s Fraud Section prosecuted the case.

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3-day course mentors future entrepreneurial leaders

Basic Training — often called boot camp — introduces new service members to military life and customs. Boot camp “accelerates” a citizen’s transformation to a soldier, sailor, airman or marine.

A Colorado-based company, Techstars Accelerator, created Patriot Boot Camp (PBC) to help service members transition out of the military. More importantly, PBC helps transitioning service members and entrepreneurial Veterans turn their business ideas into tech start-ups.

The 15th installment of Patriot Boot Camp was held in Lehi, Utah on August 23-25, 2019. Veterans, active duty service members, and military spouses with business ideas or existing businesses gathered for three days to learn from industry leaders. The event was hosted MX Data, and sponsored by MetLife Foundation, USAA, and Jared Polis Foundation.

The PBC connected the event’s attendees to a community of over fifty mentors–many of whom traveled from across the nation to make entrepreneurship tangible. A testament to the dedication and belief in this program was that the mentors all volunteered their time, at their own expense, to provide one-on-one mentoring.

More than 850 Veterans have gone through the program, and they have hired over 1,600 employees and raised $100 million in venture capital while generating millions in revenue.

By the numbers

• Jobs created: 1,600+
• Hours of mentorship: 2,500+
• Alumni entrepreneurs: 850+
• Entrepreneurs attending PBC Utah: Coming from 23 states, one from Austria
• Capital raised by alumni: $100 million
• Diversity: 50% service-connected, disabled Veteran-owned business
• Female founders: 23%

According to an article in TechCrunch, PBC graduates show “…that startups aren’t the sort of crazy risk that they first appear. Indeed, after what many of these men and women have just been through, it may not be all that daunting of a next mission after all.”

PBC is open to all active duty service members, Veterans, and military spouses. To learn more, visit https://patriotbootcamp.org/program

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PEARL HARBOR, Hawaii (AP) — On Dec. 7, 1941, then-21-year-old Lauren Bruner was the second-to-last man to escape the burning wreckage of the USS Arizona after a Japanese plane dropped a bomb that ignited an enormous explosion in the battleship’s ammunition storage compartment.

He lived to be 98 years old, marrying twice and outliving both wives. He worked for a refrigeration company for nearly four decades.

This weekend, divers will place Bruner’s ashes inside the battleship’s wreckage, which sits in Pearl Harbor where it sank during the attack 78 years ago that thrust the United States into World War II. The Southern California man will be the 44th and last crew member to be interred in accordance with this rare Navy ritual. The last three living Arizona survivors plan to be laid to rest with their families.

The somber ceremony and other events marking the anniversary of the attack come on the heels of a deadly shooting at the Pearl Harbor Naval Shipyard on Wednesday, when an active duty sailor opened fire on three civilian Department of Defense employees. Two were killed and the third hospitalized in the shooting that ended with the sailor also taking his own life.

Bruner said he wanted to return to his ship because few people go to cemeteries, while more than 1 million people visit the Arizona each year. He also saw it as a way to join old friends who never made it off the warship.

“I thought, well, all my buddies are right here. And there are a lot of people who come to see the ship,” Bruner told The Associated Press in an interview in 2016, three years before he died in his sleep in September. Bruner traveled from his La Mirada, California, home to attend Pearl Harbor anniversary events many times.

The Navy began interring Pearl Harbor survivors on their old ships in 1982. The wrecks of only two vessels remain in the harbor — the Arizona and USS Utah — so survivors of those ships are the only ones who have the option to be laid to rest this way. Most of the ships hit that day were repaired and put back into service or scrapped.

Neither underwater archaeologists at the Navy History and Heritage Command or those who handle burials for the Navy Personnel Command were aware of any interments conducted on sunken Navy vessels elsewhere.

Of the 1,177 USS Arizona sailors and Marines killed at Pearl Harbor, more than 900 could not be recovered and remain entombed on the ship, which sank in nine minutes. A memorial built in 1962 sits above the wreckage.

Sixty died on the Utah, and three have been interred there. At least one of the three living Utah survivors wants his ashes placed on his old ship.

Bruner’s ashes will be placed aboard the Arizona following a sunset ceremony Saturday, the anniversary of the Japanese attack.

Loved ones will stand on the USS Arizona Memorial’s dock and hand an urn to scuba divers in the water. The divers will guide the container to the barnacled wreckage and carefully place it inside.

Servicemen will then perform a gun salute and present an American flag to next of kin.

Daniel Martinez, chief historian for the Pearl Harbor National Memorial, said the Arizona ceremony honors those who survived the bombing while also offering a reminder of the many lives cut short because of it. Much of it is held fronting a white marble wall engraved with the names of the Arizona sailors and Marines who died in the attack.

“It’s a celebration of a life well lived,” Martinez said.

Also Saturday, the Navy and National Park Service will host their annual public ceremony at Pearl Harbor to remember those killed. It will observe a moment of silence at 7:55 a.m., the exact time the attack began decades ago.

Joseph Langdell’s ashes were interred on the Arizona in 2015. One of his two sons, Ted Langdell, said his father asked to be placed there out of regard for those who didn’t make it out, as well as for those who survived and worked hard to keep the memory of the Arizona alive.

“It’s emotional. It’s reverent. And it makes me think not just of him but of the other people. It’s hard to imagine that all of the sudden, all of these people are gone,” Ted Langdell said.

In all, more than 2,300 Americans died in the attack on Pearl Harbor.

Bruner didn’t know who was attacking until the planes got close enough for him to see the red Rising Sun insignia on their sides. The aircraft shot at “everything in sight,” he said. Then an explosion tore through his battle station.

He tried to get off the ship as fast as he could, but he couldn’t jump because the oil leaking into the water below was on fire.

Bruner and several fellow shipmates shouted to a sailor on the ship moored next to the Arizona to toss over some rope. The six of them used the rope to carry themselves hand-over-hand to the USS Vestal 100 feet (30 meters) away.

“You’re like a chicken getting barbecued,” he said. All of them made it, becoming six of the 335 sailors and Marines on the Arizona to survive. Bruner spent months recovering from burns.

He later spoke to school groups and others about his ordeal. His friend Ed Hoeschen, who often accompanied him on these visits, said Bruner never did it for the fame and glory.

“It wasn’t about him,” Hoeschen said. “It was about (people) meeting a member of the USS Arizona. And that’s what he wanted people to remember. Just remember the men of the Arizona.”

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Widespread use of pesticides and other agrochemicals can speed the transmission of the debilitating disease schistosomiasis, while also upsetting the ecological balances in aquatic environments that prevent infections, finds a new study led by researchers at the University of California, Berkeley.

Schistosomiasis, also known as snail fever, is caused by parasitic worms that develop and multiply inside freshwater snails and is transmitted through contact with contaminated water. The infection, which can trigger lifelong liver and kidney damage, affects hundreds of millions of people every year and is second only to malaria among parasitic diseases, in terms of its global impact on human health.

The study, published in the journal Lancet Planetary Health, found that agrochemicals can increase the transmission of the schistosome worm in myriad ways: by directly affecting the survival of the waterborne parasite itself, by decimating aquatic predators that feed on the snails that carry the parasite and by altering the composition of algae in the water, which provides a major food source for snails.

"We know that dam construction and irrigation expansion increase schistosomiasis transmission in low-income settings by disrupting freshwater ecosystems," said UC Berkeley's Christopher Hoover, a doctoral student in environmental health sciences and lead author of the study. "We were shocked by the strength of evidence we found also linking agrochemical pollution to the amplification of schistosomiasis transmission."

The findings come as the connections between environment and infectious disease have been laid bare by the COVID-19 pandemic, which is caused by an emerging pathogen thought to be linked to wildlife.

"Environmental pollutants can increase our exposure and susceptibility to infectious diseases," said Justin Remais, chair of the Division of Environmental Health Sciences at the UC Berkeley School of Public Health and senior author of the study. "From dioxins decreasing resistance to influenza virus, to air pollutants increasing COVID-19 mortality, to arsenic impacting lower respiratory tract and enteric infections—research has shown that reducing pollution is an important way to protect populations from infectious diseases."

After combing through nearly 1,000 studies gathered in a systematic literature review, the research team identified 144 experiments that provided data connecting agrochemical concentrations to components of the schistosome life cycle. They then incorporated these data into a mathematical model that captures the transmission dynamics of the parasite. The model simulates concentrations of common agrochemicals following their application to agricultural fields and estimates the resulting impacts on infections in the nearby human population.

The researchers found that even low concentrations of common pesticides—including atrazine, glyphosate and chlorpyrifos—can increase rates of transmission and interfere with efforts to control schistosomiasis. Agrochemical amplification of parasite transmission was not inconsequential. In the study communities in the Senegal River Basin in West Africa, the excess burden of disease attributable to agrochemical pollution was on par with disease caused by lead exposure, high sodium diets and low physical activity.

"We need to develop policies that protect public health by limiting the amplification of schistosomiasis transmission by agrochemical pollution," Hoover said. "More than 90% of schistosomiasis cases occur in areas of sub-Saharan Africa, where agrochemical use is expanding. If we can devise ways to maintain the agricultural benefits of these chemicals, while limiting their overuse in schistosomiasis-endemic areas, we could prevent additional harm to public health within communities that already experience a high and unacceptable burden of disease."

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Like many inventions, the discovery of Teflon happened by accident. In 1938, chemists from Dupont (now Chemours) were studying refrigerant gases when, much to their surprise, one concoction solidified. Upon investigation, they found it was not only the slipperiest substance they’d ever seen – it was also noncorrosive and extremely stable and had a high melting point.

In 1954 the revolutionary “nonstick” Teflon pan was introduced. Since then, an entire class of human-made chemicals has evolved: per- and polyfluoroalkyl substances, better known as PFAS. There are upward of 6,000 of these chemicals. Many are used for stain-, grease- and waterproofing. PFAS are found in clothing, plastic, food packaging, electronics, personal care products, firefighting foams, medical devices and numerous other products.

But over time, evidence has slowly built that some commonly used PFAS are toxic and may cause cancer. It took 50 years to understand that the happy accident of Teflon’s discovery was, in fact, a train wreck.

As a public health analyst, I have studied the harm caused by these chemicals. I am one of hundreds of scientists who are calling for a comprehensive, effective plan to manage the entire class of PFAS to protect public health while safer alternatives are developed.

Typically, when the U.S. Environmental Protection Agency assesses chemicals for potential harm, it examines one substance at a time. That approach isn’t working for PFAS, given the sheer number of them and the fact that manufacturers commonly replace toxic substances with “regrettable substitutes” – similar, lesser-known chemicals that also threaten human health and the environment.

Toxic chemicals

A class-action lawsuit brought this issue to national attention in 2005. Workers at a Parkersburg, West Virginia, DuPont plant joined with local residents to sue the company for releasing millions of pounds of one of these chemicals, known as PFOA, into the air and the Ohio River. Lawyers discovered that the company had known as far back as 1961 that PFOA could harm the liver.

The suit was ultimately settled in 2017 for US$670 million, after an eight-year study of tens of thousands of people who had been exposed. Based on multiple scientific studies, this review concluded that there was a probable link between exposure to PFOA and six categories of diseases: diagnosed high cholesterol, ulcerative colitis, thyroid disease, testicular cancer, kidney cancer and pregnancy-induced hypertension.

Over the past two decades, hundreds of peer-reviewed scientific papers have shown that many PFAS are not only toxic – they also don’t fully break down in the environment and have accumulated in the bodies of people and animals around the world. Some studies have detected PFAS in 99% of people tested. Others have found PFAS in wildlife, including polar bears, dolphins and seals.

Widespread and persistent

PFAS are often called “forever chemicals” because they don’t fully degrade. They move easily through air and water, can quickly travel long distances and accumulate in sediment, soil and plants. They have also been found in dust and food, including eggs, meat, milk, fish, fruits and vegetables.

In the bodies of humans and animals, PFAS concentrate in various organs, tissues and cells. The U.S. National Toxicology Program and Centers for Disease Control and Prevention have confirmed a long list of health risks, including immunotoxicity, testicular and kidney cancer, liver damage, decreased fertility and thyroid disease.

Children are even more vulnerable than adults because they can ingest more PFAS relative to their body weight from food and water and through the air. Children also put their hands in their mouths more often, and their metabolic and immune systems are less developed. Studies show that these chemicals harm children by causing kidney dysfunction, delayed puberty, asthma and altered immune function.

Researchers have also documented that PFAS exposure reduces the effectiveness of vaccines, which is particularly concerning amid the COVID-19 pandemic.

Regulation is lagging

PFAS have become so ubiquitous in the environment that health experts say it is probably impossible to completely prevent exposure. These substances are released throughout their life cycles, from chemical production to product use and disposal. Up to 80% of environmental pollution from common PFAS, such as PFOA, comes from production of fluoropolymers that use toxic PFAS as processing aids to make products like Teflon.

In 2009 the EPA established a health advisory level for PFOA in drinking water of 400 parts per trillion. Health advisories are not binding regulations – they are technical guidelines for state, local and tribal governments, which are primarily responsible for regulating public water systems.

In 2016 the agency dramatically lowered this recommendation to 70 parts per trillion. Some states have set far more protective levels – as low as 8 parts per trillion.

According to a recent estimate by the Environmental Working Group, a public health advocacy organization, up to 110 million Americans could be drinking PFAS-contaminated water. Even with the most advanced treatment processes, it is extremely difficult and costly to remove these chemicals from drinking water. And it’s impossible to clean up lakes, river systems or oceans. Nonetheless, PFAS are largely unregulated by the federal government, although they are gaining increased attention from Congress.

Reducing PFAS risks at the source

Given that PFAS pollution is so ubiquitous and hard to remove, many health experts assert that the only way to address it is by reducing PFAS production and use as much as possible.

Educational campaigns and consumer pressure are making a difference. Many forward-thinking companies, including grocers, clothing manufacturers and furniture stores, have removed PFAS from products they use and sell.

[Understand new developments in science, health and technology, each week. Subscribe to The Conversation’s science newsletter.]

State governments have also stepped in. California recently banned PFAS in firefighting foams. Maine and Washington have banned PFAS in food packaging. Other states are considering similar measures.

I am part of a group of scientists from universities, nonprofit organizations and government agencies in the U.S. and Europe that has argued for managing the entire class of PFAS chemicals as a group, instead of one by one. We also support an “essential uses” approach that would restrict their production and use only to products that are critical for health and proper functioning of society, such as medical devices and safety equipment. And we have recommended developing safer non-PFAS alternatives.

As the EPA acknowledges, there is an urgent need for innovative solutions to PFAS pollution. Guided by good science, I believe we can effectively manage PFAS to reduce further harm, while researchers find ways to clean up what has already been released.

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Three generic pharmaceutical manufacturers, Taro Pharmaceuticals USA, Inc., Sandoz Inc. and Apotex Corporation, have agreed to pay a total of $447.2 million to resolve alleged violations of the False Claims Act arising from conspiracies to fix the price of various generic drugs. These conspiracies allegedly resulted in higher drug prices for federal health care programs and beneficiaries according to the Justice Department.

The government alleges that between 2013 and 2015, all three companies paid and received compensation prohibited by the Anti-Kickback Statute through arrangements on price, supply and allocation of customers with other pharmaceutical manufacturers for certain generic drugs manufactured by the companies.

Taro Pharmaceuticals USA, Inc., headquartered in New York, has agreed to pay $213.2 million. The Taro drugs allegedly implicated in this scheme address a wide variety of health conditions, and include etodolac, a nonsteroidal anti-inflammatory drug used to treat pain and arthritis, and nystatin-triamcinolone cream and ointment, a combination of an antifungal medicine and steroid used to treat certain kinds of skin infections.

Sandoz Inc., headquartered in New Jersey, has agreed to pay $185 million. The Sandoz drugs at issue include benazepril HCTZ, used to treat hypertension, and clobetasol, a corticosteroid used to treat skin conditions.

Apotex Corporation, headquartered in Florida, has agreed to pay $49 million in connection with its sale of pravastatin, a drug used to treat high cholesterol and triglyceride levels.

“Illegal collaboration on the price or supply of drugs increases costs both to federal health care programs and beneficiaries,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “The department will use every tool at its disposal to prevent such conduct and to protect these taxpayer-funded programs.”

“These civil settlements are another achievement in my office’s efforts to hold generic drug companies accountable for the consequences arising from price-fixing schemes, including the harm to federal health care programs,” said Acting U.S. Attorney Jennifer Arbittier Williams for the Eastern District of Pennsylvania. “We will continue to aggressively pursue these violations of the Anti-Kickback Statute and the False Claims Act and obtain significant recoveries.”

“Conspiring to raise prices on generic medications is illegal and could prevent patients from being able to afford their needed prescription drugs. Americans have the right to purchase generic drugs set by fair and open competition, not collusion,” said Special Agent in Charge Maureen R. Dixon of the Philadelphia Regional Office of the Inspector General, Department of Health and Human Services (HHS-OIG). “HHS-OIG along with our law enforcement partners will continue to investigate allegations of companies engaging in actions that put the public and the Medicare program at risk.”  

In connection with its settlement agreement, each company also entered a five-year corporate integrity agreement (CIA) with OIG. The CIAs include unique internal monitoring and price transparency provisions. They also require the companies to implement compliance measures including risk assessment programs, executive recoupment provisions and compliance-related certifications from company executives and board members.

“These kickback schemes harm Medicare, Medicaid and patients,” said Chief Counsel Gregory E. Demske for the Inspector General at HHS. “The CIAs promote transparency and accountability by requiring the companies to report price-related information to OIG and mandating individual certifications by key executives involved in pricing and contracting functions.”

“Protecting TRICARE, the healthcare system for U.S. military members and their dependents, is a top priority for the Department of Defense, Office of Inspector General, Defense Criminal Investigative Service (DCIS),” said Special Agent in Charge Patrick J. Hegarty, DCIS Northeast Field Office. “When pharmaceutical corporations artificially inflate prices, they undermine the integrity of TRICARE and place an unnecessary financial burden on the program. The settlement agreements announced today are the result of a joint effort and demonstrate the ongoing commitment of DCIS to work with our law enforcement partners, DOJ Civil Frauds and the USAO-EDPA, to investigate healthcare fraud.”

The Anti-Kickback Statute prohibits companies from receiving or making payments in return for arranging the sale or purchase of items such as drugs for which payment may be made by a federal health care program. These provisions are designed to ensure that the supply and price of health care items are not compromised by improper financial incentives. These settlements reflect the important role of the False Claims Act to ensure that the United States is fully compensated when it is the victim of kickbacks paid to further anticompetitive conduct.      

All three companies previously entered into deferred prosecution agreements with the Antitrust Division to resolve related criminal charges. Taro paid a criminal penalty of $205.6 million and admitted to conspiring with two other generic drug companies to fix prices on certain generic drugs. Sandoz paid a criminal penalty of $195 million and admitted to conspiring with four other generic drug companies to fix prices on certain generic drugs. Apotex paid a criminal penalty of $24.1 million and admitted to conspiring to increase and maintain the price on pravastatin. The civil settlement payments announced today are in addition to the criminal penalties paid by the companies.  

Today’s civil settlements are the third, fourth and fifth arising from this investigation and were handled by the Civil Division’s Commercial Litigation Branch (Fraud Section) and the U.S. Attorney’s Office for the Eastern District of Pennsylvania with support from the Office of Inspector General for the Department of Health and Human Services, the Defense Health Agency Program Integrity Office, DCIS and the Office of Inspector General for the Department of Veterans Affairs.

The investigation and resolution of these matters illustrates the government’s emphasis on combating healthcare 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).

The matters were handled by Senior Trial Counsels Jennifer L. Cihon and Laurie A. Oberembt and Assistant U.S. Attorneys Landon Y. Jones III, Rebecca S. Melley and Anthony D. Scicchitano.

Except for those facts admitted to in the deferred prosecution agreements, the claims resolved by the civil settlements are allegations only, and there has been no determination of liability.

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A licensed pharmacist was arrested today in Chicago on charges related to his alleged sale of dozens of authentic Centers for Disease Control and Prevention (CDC) COVID-19 vaccination cards on eBay.

According to court documents, in March and April 2021, Tangtang Zhao, 34, of Chicago, sold 125 authentic CDC vaccination cards to 11 different buyers for approximately $10 per card. Zhao was a licensed pharmacist in Illinois and was employed at Company 1, a pharmacy which distributed and administered COVID-19 vaccines at its physical locations nationwide. As required by the CDC, Company 1 provided a CDC Vaccination Record Card to each vaccine recipient. Zhao, who worked at Company 1 as a pharmacist during that time, obtained and subsequently offered authentic CDC vaccination cards for sale online. The indictment charges Zhao with 12 counts of theft of government property.

“We take seriously, and will vigorously investigate, any criminal offense that contributes to the distrust around vaccines and vaccination status,” said Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division. “The Department of Justice and its law enforcement partners are committed to protecting the American people from these offenses during this national emergency.”

“Knowingly selling COVID vaccination cards to unvaccinated individuals puts millions of Americans at risk of serious injury or death,” said Special Agent in Charge Emmerson Buie Jr. of the FBI’s Chicago Field Office. “To put such a small price on the safety of our nation is not only an insult to those who are doing their part in the fight to stop COVID-19, but a federal crime with serious consequences.”

“Stealing and selling COVID-19 vaccination cards is inexcusable and will not be tolerated,” said Special Agent in Charge Lamont Pugh III of the U.S. Department of Health & Human Services, Office of Inspector General (HHS-OIG) – Chicago Region. “Fraudsters who engage in such unlawful conduct undermine efforts to address the pandemic and profit at the public’s expense. The health and safety of the public is our top priority, and we encourage people to obtain vaccination cards from their administering medical providers.”

Zhao is charged by indictment with 12 counts of theft of government property. Zhao made his initial court appearance on Aug. 17 before U.S. Magistrate Judge Sheila M. Finnegan of the U.S. District Court for the Northern District of Illinois. If convicted, he faces a sentence of 10 years in prison per count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

The FBI and HHS-OIG are investigating the case.

Trial Attorney Leslie S. Garthwaite of the Criminal Division’s Fraud Section is prosecuting the case.

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LOS ANGELES – An Orange County pharmacist has been sentenced to 70 months in federal prison for submitting more than $13 million in claims for medically unnecessary compounded medication prescriptions, the Justice Department announced today.

Thu Van Le, 42, a.k.a. “Tony Le,” of Placentia, was sentenced Monday by United States District Judge R. Gary Klausner.

In addition to the prison term, Judge Klausner ordered Le to pay $10,982,759 in restitution to Tricare, the U.S. military’s managed health care plan, and $768,488 in restitution to Amplan, Amtrak’s employee health care benefit plan.

Le, a pharmacist who owned TC Medical Pharmacy in Corona, pleaded guilty on July 12 to one count of health care fraud.

From March 2015 to December 2016, Le’s pharmacy submitted more than $13 million in total claims to Tricare and AmPlan, against which Tricare paid $10,982,759 and AmPlan paid $768,488. Le, in turn, paid so-called “marketers” handsome kickbacks of up to 50 percent of the Tricare reimbursements.

The marketers used personal and insurance information to generate fraudulent prescriptions for compounded medications, according to court documents. Marketers who participated in the scheme solicited beneficiaries of the health plans through misleading cold calls that promised free compounded medications. In some cases, beneficiaries were not contacted at all and simply received expensive medications that they did not order.

Compounded drugs are tailor-made products doctors may prescribe when the Food and Drug Administration-approved alternative does not meet the health needs of a patient.

Le agreed to be bound by Tricare and AmPlan rules for reimbursement of claims for their beneficiaries. Tricare and AmPlan required that medications be medically necessary, that beneficiaries be examined by physicians, and that Le’s pharmacy collect co-payments. The prescriptions were supposed to be for unique patient needs, but they instead were formulated to maximize reimbursements and were prepared on an assembly-line basis.

The Defense Criminal Investigative Service, the FBI, IRS Criminal Investigation, Amtrak’s Office of Inspector General, the Office of Personnel Management’s Office of Inspector General, the United States Department of Labor – Employee Benefits Security Administration, the Department of Health and Human Services, and the California Department of Insurance investigated this matter.

Assistant United States Attorney Mark Aveis of the Major Frauds Section prosecuted this case.

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DETROIT - An indictment was unsealed today charging two patient recruiters and the owner and operators of a pharmacy with conspiracy to illegally distribute prescription drugs, and other opioid-related charges, Acting U.S. Attorney Saima Mohsin announced today.

Mohsin was joined in the announcement by Special Agent in Charge Timothy Waters, Federal Bureau of Investigation, Detroit Division, and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office.

Charged in the indictment are:

• Dangelo Terrell Stephens, 38, of Detroit;

• Latasha Maria Neely, 38, of Detroit;

• Hassan Samir Saad, 33, of Dearborn; and

• Ali Hussein Keblawi, 26, of Dearborn.

The indictment alleges that from June 2020 through July 2021, Stephens and Neely worked as patient recruiters/marketers, who would bring “patients” or patient information to area doctors and clinics. Those doctors and clinics, which include the owner, operators, and physician at Tranquility Wellness Center, who have been indicted in a companion case, would write or cause the writing of controlled substance prescriptions in the “patient” names, without medical necessity and outside the scope of professional medical practice, in exchange for cash payments.

As part of the conspiracy, Stephens and Neely needed the cooperation of area pharmacies, including their owners and employees. Saad was a licensed pharmacy technician who worked at and owned Heritage Medical Pharmacy, LLC, in Redford, Michigan. Keblawi was an employee at Heritage. In exchange for cash, Saad and Keblawi filled the unlawful prescriptions obtained by Stephens and dispensed, or caused the dispensing, of controlled substances to Stephens, and not to the patients to which they were prescribed. And Saad and Keblawi knew that the prescriptions were illegitimate, and, by dispensing the controlled substances, they failed to exercise their corresponding professional responsibility to determine that the prescriptions were issued for a legitimate medical purpose. Stephens and Neely then sold the controlled substances on the street.

The primary prescription drug-controlled substances illegally prescribed, filled at pharmacies, and distributed included Schedule II controlled substances Oxycodone, Oxymorphone, and Oxycodone-Acetaminophen (Percocet). These drugs were in high demand on the illegal street market, particularly Oxycodone 30mg and Oxymorphone 40mg.

Stephens is also charged with three counts of distributing Oxycodone pills, and Stephens, Saad, and Keblawi are charged with one count of distributing and aiding and abetting the distribution of Oxycodone pills.

According to the indictment, Stephens and Neely unlawfully distributed a combined total of more than 28,000 dosage units of Schedule II opioid prescriptions during the conspiracy. These controlled substances had a conservative street value more than $775,000.

Also, during the conspiracy, Saad and Keblawi unlawfully dispensed a combined total of more than 5,500 dosage units of Schedule II controlled substances, carrying a conservative estimated wholesale street value of more than $150,000.

While most of the unlawful controlled substance prescriptions were paid for in cash, both controlled and non-controlled “maintenance” medications were billed to health care benefit programs by pharmacies. Billings to the Medicare and Medicaid programs for medically unnecessary prescription drug medications and maintenance medications during this conspiracy exceeded $200,000

“The road to addiction often begins with prescription drugs, “said Acting US Attorney Mohsin. “It is for this reason we are focusing our efforts on removing individuals who contribute to the devastating opioid crisis in this country,”

“The FBI is focused on stemming the supply of illegal opioids into our communities, especially those illegally distributed by doctors and clinics,” said Timothy Waters, Special Agent in Charge of the FBI’s Detroit Division. “While we continue to work with our partners to combat this crisis that devastates communities, we ask for the public’s help by reporting any information related to the illegal sale and distribution of opioids.”

“The investigation into the unlawful prescribing and distribution of medically unnecessary controlled and/or non-controlled substances remains a priority of the OIG,” said Lamont Pugh III, Special Agent in Charge, U.S. Department of Health & Human Services, Office of Inspector General – Chicago Region. “The opioid epidemic is only exacerbated by those who seek profit over the health and safety of their patients. The OIG will continue to work with our law enforcement partners to identify instances where providers engage in the illegal distribution of opioids and waste vital taxpayer dollars.”

This case is being prosecuted by Assistant United States Attorneys Andrew J. Lievense and Alison Furtaw. The Eastern District of Michigan is one of the twelve districts included in the Opioid Fraud Abuse and Detection Unit, a Department of Justice initiative that uses data to target and prosecute individuals that are contributing to the nation’s opioid crisis.

The case was investigated by special agents and task force officers of the Federal Bureau of Investigation and the Department of Health and Human Services-Office of the Inspector General.

An indictment is only a charge and is not evidence of guilt. Each defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.

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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.

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TRENTON, N.J. – The former co-owner of a Union City, New Jersey, pharmacy was sentenced today to 41 months in prison for his role in a scheme to pay bribes to health care professionals and evading taxes on $33.9 million in income, Acting U.S. Attorney Rachael A. Honig announced.

Igor Fleyshmakher, 59, of Holmdel, New Jersey, previously pleaded guilty before U.S. District Judge Michael A. Shipp to an information charging him with conspiring to violate the federal anti-kickback statute and tax evasion. Judge Shipp imposed the sentence today in Trenton federal court.

According to documents filed in this case and statements made in court:

The Prime Aid Pharmacies – now closed – operated as “specialty pharmacies” out of locations in Union City, New Jersey, and Bronx, New York. They processed expensive medications used to treat various conditions, including Hepatitis C, Crohn’s disease, and rheumatoid arthritis. Igor Fleyshmakher was a co-owner of Prime Aid Union City. Samuel “Sam” Khaimov was the other co-owner of Prime Aid Union City and the lead pharmacist of Prime Aid Bronx. Yana Shtindler was Khaimov’s wife and managing director of Prime Aid Union City. Ruben Sevumyants was Prime Aid Union City’s operations manager, and Alex Fleyshmakher worked at Prime Aid Union City and was an owner of Prime Aid Bronx. Eduard “Eddy” Shtindler (Yana Shtindler’s brother) was a Prime Aid Union City employee.

Starting in 2010, to obtain a higher volume of prescriptions, Igor Fleyshmakher, Khaimov, Sevumyants, Alex Fleyshmakher, Eddy Shtindler, and other Prime Aid employees paid bribes to doctors and doctors’ employees to induce doctors’ offices to steer prescriptions to the Prime Aid Pharmacies. The bribes included expensive meals, designer bags, and payments by cash, check, and wire transfers. The bribes and kickbacks were paid to, among others, doctors and doctors’ employees in New Jersey and New York.

As part of his plea agreement, Igor Fleyshmakher agreed that the improper benefit conferred as part of the conspiracy to violate the federal anti-kickback statute was between $3.5 million and $9.5 million.

In addition, between 2012 and 2014, Igor Fleyshmakher diverted a substantial amount of Prime Aid Union City income into a secret bank account that he opened and controlled. He concealed the account from the pharmacy’s tax preparers and did not report any of the funds he deposited into it on his personal income tax returns. In total, he diverted $33.9 million of income into the secret account, all of which he failed to report to the IRS. As a co-owner of the pharmacy, his conduct resulted in a $5.8 million tax loss to the IRS on his share of that income for tax years 2012 through 2014.

In addition to the prison term, Judge Shipp sentenced Fleyshmakher to three years of supervised release and ordered him to pay $5.8 million in restitution and a $100,000 fine.

Khaimov, Yana Shtindler, and Sevumyants have been charged together by superseding indictment with health care fraud offenses and violations of the anti-kickback statute, and that matter is pending. In addition, the following individuals associated with the Prime Aid Pharmacies have pleaded guilty for their respective roles in the kickback and bribery scheme described above: Joel Grimshaw, a former Prime Aid sales representative, Yudelka “Vicky” Ayala, a doctor’s employee who received over $200,000 in bribes and kickbacks as part of the scheme, and Alex Fleyshmakher, who also pleaded guilty to conspiring to defraud the IRS, resulting in losses to the IRS of over $9,000,000. Eddy Shtindler also pleaded guilty for his role in a related kickback conspiracy. These four defendants have not yet been sentenced.

Acting U.S. Attorney Honig credited special agents of the FBI, under the direction of Special Agent in Charge George M. Crouch Jr. in Newark; special agents of IRS-Criminal Investigation, under the direction of Special Agent in Charge Michael Montanez; special agents of the Department of Health and Human Services-Office of Inspector General, under the direction of Special Agent in Charge Scott J. Lampert; and the N.J. Office of the State Comptroller, under the direction of Acting Comptroller Kevin D. Walsh, with the investigation leading to today’s sentencing.

The government is represented by Assistant U.S. Attorney Joshua L. Haber of the Health Care Fraud Unit of the U.S. Attorney’s Office in Newark.

The charges against and allegations in the information pertaining to Khaimov, Yana Shtindler, and Sevumyants are merely accusations, and those three defendants are presumed innocent unless and until proven guilty.

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PHILADELPHIA (WPVI) -- A non-profit is helping local Veterans one dog at a time. Pets for Vets just opened their first Philadelphia location and the results are already exceeding expectations. Now they have plans to expand and help other Vets find their perfect match.

Ray Abarintos and Suzy are a match made in heaven. The shepherd mix and her owner met nearly a year ago and have been inseparable ever since with Abarintos jokingly referring to her as "Velcro Dog."

"The moment she came through the door she was scanning the area and she saw me, she was a little bit hesitant but I knew that this dog is the right one for me," said Ray Abarintos, a Veteran.

The beginning of their friendship would mark the end of Abarintos' more challenging days as a Veteran trying to adapt to life as a civilian.

"Life was actually difficult," he said, "Once a week or so, I would get flashbacks, it could be from a loud noise, certain smell, see something on the film."

Abarintos served in the Navy and Coast Guard. Several years ago he was diagnosed with PTSD and traumatic brain injury or TBI. It's exactly the type of case Pets for Vets frequently handles. The national non-profit believes dogs can help reduce suffering, loneliness and improve mental health. It just opened a new chapter in Center City under the Ms. Marcum Share the Love Foundation which also helps military Veterans.

"Everything that happened with Ray is what I envisioned happening with this, what Pets for Vets calls a super bond between the dog and the person," said Bradford Putt of Philadelphia Pets for Vets.

Five-year-old Suzy was adopted in April of last year from Match Dog Rescue in New Jersey. Longtime trainer Patricia Bentz helps choose the dogs and trains them to be good companions, which is different from a service dog.

"Pets for Vets focuses on finding providing Veterans with companion pet dogs. A service dog is meant to satisfy at least two functions for the person that they do the service work for," said Patricia Bentz, owner of K-9 Training & Behavioral Therapy.

For Ray, the companionship has proven to be life-changing. Now he hopes his fellow brothers and sisters will have the courage to do the same.

"Asking for help does not mean that you're weak," he said.

Pets for Vets hopes to expand in Philadelphia. But the non-profit needs your help to assist Vets who are waiting for their perfect match. You can donate your time by being a foster parent, your expertise as a certified k9 trainer or make a monetary donation. For more information, CLICK HERE.

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PHILIPS CPAP AND BILEVEL PAP RECALL

Philips Respironics announced a voluntary recall for certain CPAP, BiLevel PAP, and mechanical Ventilator Devices due to issues related to deterioration of the sound abatement foam used in these devices. This recall affects CPAP and BiLevel PAP devices manufactured prior to April 26, 2021. VA has distributed approximately 300,000 of these devices to Veterans for home use. An additional 2,000 devices are used within VA in hospital or clinic settings.

VA clinical teams are reviewing patient records to identify those who have received these devices and will work directly with impacted Veterans to repair or replace their equipment.

While there is a potential risk from the deterioration of the sound abatement foam, those risks have to be balanced against the known health risks of untreated sleep apnea. VA clinical experts are working with the FDA and the manufacturer to understand those risks. We expect to issue additional guidance in the coming days.

Veterans with questions can send a secure message to their care team through MyHealtheVet.

Frequently Asked Questions

Why are the Philips Respironics CPAP and BiPAP devices being recalled?

The manufacturer has identified a problem with a breakdown of the foam material used for sound reduction in their CPAP and BiPAP devices. Very small particles from the foam could break lose and come through the air hose.

What should Veterans do if they have use Philips Respironics CPAP or BiPAP device?

If you are a Veteran that uses a Philips Respironics CPAP or BiPAP device, continue to use your device as prescribed. You should register your device at https://www.philipssrcupdate.expertinquiry.com. Philips Respironics will send you a new device when one is available. This may take several months. If you are concerned about using your current device, call your care team or send them a secure message through MyHealtheVet to schedule an appointment.

Does this recall impact VHA sleep clinics?

Due to the volume of units affected, VHA sleep clinics may need to alter day-to-day operations as they support Veterans impacted by the recall.

If these devices are being recalled, why should I still use mine?

While there is a potential risk from the deterioration of the sound reduction foam, those risks have to be balanced against the known health risks of untreated sleep apnea. VA clinical experts are working with the FDA and the manufacturer to understand those risks. We expect to issue additional guidance in the coming days.

Will my CPAP or BiPAP be replaced?

Each patient’s needs are different, and your care team will determine if a CPAP or BiPAP from a different manufacturer will work for you, if a replacement is available, or if PAP therapy is no longer recommended for you. It is VA’s goal for Veterans who continue with PAP therapy to be provided with a replacement device as soon as possible. VA requests that you register your device through the Philips Respironics Patient Portal at: https://www.philipssrcupdate.expertinquiry.com or call 877-907-7508. Philips Respironics will send you a replacement device. This may take several months.

When I registered on Philips site, they asked if I used an ozone sanitizer. Is that because I voided the warranty by using the cleaning device?

Response from Philips Respironics: "Our testing has shown that the use of ozone can accelerate the breakdown of the foam. We are looking to use the answer to that question as a means of prioritizing devices in the recall. It has no bearing on the warranty."

How should I clean my CPAP or BiPAP device?

Only clean your device according to the manufacturer’s recommendations. Using ozone or ultraviolet light cleaners may contribute to breakdown of the sound reduction foam.

Does this issue only impact devices purchased by VA?

No. This impacts all Philips Respironics CPAP and BiLevel PAP devices manufactured prior to April 26, 2021.

Is additional information available on the Philips Respironics device recall?

More information is available at http://www.philips.com/src-update.

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The US Food and Drug Administration (FDA) has published an update on the Philips CPAP/BiPAP recall first announced earlier this year. The agency says it recently wrapped up an inspection of the Philips manufacturing facility where these devices were made, noting that it is looking into the silicone-based foam used as part of the device repair program.

The recall

In June, Philips Respironics recalled certain CPAP and BiPAP machines, as well as ventilators used by medical facilities, because of the sound abatement foam used in these models. That foam is made from polyester-based polyurethane (PE-PUR) that may break down over time.

When the foam breaks down, according to the initial advisory published by the FDA, the user may breathe in small particles or chemicals, potentially putting them at risk of health issues — including, the agency warns, “serious injury, which can be life-threatening, cause permanent impairment and require medical intervention to prevent permanent injury to users.”

In addition to the ventilators impacted by this recall, Philips has also recalled a number of CPAP and BiPAP models, including its DreamStation ASV, SystemOne ASV4, OmniLab Advanced+, Dorma 400, REMstar SE Auto, and more. Impacted users are covered by the company’s repair program, which will swap out the PE-PUR foam with a silicone-based alternative.

Inspection update

In a new statement, the FDA updated the public on this recall and the recent inspection it conducted of a manufacturing facility owned by Philips Respironics. The agency says it is looking into what may have resulted in the PE-PUR foam problem in addition to checking on whether the company is adhering to the FDA’s manufacturing rules.

The inspection is extensive, covering everything from how employees are trained to the production and testing of these devices. The agency hasn’t published a final determination yet but does say that its inspection closeout report related to this inspection is now available [PDF].

The inspection was anticipated and now that it is complete, Philips will do its part and respond to the agency before any “next steps” are taken. The FDA notes that it approved the company’s plan to replace the PE-PUR foam with a silicone-based alternative earlier this year based partly on testing data Philips provided to the agency.

Replacement foam concern

The agency’s update reveals that during its inspection, the FDA learned “additional information” it hadn’t previously received involving the silicone-based foam alternative. A “singular, similar device marketed outside of the US” failed “one safety test,” the FDA says, when it comes to the release of volatile organic compounds, a type of chemical that raises safety concerns.

As a result, the FDA wants Philips to use an independent lab for extra testing of the silicone-based foam to determine if it presents any safety risks to users. The agency notes that it doesn’t yet have enough data to determine whether silicone-based foam is of any risk to users — and, it acknowledges, some patients have already had their devices repaired to feature the foam alternative.

In a statement to the public about this, the FDA says:

Currently, while this independent testing is performed, the FDA does not recommend that patients who have participated in the repair and replace program discontinue use of their product. The FDA has reached this determination based on an overall benefit-risk assessment. At this time, the agency has determined that discontinuing use of one of these devices may be more harmful to a patient’s health and quality of life.

The FDA will issue an update in the future once it has more data on the silicone-based foam alternative used in these products.

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Massive medical device recall leaves patients unsure what to do

BOSTON —

Last month, Philips issued a huge recall of ventilators and continuous positive airway pressure machines, leaving millions of people with sleep apnea unsure of how they'll get a good night's sleep.

Philips has not offered a timeline of when repairs will be made, and for many, answers aren't very easy to find.

Like millions of people, Michael Crosta of Abington is facing a conundrum over his Philips CPAP machine, which helps him keep breathing and sleep soundly despite sleep apnea.

"It's a health risk," he said of the machine. "You tell me not to use this machine because Philips is recalling it and it may cause cancer, but this is a script that I'm supposed to use on a daily basis. What am I supposed to do?"

Karen Roberts of Plaistow, New Hampshire, received the same recall notice from Philips over her machine.

"Now I'm worried," she said. "I feel like I really need that medical device to keep me safe."

Philips said foam inside the device may give off dangerous gas or break down into potentially dangerous tiny particles, which can be ingested. The company plans to replace the foam but doesn't yet have the approval to do that, and patients like Crosta and Roberts are only authorized by insurance to buy a new CPAP machine every five years.

Roberts said she called Philips and was told to call her doctor, who told her to call the medical device company she bought the machine from who pointed her to her insurance, which sent her back to Philips.

The company says patients should register the machine to make sure they're on the list for a fix.

"It leaves me at risk of health issues, and I really don't know what to do at this point," Roberts said. "I've called everyone I can think of."

"I don't have anything to use," Crosta said. "What am I supposed to use?"

Dr. Lawrence Epstein is director of the Division of Sleep and Circadian Disorders at Brigham and Women's Hospital. He said patients with severe problems should keep using the machines despite the risks while they assess the situation with their physician and said others have to judge for themselves — or with their doctor's advice — whether the benefits of the machines outweigh the dangers.

"Our best judgment is that the risk of a complication from it is rather low if they're not having specific symptoms. And those have been cough, chest pressure, headache, sinus infection," Epstein said. "If it's a life-threatening condition for which they're using the machine, then they should definitely continue to use it while waiting unless they're having some symptoms."

In a statement, Philips tells us it's moving as quickly as it can, but says there are three to four million machines impacted by this, half of those in this country. And the company needs FDA approval for the fix.

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About 3-4 million devices are impacted by the recall

Philips has issued a recall for select sleep apnea machines and ventilators over concerns that a foam component may disintegrate and be inhaled by the user possibly causing health issues including toxic and carcinogenic effects.

The products impacted by the recall include 3 million to 4 million specific Philips Bi-Level Positive Airway Pressure (Bi-Level PAP), Continuous Positive Airway Pressure (CPAC) and mechanical ventilator devices. The company first warned of the issue in April 2021.

"The company continues to monitor reports of potential safety issues as required by medical device regulations and laws in the markets in which it operates," the company said in a news release posted Monday. "To date, there have been no reports of death as a result of these issues. Philips has received reports of possible patient impact due to foam degradation. The potential risks of particulate exposure include headache, irritation, inflammation, respiratory issues, and possible toxic and carcinogenic effects. The potential risks of chemical exposure due to off-gassing include headache, irritation, hypersensitivity, nausea/vomiting, and possible toxic and carcinogenic effects. Philips has received no reports regarding patient impact related to chemical emissions."

Those who are using the impacted BiLevel PAP and CPAP devices are advised to discontinue use and consult a physician or durable medical equipment provider, while those who are using the mechanical ventilator devices should consult their physician before determining a course of action.

The company said it has already begun preparing to replace the sound abatement foam with new material, and will ship out new first-generation DreamStation products to impacted families following regulatory approval. The company’s DreamStation 2 CPAP is not impacted by the issue.

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MINNEAPOLIS – RehabAuthority, LLC, a physical therapy company with operations in Minnesota, has agreed to pay $4 million to resolve allegations that it submitted false claims for payment for outpatient physical therapy services in violation of the False Claims Act.

The settlement resolves allegations that, from January 1, 2014, to December 31, 2018, RehabAuthority clinics submitted or caused to be submitted false claims for payment to the government for outpatient physical therapy. The clinics, located in Minnesota, North Dakota, Idaho, and Wyoming, improperly billed Medicare Part B, Minnesota Medicaid, TRICARE, and the Veterans Health Administration for one-on-one outpatient physical therapy, including therapeutic exercises, manual therapy, ultrasounds, therapeutic activities, and gait training. The resolution centered on allegations that the company billed the government for direct, one-one-one care with physical therapists, but did not provide it when it overbooked government beneficiaries for certain outpatient physical therapy services.

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act against RehabAuthority. Under the qui tam provisions of the False Claims Act, a private party can file an action on behalf of the United States and receive a portion of the recovery. The qui tam case is captioned United States and the State of Minnesota ex rel. Cami Lane v. RehabAuthority, LLC, et al., No. 17-cv-5103 (DWF/ECW).

The resolution obtained in this matter was the result of a coordinated effort between the U.S. Attorney’s Office for the District of Minnesota, the Office of Inspector General of the U.S. Department of Health and Human Services, the Defense Health Agency, the U.S. Department of Veterans Affairs, the Office of the Minnesota Attorney General, and the Minnesota Department of Human Services.

Acting U.S. Attorney W. Anders Folk of the District of Minnesota made the announcement.

Assistant U.S. Attorney Ann M. Bildtsen handled the matter.

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Soyke Knew Patients Lacked Legitimate Need for Prescriptions and Also Admitted to Engaging in Unwanted, Sexual Contact with Female Patients

Baltimore, Maryland – U.S. District Judge Richard D. Bennett sentenced William Soyke, age 68, of Hanover, Pennsylvania to 37 months in federal prison, followed by three years of supervised release, for conspiracy to distribute and dispense oxycodone, fentanyl, methadone, and alprazolam outside the scope of professional practice and not for a legitimate medical purpose.

The sentence was announced by Acting United States Attorney for the District of Maryland Jonathan F. Lenzner; Special Agent in Charge Thomas J. Sobocinski of the Federal Bureau of Investigation, Baltimore Field Office; Assistant Special Agent in Charge Orville O. Greene of the Drug Enforcement Administration, Baltimore District Office; and Special Agent in Charge Maureen Dixon, Office of Investigations, Office of Inspector General of the Department of Health and Human Services.

According to the plea agreement, Sokye was employed as a physician assistant with Drs. Rosen and Hoffberg from 2011 to 2018, where he treated patients during follow-up doctor appointments. As a physician assistant, Soyke had privileges to prescribe controlled substance medications but was required to operate under a delegation agreement between himself and the Rosen Hoffberg owners.

In his plea, Soyke admitted that he believed that Drs. Rosen and Hoffberg prescribed excessive levels of opioids. Despite Soyke’s attempts to lower patient’s prescription doses, both doctors overruled Sokye’s opinion. Further, if another health care provider within the practice declined to treat a patient due to the patient’s aberrant behavior (such as failing a drug screening test for illicit drugs or selling their prescriptions), Drs. Rosen and Hoffberg would assume that patient’s care.

As stated in the plea agreement, Sokye was aware that many of the patients presenting to Rosen Hoffberg did not have a legitimate medical need for the oxycodone, fentanyl, alprazolam, and methadone they were being prescribed. Nevertheless, Soyke issued prescriptions for these drugs to patients without a legitimate medical need and outside the bounds of acceptable medical practice.

Soyke also admitted that in several instances he engaged in sexual, physical contact with female patients who were attempting to get prescriptions. Specifically, Soyke asked some female customers to engage in a range of motion test, and while they were bending over, he would position himself behind them such that his genitalia would rub against the customers’ buttocks through their clothes. These patients often acceded to this sexual abuse for fear of not getting the medications to which they were addicted. Although the female patients complained to Dr. Rosen and Dr. Hoffberg about Soyke’s behavior, the doctors did not fire Soyke because Soyke saw the largest number of patients at the practice and generated significant revenue for Rosen Hoffberg.

Howard Hoffberg, M.D., the Associate Medical Director and part-owner of Rosen-Hoffberg Rehabilitation and Pain Management, pleaded guilty on June 9, 2021, to accepting kick-backs from a pharmaceutical company in exchange for prescribing a drug marketed by the company for breakthrough pain in cancer patients for off-label purposes.

Acting U.S. Attorney Jonathan Lenzner commended the FBI, the DEA, and HHS-OIG for their work in the investigation. Mr. Lenzner thanked Assistant U.S. Attorney Jason D. Medinger, who prosecuted the case.

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A New York physician was charged in an indictment unsealed today in the Eastern District of New York for an alleged $10 million health care fraud scheme involving the submission of false and fraudulent claims to Medicare and Medicare Part D plans.

According to court documents, Elemer Raffai, 56, of Rome, between approximately July 2016 and June 2017, allegedly signed prescriptions and order forms via purported telemedicine services for durable medical equipment (DME) that were not medically necessary. Raffai caused these claims to be submitted based solely on a short telephone conversation for beneficiaries he did not physically examine and evaluate and that were induced, in part, by the payments of bribes and kickbacks to Raffai. The indictment further alleges that Raffai, with others, submitted or caused the submission of approximately $10 million in false and fraudulent claims to Medicare for DME, and Medicare paid more than $4 million on those claims.

Raffai is charged with health care fraud. He was arrested and is making his initial court appearance today in the U.S. District Court for the Northern District of New York. If convicted, Raffai faces a maximum total penalty of 10 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division; U.S. Attorney Breon Peace for the Eastern District of New York; Special Agent in Charge Scott J. Lampert of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Office of Investigations; Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division; and Special Agent in Charge Janeen DiGuiseppi of the FBI’s Albany Field Office made the announcement.

HHS-OIG and the FBI investigated the case.

Trial Attorneys Kelly M. Lyons and Andrew Estes of the Criminal Division’s Fraud Section prosecuted the case.

An indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

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A New York physician was charged in an indictment unsealed today in the Eastern District of New York for an alleged $10 million health care fraud scheme involving the submission of false and fraudulent claims to Medicare and Medicare Part D plans.

According to court documents, Elemer Raffai, 56, of Rome, between approximately July 2016 and June 2017, allegedly signed prescriptions and order forms via purported telemedicine services for durable medical equipment (DME) that were not medically necessary. Raffai caused these claims to be submitted based solely on a short telephone conversation for beneficiaries he did not physically examine and evaluate and that were induced, in part, by the payments of bribes and kickbacks to Raffai. The indictment further alleges that Raffai, with others, submitted or caused the submission of approximately $10 million in false and fraudulent claims to Medicare for DME, and Medicare paid more than $4 million on those claims.

Raffai is charged with health care fraud. He was arrested and is making his initial court appearance today in the U.S. District Court for the Northern District of New York. If convicted, Raffai faces a maximum total penalty of 10 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division; U.S. Attorney Breon Peace for the Eastern District of New York; Special Agent in Charge Scott J. Lampert of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Office of Investigations; Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division; and Special Agent in Charge Janeen DiGuiseppi of the FBI’s Albany Field Office made the announcement.

HHS-OIG and the FBI investigated the case.

Trial Attorneys Kelly M. Lyons and Andrew Estes of the Criminal Division’s Fraud Section prosecuted the case.

An indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

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Physician Partners of America LLC (PPOA), headquartered in Tampa, Florida, its founder, Rodolfo Gari, and its former chief medical officer, Dr. Abraham Rivera, have agreed to pay $24.5 million to resolve allegations that they violated the False Claims Act by billing federal healthcare programs for unnecessary medical testing and services, paying unlawful remuneration to its physician employees and making a false statement in connection with a loan obtained through the Small Business Administration’s (SBA) Paycheck Protection Program (PPP). Certain PPOA affiliated entities are jointly and severally liable for the settlement amount, including the Florida Pain Relief Group, the Texas Pain Relief Group, Physician Partners of America CRNA Holdings LLC, Medical Tox Labs LLC and Medical DNA Labs LLC.

The United States alleged that PPOA caused the submission of claims for medically unnecessary urine drug testing (UDT), by requiring its physician employees to order multiple tests at the same time without determining whether any testing was reasonable and necessary, or even reviewing the results of initial testing (presumptive UDT) to determine whether additional testing (definitive UDT) was warranted. PPOA’s affiliated toxicology lab then billed federal healthcare programs for the highest-level UDT. In addition, PPOA incentivized its physician employees to order presumptive UDT by paying them 40% of the profits from such testing in violation of the Stark Law, which prohibits physicians from referring patients to receive “designated health services” payable to Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.

The United States further alleged that PPOA required patients to submit to genetic and psychological testing before the patients were seen by physicians, without making any determination as to whether the testing was reasonable and necessary, and then billed federal healthcare programs for the tests.

The United States further alleged that when Florida suspended all non-emergency medical procedures to reduce transmission of COVID-19 in March 2020, PPOA sought to compensate for lost revenue by requiring its physician employees to schedule unnecessary evaluation and management (E/M) appointments with patients every 14 days, instead of every month as had been PPOA’s prior practice. PPOA then instructed its physicians to bill these E/M visits using inappropriate high-level procedure codes. Moreover, the United States alleged that at the same time PPOA was engaged in this unlawful overbilling, PPOA falsely represented to the SBA that it was not engaged in unlawful activity in order to obtain a $5.9 million loan through the PPP. The settlement announced today resolves liability under the False Claims Act and the Financial Institutions Reform, Recovery and Enforcement Act (FIRREA) arising from the false claims submitted to federal healthcare programs for the E/M visits as well for PPOA’s false statement in connection with its PPP loan.

“Billing federal healthcare programs for services that providers know are unnecessary or unreasonable undermines the quality of care that patients receive and increases the costs of these taxpayer-funded programs,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “The department is committed to ensuring that healthcare providers base their treatment decisions on their patients’ needs rather than their own financial interests.”

“Holding healthcare providers accountable for inflated claims and false statements helps ensure the integrity of the healthcare system as a whole,” said U.S. Attorney Roger B. Handberg for the Middle District of Florida. “Settlements like this one are an important step in that direction.”

“Since the beginning of the pandemic, the SBA has been focused on providing relief swiftly, equitably and efficiently to millions of struggling small business owners – ensuring that relief has been distributed with the utmost integrity has been central to that mission under Administrator Guzman,” said General Counsel Peggy Delinois Hamilton for the SBA. “The SBA takes fraud seriously and will continue to make it our priority to work alongside the Office of the Inspector General to identify and address any potential fraud to ensure sound administration of relief programs.”

In connection with the settlement, PPOA also entered into a five-year Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). Under the CIA, PPOA agreed to undertake significant compliance efforts, including: maintain a compliance department, medical director and oversight board; retain a compliance expert; provide management certifications; maintain written standards, training and education; obtain multiple annual claims reviews by an Independent Review Organization; establish a risk assessment and internal review process; and implement monitoring of testing referrals.

“When health care providers bill taxpayer-funded health care programs for medically unnecessary services, they divert government funds designed to assist business owners during this pandemic,” said Special Agent in Charge Omar Pérez Aybar of HHS-OIG. “Our agency will work with our law enforcement partners to thoroughly investigate health care fraud schemes.”

“This settlement allows OWCP to recover medical bill payments under the Federal Employees’ Compensation Act and return those funds to the Employees’ Compensation Fund,” said Director Christopher Godfrey of the Department of Labor (DOL) Office of Workers’ Compensation Programs (OWCP). “The Department of Labor’s Office of Inspector General, as well as various other agencies’ offices of inspector general (OIG), devote significant investigative resources to detecting cases of possible abuse within the FECA program, and this settlement demonstrates the commitment of the DOL and its OIG in helping to ensure that funds issued through the program are paid appropriately.”

“When actors within our health care system are focused on profit rather than patient care, it undermines the integrity of the medical decision-making process,” said Special Agent in Charge Cynthia A. Bruce of the Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Southeast Field Office. “DCIS will continue to work with our investigative partners to protect the funding entrusted to the Defense Health Agency that serves our military members and their families.”

“Veterans Affairs' Community Care programs provide veterans and their families the ability to obtain critical healthcare services from providers within their own communities,” said Special Agent in Charge David Spilker of the Department of Veterans Affairs Office of Inspector General’s (VA OIG) Southeast Field Office. “This civil settlement reinforces the VA OIG’s commitment to safeguarding the integrity of VA’s healthcare programs and operations and preserving taxpayer funds.”

“When providers submit false claims for medically unnecessary tests, they are not only violating their patients’ trust but also compromising the integrity of the Federal Employees Health Benefits Program (FEHBP),” said Special Agent in Charge Amy K. Parker of the U.S. Office of Personnel Management, Office of the Inspector General (OPM OIG). “This settlement demonstrates the OPM OIG’s commitment to protecting patients from tests that are not medically reasonable or necessary and safeguarding the FEHBP from fraudulent claims.”

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Donald Haight, Dawn Baker, Dr. Harold Cho, Dr. Venus Dookwah-Roberts and Dr. Michael Lupi, who are current or former employees of PPOA or its affiliated entities. Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery. The qui tam cases are captioned United States ex rel. Haight v. Physician Partners of Am.; United States ex rel. Baker v. Physician Partners of Am LLC; United States ex rel. Lupi v. Physician Partners of Am. LLC; and United States ex rel. Dookwah-Roberts v. Physician Partners of Am. LLC.

The resolution obtained in this matter was the result of a coordinated effort between the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section; the U.S. Attorney’s Office for the Middle District of Florida; HHS-OIG; VA OIG; DCIS; DOL OIG; and OPM OIG.

The investigation and resolution of this matter illustrates the government’s emphasis on combating healthcare 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).

On May 17, 2021, the Attorney General established the COVID-19 Fraud Enforcement Task Force to marshal the resources of the Department of Justice in partnership with agencies across government to enhance efforts to combat and prevent pandemic-related fraud. The task force bolsters efforts to prevent fraud by, among other methods, augmenting and incorporating existing coordination mechanisms, identifying resources and techniques to uncover fraudulent actors and their schemes, and sharing and harnessing information and insights gained from prior enforcement efforts. For more information on the department’s response to the pandemic, please visit https://www.justice.gov/coronavirus. Tips and complaints from all sources about potential fraud affecting COVID-19 government relief programs can be reported by visiting the webpage of the Civil Division’s Fraud Section, which can be found here. Anyone with information about allegations of attempted fraud involving COVID-19 can also report it by calling the Department of Justice’s National Center for Disaster Fraud (NCDF) Hotline at 866-720-5721 or via the NCDF Web Complaint Form at: https://www.justice.gov/disaster-fraud/ncdf-disaster-complaint-form.

The matter was handled by Senior Trial Counsel David W. Tyler of the Civil Division and Assistant U.S. Attorney Lindsay Saxe Griffin for the Middle District of Florida.

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PITTSBURGH, Pa. – A resident of Pittsburgh, Pennsylvania, was sentenced in federal court for conspiracy to defraud the Pennsylvania Medicaid program, health care fraud, and aggravated identity theft, United States Attorney Cindy K. Chung announced today.

United States District Judge Cathy Bissoon sentenced Tamika Adams, 45, to sixty-five months of imprisonment, followed by two years of supervised release, for her role in a years-long conspiracy. Adams was also ordered to pay restitution to the Pennsylvania Medicaid program in the amount of $445,131.67.

During her plea hearing on March 13, 2020, Adams admitted that at various times between 2011 and 2014 she was an employee of three related entities operating in the home health care industry—Moriarty Consultants, Inc. (MCI), Activity Daily Living Services, Inc. (ADL), and Everyday People Staffing, Inc. (EPS). MCI, ADL, and a fourth entity, Coordination Care, Inc. (CCI), were approved under the Pennsylvania Medicaid program to offer certain services to qualifying Medicaid recipients (“consumers”), including personal assistance services (PAS), service coordination, and non-medical transportation, among other services. EPS nominally performed back-office functions for MCI, ADL, and CCI.

Between January 2011 and the defendant’s departure from the entities in and around 2014, MCI, ADL, and CCI collectively received tens of millions of dollars in Medicaid payments based on claims submitted for home health services, with PAS payments accounting for the vast majority of the total amount. During that time, Adams admitted that she participated in a wide-ranging conspiracy to defraud the Pennsylvania Medicaid program for the purpose of obtaining millions of dollars in illegal Medicaid payments through the submission of fraudulent claims for services that were never provided to the consumers identified on the claims, or for which there was insufficient or fabricated documentation to support the claims.

As part of the conspiracy, Adams admitted that she fabricated timesheets to reflect the provision of in-home PAS care that, in fact, she never provided to the consumer identified on the timesheets. In one instance, Adams admitted submitting false timesheets claiming that she provided more than 80 hours of care in a single week to a consumer, while also working full-time as the nominal president of ADL. During a two-year period in which the same consumer lived with Adams, the defendant admitted taking steps to conceal their co-habitation and the fact that she served as the consumer’s power of attorney (both disqualifying circumstances) from the Medicaid program.

Likewise, Adams admitted that she paid kickbacks to at least one consumer—her spouse at the time—in exchange for his participation in the scheme. Specifically, Adams admitted that she and her father, co-defendant Tony Brown, used Brown’s name on time sheets for fabricated care of Adams’s then-spouse. At various times, Adams admitted that she, Tony Brown, and her spouse would meet at an MCI office on the day that Brown received payment for the fraudulent care so that the three individuals could divide the proceeds. In total, Adams acknowledged causing losses to the Pennsylvania Medicaid program in excess of $250,000 related to her spouse.

Adams also admitted that during the conspiracy, she caused the submission of Medicaid claims for PAS care that her friend, an MCI employee, purportedly provided to various consumers, without the friend’s knowledge and when in fact no such care had been provided to the consumers. During this time, Adams admitted that her friend was recovering from a serious injury and unable to work. Adams further misused her friend’s personally identifiable information to obtain and misappropriate the resulting salary payments. Finally, Adams admitted that during the course of audits of MCI, ADL, and CCI, she fabricated documentation for submission to state authorities in an effort to conceal the Medicaid fraud scheme. Among other things, Adams fabricated PAS timesheets, criminal history checks for attendants, child-abuse clearance forms for attendants, and certain consumer affidavits to ensure that files requested as part of the audits appeared complete.

To date, a total of sixteen defendants have been charged in connection with this investigation. Adams was the twelfth defendant to enter a guilty plea. The remaining defendants, including Tony Brown, are presumed innocent unless and until proven guilty.

Assistant United States Attorney Eric G. Olshan and Special Assistant United States Attorney Edward Song are prosecuting this case on behalf of the government. The Federal Bureau of Investigation, Pennsylvania Office of the Attorney General – Medicaid Fraud Control Unit, Internal Revenue Service – Criminal Investigation, U.S. Department of Health and Human Services – Office of Inspector General, and United States Postal Inspection Service conducted the investigation.

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House lawmakers on Monday easily passed legislation designed to give additional grants for housing upgrades to disabled Veterans, sending the measure to the president to be signed into law.

The bill, under discussion on Capitol Hill for more than a year, did not have any significant opposition but has been mired in legislative gridlock for months. It had been a priority of officials from the Wounded Warrior Project, who argued the current VA Specially Adaptive Housing Grant was too limited in its current form.

Under the current program, the housing grants — used for a host of home upgrades like wheelchair ramps, accessible cabinets and wider doorways — can total about $90,000 but can only be given to Veterans once in a lifetime.

Advocates argued that severely limits disabled Veterans’ ability to purchase second homes. They also pushed for an increase in the maximum amount of funding able to be awarded, noting that many home renovation projects for disabled individuals can cost significantly more than the current cap.

Ryan Kules, a combat stress recovery director at Wounded Warrior Project for whom the bill is named, said when he was house hunting in 2015, his family had to factor in an extra $100,000 in anticipated costs to make most homes accessible for his injuries. The Army Veteran lost his right arm and left leg in a roadside bomb attack in Iraq in 2005.

“I know the difference that these benefits can make on a warriors home-life,” he said following Monday’s passage.

Under the new legislation, Veterans will become eligible for additional grants every 10 years, and the total cap on each payout will rise to nearly $100,000. Kules called that “such an important benefit that will serve severely wounded Veterans today and for generations to come.”

Senate lawmakers had passed the measure back in March. In a statement, Sen. Kyrsten Sinema, D-Ariz. (one of several bill sponsors from both parties) praised the final legislative step as a win for Veterans.

“Many Veterans carry wounds from military service that make everyday life more challenging,” she said. “Our bipartisan bill breaks down barriers to help Veterans access the specially adaptive housing benefits they’ve earned.”

The president is expected to sign the measure into law in coming days.

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Reflect on the drama and tragedies of the Great War

As I peek inside the drab zigzagged trench, held together by sticks and topped with piles of sandbags, I'm struck by the unspeakable conditions of warfare. On the ground lie two soldiers (mannequins) mired in mud while a soundtrack overhead haunts with a cacophony of explosives and unyielding shellfire. A recreation of a trench occupied by French soldiers more than a century ago, the exhibit is just one of the many at the National World War I Museum and Memorial (NWWIMM) in Kansas City, Missouri, that bring home the gruesomeness of a war that eclipsed 40 million casualties.

They all serve the NWWIMM's weighty mission: to help visitors “remember, interpret and understand the Great War and its enduring impact on the global community.”

Wandering through the 50,000-square-foot museum, you'll eye one of the world's most diverse collections of World War I artifacts (more than 300,000) — so impressive that Congress has recognized the museum as the nation's official World War I museum. The memorabilia runs the gamut from colorful propaganda posters and original nurse and soldier uniforms to a battle-scarred, American-used Renault FT-17 tank and combat weaponry, including German grenades and Spanish revolvers.

Complementing the museum: The 217-foot-tall Liberty Memorial Tower, an Egyptian Revival-style monument protected by two Assyrian Sphinxes ("Memory” and “Future").

The backstory

A patriotic group of Kansas Citians spearheaded construction of the museum and memorial two weeks after the November 1918 armistice. The group, which called itself the Liberty Memorial Association (LMA), wanted to honor World War I service members because so many soldiers had traveled through the city's Union Station, a centrally located departure point, when they deployed. In just 10 days of fundraising, the grassroots initiative raised an astounding $2.5 million from the community (a modern-day equivalent north of $40 million) to inaugurate the symbolic project. President Calvin Coolidge officially dedicated the museum upon its opening on Nov. 11, 1926.

"It [the Liberty Memorial] has not been raised to commemorate war and victory,” the 30th U.S. president said to the crowd of some 150,000 Americans on hand that day, “but rather the results of war and victory, which are embodied in peace and liberty.”

Deteriorating conditions forced the NWWIMM's closure in 1994, but it reopened on Memorial Day 2002, following a hefty restoration that included both the memorial tower and the original museum, adjacent to the memorial. A multimillion-dollar expansion of the museum, built underground under the memorial, debuted in December 2006.

A big surprise to many of the NWWIMM's half-million annual visitors: its global interpretation of “the war to end all wars,” a nod to the LMA's original intention to represent and collect artifacts from all participating nations (34 in total) on every front, be it Germany, France or Brazil. “There are no sides taken [at the museum] — no winners or losers,” says senior curator Doran Cart. “Even though it's in the United States, it's not an American museum — but an international museum about the war."

Inside the museum

The NWWIMM covers ample ground — with a sprawling main gallery and five exhibition spaces spread across three floors — so maximizing your time and making the most of your visit requires a game plan.

Start with the 12-minute introductory film in the lobby auditorium (shown every 15 minutes), which will help you better understand the power struggle and generations of chess moves that ignited this Great War. “Peace is war held in check,” the movie's narrator proclaims, underscoring Europe's mounting tension and waning aristocracy at the turn of the 20th century, eventually culminating in the straw that broke the camel's back: the 1914 assassination of Austria's Archduke Franz Ferdinand.

Next, you'll want to spend most of your time in the main gallery, home to the museum's most significant artifacts, which contribute to a meticulous telling of the war's numerous twists and turns. The glass bridge that connects the lobby to this gallery hovers above a Western Front poppy field that symbolizes the millions of lives lost as a direct result of combat. The view of the 9,000 bright-red artificial flowers, each representing 1,000 combatant deaths, will tug at your heartstrings for the countless sacrifices made.

Move through the main gallery and its two sections, counterclockwise, for a chronological journey through World War I. The first section focuses on the period before the U.S. entered the conflict (1914 to spring 1917), including six life-size trench re-creations. They offer a ground-level view of the dreary underground network (enhanced by the ambient sound of gunshots) that, if laid end to end, would have stretched a staggering 35,000 miles. Dubbed “the long grave already dug” by British poet John Masefield, the tunnels were a final resting place for millions of soldiers.

You'll also see numerous war relics, including French death certificates, authentic Austrian mourning cards, Belgian bread bags soldiers used to haul their rations, and an antique brass Princess Mary Christmas gift box that held the candies, pencils and cigarettes of a British infantryman. Keepsakes like these help you imagine the young soldiers sharing a smoke and memories of their loved ones as they fought to survive far from home.

The U.S. joins the fight

Before entering the main gallery's second section, whose focus begins on April 6, 1917, the day President Woodrow Wilson declared war on Germany, make sure you don't skip the thought-provoking 15-minute film that introduces America's entry into the conflict. Although the U.S. had vowed not to get involved in the war, it had no choice but to when news broke that Germany's foreign minister secretly offered to finance Mexico in a war against America, as the film reveals. Below the screen sits a poignant replication of “No Man's Land” — the barren wasteland of tree stumps and barbed wire between enemy forces.

Visitors can walk through the re-created environment of a French farmhouse turned howitzer-blasted shell crater and admire an original 1917 Harley Davidson, one of 20,000 motorcycles sent to support the war effort in Europe. Elsewhere in this section, lesser-known stories reveal the unheralded details of the Choctaw code talkers (who used Native American languages for military code to fool the Germans), the Black Rattlers (the celebrated 369th Infantry Regiment of African American soldiers) and the Gold Star Mothers, who took postwar pilgrimages to their sons’ and husbands’ gravesites.

Before exiting this gallery, you can design your own propaganda poster on one of the interactive counters, then email it to yourself to print at home.

In the museum's other galleries, exhibitions that rotate frequently focus on niche topics related to World War I. Through Sept. 6, “Silk and Steel: French Fashion, Women and WWI,” currently the museum's special exhibition, showcases the importance of women's fashion to morale, economies and war allegiances through capes, coats, hats, shoes and vintage dresses of revered French designers. The “Votes & Voices” exhibition (no end date set) celebrates the women's suffrage movement and ratification of the 19th Amendment.

Cap your visit to the NWWIMM by ascending the Liberty Memorial Tower (when it reopens post-COVID-pandemic) for a panoramic view of the Kansas City skyline, a must-do for the able-bodied. (To reach the open-air observation deck, you first take an elevator, then must climb 45 steps.) If you can't make the climb up, the tower shines from the ground just as well.

Where to Stay

Crossroads Hotel: You're just a short stroll from the museum at this 131-room downtown property in the Crossroads Arts District. The 100-year-old brick bottling warehouse turned hotel is the former business stomping grounds of Kansas City political boss Tom Pendergast. Venture up to its scenic rooftop for the view and a beer garden. Rooms from $189

Home2 Suites Kansas City Downtown: Book a room in this 114-suite property for a budget stay in the Crossroads district. The Kansas City Streetcar, a free downtown shuttle service, stops just across from the hotel, giving you easy access to downtown attractions, such as the restaurants and shops at River Market. It doesn't stop at the museum, which is within walking distance from the hotel. Rooms from $99

Where to Dine

Barbecue kingpins: When in K.C., do as the locals do and chow down on what many die-hard barbecue fans consider the country's best barbecue. At Joe's Kansas City Bar-B-Que, which tops most lists in the city — and some national ones — you can't go wrong with the pulled pork sandwich or any of the slow-cooked meats. For the best environment, head to Joe's original location in an old gas station on West 47th Avenue, about 5 miles south of the museum.

The ribs at Arthur Bryant's Barbeque on Brooklyn Avenue have attracted the chops of Presidents Jimmy Carter and Barack Obama — and Harry Truman, when he was alive. It's an easy drive that's 2.5 miles northwest of the museum.

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There were 36 'serious incidents' at VA medical facilities in 2022

Police staffing shortages at Department of Veterans Affairs hospitals are leaving veteran workers in danger, according to a report from the VA's Office of the Inspector General.

The audit, released last Wednesday, found workers and veterans receiving treatment at VA facilities were vulnerable to crime because of a 33% vacancy rate of officers from the police department that serves the medical centers - with some sites seeing a vacancy rate as high as 63%, according to Military.com.

The report found that in 2022 there were 36 "serious incidents" across 32 medical facilities, according to Military.com. "Serious incidents" are defined as ones that "draw attention or cause harm," the outlet reported, including disturbances such as displaying a firearm, the theft of VA property, or injury to people or property.

"All 36 incidents presented significant concerns and highlight VA's need to protect its property and systems, as well as secure its facilities to help ensure the safety of staff, patients, and visitors," Larry Reinkemeyer, VA's assistant inspector general for audits and evaluations, wrote in the report.

The serious incidents at VA centers last year included a bomb threat at the Wichita medical center that was later deemed a hoax, a lockdown at a center in Ohio when a man fired a round of his shotgun just outside the facility, and when a patient grabbed an officer’s gun and fired it at a facility in San Diego.

The Veterans Health Administration System has 171 hospitals across the U.S. and 1,100 clinics. Of those facilities, a third of them reported severe police staffing shortages in 2022.

The audit was conducted by 150 inspectors who were sent to 70 VA medical centers across the nation unannounced for a three-day period.

VA officials have since said they are "aggressively" working to recruit qualified candidates for the Veterans Affairs Police Services department, Military.com reported.

"We are always aggressively recruiting for high-quality VA police candidates," a VA spokesman told Military.com. "Law enforcement is currently a highly competitive market in the country, with more vacancies than applicants."

A VA spokesperson added in comment to Fox News Digital on Monday that the "VA continues to take action to improve security at its medical facilities nationwide.

"Included among our many efforts is focusing on recommendations in the 'Review of Security and Preparedness at VA Medical Facilities' OIG Report," the spokesperson continued. "We are currently monitoring security related vacancies, reporting monthly on hiring trends, ensuring proper levels of staffing for inspections and other security staff, and ensuring that facility security equipment is well maintained and operational."

Beyond the staffing shortages, security measures such as cameras at the facilities were found to be insufficiently monitored.

"The OIG acknowledges that the presence of operational security cameras results in a large amount of footage to review, and many facilities may not have sufficient personnel to do so," the report stated. "However, having this footage available to review would help facilities and other authorities investigate any reported incidents."

The report also found that police officers still on the force have been overworked. Police officers at 70 VA facilities across the country logged a total of 292,000 overtime hours, worth $13.4 million, Military.com reported.

"Continuous monitoring will make VA facilities more secure and safe for Veterans, their families, caregivers and employees," the VA spokesperson added in comment to Fox News Digital. "Veterans and families should know that while we are actively attempting to expand police coverage, our facilities remain safe."

Staffing issues have plagued police departments across the country in recent years, with many police leaders blaming the emergence of the "defund the police" movement and anti-cop sentiment that swept the nation in 2020 as protesters and rioters following the killing of George Floyd.

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Acting U.S. Attorney Bridget M. Brennan announced that a federal jury found William R. Bauer, 84, of Port Clinton, Ohio, guilty of prescribing powerful controlled substances, including opioids, to patients without medical necessity and outside the usual course of medical practice.

Following a two-week trial, Bauer was convicted on Wednesday, July 21, 2021, of 76 counts of distribution of controlled substances and 25 counts of health care fraud. Bauer was initially indicted in August of 2019, and a superseding indictment was filed in October of 2019. The indictment was amended again in June of 2021.

Evidence presented at trial established that between 2015 and 2019, Bauer, at his practice in Bellevue, Ohio, repeatedly prescribed controlled substances including Oxycodone, Fentanyl, Morphine, and Tramadol, outside the usual course of professional practice and not for a legitimate medical purpose. The indictment focused on Bauer’s treatment of 14 patients. The evidence presented at trial showed that Bauer prescribed high doses of opioids and other controlled substances to patients without regard to any improvement in pain level, function, or quality of life; prescribed dangerous drug combinations; failed to consider a patient’s state of addiction and ignored warning signs of abuse and diversion such as patient family members stealing medications, patients frequently requesting early refills, patients losing medications and other actions.

Bauer was also convicted of health care fraud. Evidence introduced at trial established that Bauer regularly administered epidural injections and trigger point injections, without medical necessity, that failed to meet certain procedural requirements. Because these injections failed to meet the procedural requirements, they were rendered ineffective and were fraudulently billed to insurers. Evidence at trial also showed that between January 2007 and August 16, 2019, Bauer prescribed controlled substances outside the usual course of medical practice and not for a legitimate medical purpose, thus resulting in insurers paying for medically unnecessary controlled substances.

Sentencing will be determined at a later date.

This case was investigated by the Federal Bureau of Investigation, the Drug Enforcement Administration, the Department of Health and Human Services – Office of Inspector General and the Ohio Attorney General’s Office. The case is being prosecuted by Assistant U.S. Attorneys Ava R. Dustin, Michael A. Sullivan, Robert N. Melching and Payum Doroodian.

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Acting U.S. Attorney Michelle M. Baeppler announced that William Bauer, 85, of Port Clinton, Ohio, was sentenced today by U.S. District Judge Jack Zouhary to 5 years in prison and was ordered to pay $464,099.14 in restitution, of which $253,300.55 will be paid to Medicare and $210,798.59 to Medicaid. In addition, Judge Zouhary ordered Bauer to pay $100,000 in community restitution. The community restitution will be distributed 65% to the Ohio Attorney General, Crime Victim Services Section, and 35% to the Ohio Department of Mental Health & Addiction Services. The Court strongly recommended that the community restitution amount go to the Mental Health and Recovery Services Board of Seneca, Ottawa, Sandusky and Wyandot Counties.

Judge Zouhary pronounced the sentence after Bauer was convicted at trial of 76 counts of distribution of controlled substances and 25 counts of health care fraud.

“This defendant unnecessarily distributed dangerous and highly addictive controlled substances and repeatedly ignored warning signs that his actions were causing detrimental harm to his patients and the community,” said Acting U.S. Attorney Michelle M. Baeppler. “No matter your title, those who flood the streets with dangerous drugs and prey upon vulnerable individuals will answer for their actions.”

“Criminal misconduct within the healthcare system is harmful and destructive,” said FBI Special Agent in Charge Eric B. Smith. “Not only does healthcare fraud impact insurers through monetary loss, but also to physicians, hospitals, and taxpayers who were unwitting participants to the deceitful actions. We will continue to work diligently to uncover fraudulent schemes that risk public health.”

“The sentencing of William Bauer demonstrates our commitment to stopping those who fuel the opioid epidemic,” said Kent R. Kleinschmidt, Acting Special Agent in Charge of the U.S. Drug Enforcement Administration’s Detroit Field Division. “Medical professionals who disregard their oath and instead seek to profit at the expense of their patients and community will be brought to justice.”

According to court documents and evidence presented at trial, between 2007 and 2019, Bauer, at his practice in Bellevue, Ohio, repeatedly prescribed medically unnecessary controlled substances, including Oxycodone, Fentanyl, Morphine and Tramadol, outside the usual course of professional practice and not for a legitimate medical purpose.

During the trial, prosecutors showed that Bauer prescribed high doses of opioids and other controlled substances to patients without regard to any improvement in pain level, function, or quality of life; prescribed dangerous drug combinations; failed to consider a patient’s state of addiction and ignored warning signs of abuse and diversion such as patients’ stealing medications, frequently requesting early refills, losing medications and other actions.

The case focused on Bauer’s treatment of 14 patients. Throughout the trial, prosecutors showed that these patients suffered a loss of employment, fractured families and experienced deteriorating mental health conditions as a result of their drug dependency. In one instance, court documents state that in 2015 a patient of Dr. Bauer died from an accidental overdose.

In addition to his conviction for distributing controlled substances, Bauer was also convicted of health care fraud. As part of the health care fraud scheme, Bauer billed insurers after prescribing medically unnecessary controlled substances and administered needless epidural and trigger point injections that failed to meet certain procedural requirements. Because these injections failed to meet the procedural requirements, they were rendered ineffective and fraudulently billed to insurers.

“This doctor contributed to the tidal wave of opioid overdoses that flooded our communities,” Ohio Attorney General Dave Yost said. “I am proud of the state and federal partnerships that continue to work to stem the tide of addiction.”

“Providers sow distrust in our nation’s health care system when they participate in health care fraud and activities that endanger their patients,” said Mario M. Pinto, Special Agent in Charge with the Department of Health and Human Services, Office of Inspector General. “Along with our law enforcement partners, HHS-OIG will continue to hold accountable those who threaten the safety of beneficiaries through overprescribing and engaging in health care fraud.”

Court documents state that the total loss amount to Medicare and Medicaid due to the fraudulent billing practices was $464,099.14.

This case was investigated by the Federal Bureau of Investigation, the Drug Enforcement Administration, the Department of Health and Human Services – Office of Inspector General and the Ohio Attorney General’s Office. The case is being prosecuted by Assistant U.S. Attorneys Ava R. Dustin, Michael A. Sullivan, Robert N. Melching and Payum Doroodian.

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NEWPORT NEWS, Va. – A Portsmouth woman pleaded guilty today to wire fraud and aggravated identity theft in connection with a scheme to defraud Veterans.

“This defendant has been brought to justice for orchestrating numerous fraudulent schemes against Veterans who honorably served their country,” said Raj Parekh, Acting U.S. Attorney for the Eastern District of Virginia. “For those who steal, misappropriate, and divert funds that belong to our country’s Veterans, this case sends a strong message that you will be prosecuted and held accountable for your inexcusable conduct.”

According to court documents, Rita Copeland, 59, operated an entity known as “Veteran Services of the Commonwealth.” Copeland purported to provide caregiving, contracting, and rental assistance services to various Veterans from 2016 through 2020. Copeland caused a number of victims to apply for Home Improvements and Structural Alterations (HISA) grants through the U.S. Department of Veterans Affairs. Such grant payments are to be used for certain designated improvements to the residences of Veterans. Copeland failed to perform all of the promised work and used a portion of these payments to her own benefit, contrary to the designated purposes of the funds.

Copeland also diverted the income and retirement fund payments of another Veteran to a bank account that she had opened. In addition, Copeland fraudulently obtained and diverted loan funds and used the credit and debit cards of this elderly victim. Finally, Copeland engaged in a rental fraud scheme, purporting to link Veterans and others with landlords, but then diverting rental and security deposit payments to her own benefit.

Copeland pleaded guilty to one count of wire fraud and one count of aggravated identity theft, and she is scheduled to be sentenced on August 27. She faces a maximum penalty of 20 years for wire fraud and a mandatory consecutive term of two years for aggravated identity theft. Actual sentences for federal crimes are typically less than the maximum penalties. A federal district court judge will determine any sentence after taking into account the U.S. Sentencing Guidelines and other statutory factors.

Raj Parekh, Acting U.S. Attorney for the Eastern District of Virginia; Brian Dugan, Special Agent in Charge of the FBI’s Norfolk Field Office; and Michael J. Missal, Inspector General, U.S. Department of Veterans Affairs, made the announcement after Senior U.S. District Judge Henry E. Hudson accepted the plea.

Assistant U.S. Attorney Brian Samuels is prosecuting the case.

This case is being investigated by the FBI’s Norfolk Division’s Peninsula Resident Agency.

Combatting elder abuse and financial fraud targeted at seniors is a key priority of the Department of Justice. Elder abuse is an intentional or negligent act by any person that causes harm or a serious risk of harm to an older adult. It is a term used to describe five subtypes of elder abuse: physical abuse, financial fraud, scams and exploitation, caregiver neglect and abandonment, psychological abuse, and sexual abuse. Elder abuse is a serious crime against some of our nation’s most vulnerable citizens, affecting at least 10 percent of older Americans every year. Together with our federal, state, local, and tribal partners, the Department of Justice is steadfastly committed to combatting all forms of elder abuse and financial exploitation through enforcement actions, training and resources, research, victim services, and public awareness. This holistic and robust response demonstrates the Department’s unwavering dedication to fighting for justice for older Americans.

A copy of this press release is located on the website of the U.S. Attorney’s Office for the Eastern District of Virginia. Related court documents and information are located on the website of the District Court for the Eastern District of Virginia or on PACER by searching for Case No. 4:20-cr-63.

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NEWPORT NEWS, Va. – A Portsmouth woman was sentenced today to 9.5 years in prison for wire fraud and aggravated identity theft in connection with a scheme to defraud Veterans.

“What is most egregious about the defendant’s conduct is that she used her own status as a former Veteran to defraud and take advantage of other Veterans,” said Raj Parekh, Acting U.S. Attorney in the Eastern District of Virginia. “The sentence imposed in this case reflects the serious nature of these fraud schemes and the potential consequences that those who victimize Veterans, who have sacrificed so much for our country, could face in the Eastern District of Virginia.”

According to court documents, Rita Copeland, 59, operated an entity known as “Veteran Services of the Commonwealth.” From 2016 through 2020, Copeland purported to provide caregiving, contracting, and rental assistance services to various Veterans. Copeland caused a number of victims to apply for Home Improvements and Structural Alterations (HISA) grants through the U.S. Department of Veterans Affairs. Such grant payments are to be used for certain designated improvements to the residences of Veterans. Copeland failed to perform all of the promised work and used a portion of these payments to her own benefit, contrary to the designated purposes of the funds.

Copeland also diverted the income and retirement fund payments of another Veteran to a bank account that she had opened. In addition, Copeland fraudulently obtained and diverted loan funds and used the credit and debit cards of this elderly victim. Finally, Copeland engaged in a rental fraud scheme, purporting to link Veterans and others with landlords, but then diverted rental and security deposit payments to her own benefit. In total, from at least 2017-2020, Copeland’s fraud schemes impacted at least 29 victims, resulting in a combined loss of approximately $430,000.

Raj Parekh, Acting U.S. Attorney for the Eastern District of Virginia; Brian Dugan, Special Agent in Charge of the FBI’s Norfolk Field Office; and Michael J. Missal, Inspector General, U.S. Department of Veterans Affairs, made the announcement after sentencing by Senior U.S. District Judge Henry E. Hudson.

Assistant U.S. Attorney Brian Samuels prosecuted the case.

Combatting elder abuse and financial fraud targeted at seniors is a key priority of the Department of Justice. Elder abuse is an intentional or negligent act by any person that causes harm or a serious risk of harm to an older adult. It is a term used to describe five subtypes of elder abuse: physical abuse, financial fraud, scams and exploitation, caregiver neglect and abandonment, psychological abuse, and sexual abuse. Elder abuse is a serious crime against some of our nation’s most vulnerable citizens, affecting at least 10 percent of older Americans every year. Together with our federal, state, local, and tribal partners, the Department of Justice is steadfastly committed to combatting all forms of elder abuse and financial exploitation through enforcement actions, training and resources, research, victim services, and public awareness. This holistic and robust response demonstrates the Department’s unwavering dedication to fighting for justice for older Americans.

A copy of this press release is located on the website of the U.S. Attorney’s Office for the Eastern District of Virginia. Related court documents and information are located on the website of the District Court for the Eastern District of Virginia or on PACER by searching for Case No. 4:20-cr-63.

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Kansas Sen. Jerry Moran is pushing for legislation that would expand medical benefits for post-9/11 Veterans suffering from health problems related to working with toxic burn pits.

A bill he co-sponsored with Montana Sen. Jon Tester was introduced this week and passed through the Senate Veterans Affairs Committee on Wednesday, as Congress tries to chart a path to help an estimated 3.5 million post-9/11 Veterans who may have been exposed to toxic burn pits.

The open-air burning of trash and other waste like chemicals, human waste, munitions, petroleum and plastics in pits was common in Iraq, Afghanistan and other parts of Southwest Asia where troops served, according to the Department of Veterans Affairs.

“Post-9/11 Veterans are the newest generation of American heroes to suffer from toxic exposures encountered during military service,” Moran said. “The Health Care for Burn Pit Veterans Act is an important first step to make certain our Veterans receive the care they need as a result of their service.”

Moran and Tester said their bill is part of a three pronged approach to expand benefits for Veterans. It gives those who served after 9/11 an additional five years of health care eligibility after they are discharged and an extra year of open enrollment for people who have been discharged for more than 10 years.

It would also require the VA to establish screening procedures for burn pit exposure and symptoms and establish an outreach program for Veterans who might have missed the window for eligibility.

“As more and more Veterans report alarming rates of toxic exposure related illnesses, one thing is abundantly clear: without action, post-9/11 Veterans will suffer as Vietnam Veterans have,” Tester said. “And every year more toxic exposure Veterans will pay the ultimate price while waiting for the treatment that they need.”

The Senate bill is a pared down version of an earlier bill introduced in the House of Representatives that would provide benefits to all Veterans, not just those who served after 9/11. According to the Congressional Budget Office, the House bill would cost more than $300 billion.

Moran and Tester said the bill they proposed, which they said would cost a little under $1 billion, is the bill that they believe has enough votes to pass the Senate. It had unanimous support from the Veterans Affairs Committee.

The Senate bill is the first in what Moran and Tester described as a set of three measures that will include a new process for the VA to add conditions presumed to have come from exposure (the VA added asthma, rhinitus and sinusitus in May).

Tester said the pared down approach is necessary in order to get the bill through the Senate.

“The goal here is to get this thing done by the end of this Congress,” Tester said. “The question becomes how you get done. And I think this is the best way to get this through the Senate and that’s why we’re proceeding this way.”

While the bill made it out of committee, it will still have to pass the full Senate and the House of Representatives. Because the House Committee of Veterans Affairs already passed a different bill, there will likely be negotiation between the House and the Senate on how to move forward.

“We have ongoing conversations with the Chairman, Ranking Member and members of the committee that will continue,” Moran said. “I would guess that legislation will pass Congress. And it’s the kind of legislation that will be able to be supported in a bipartisan way and signed by the President.”

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HARRISBURG – The United States Attorney’s Office for the Middle District of Pennsylvania announced that a Lower Paxton Postal employee, Candy Ehler, age 51, of Harrisburg, Pennsylvania, pled guilty on March 29, 2021, before U.S. District Court Judge Sylvia H. Rambo to three counts of theft of mail by an employee.

According to Acting United States Attorney Bruce D. Brandler, on August 2, 2019, the United States Postal Service was notified that a medication package had not been received by its intended recipient. A pattern of missing/stolen medication packages containing opioid based controlled substances that required signature confirmation of receipt was confirmed. These packages were attempted to be delivered by the assigned mail carrier, but were returned to the Lower Paxton Post Office due to the intended recipients not being at their residence. Once returned to the Post Office, video surveillance revealed Postal Carrier Ehler, removing three controlled substance medication packages that were not on her primary route. Ehler did not have a request for second delivery attempt, and the intended recipients never received their medication.

The charges stem from an investigation by the United States Postal Service Office of Inspector General and Department of Veteran’s Affairs Office of Inspector General. Assistant United States Attorney Daryl F. Bloom is prosecuting the case.

A sentence following a finding of guilt is imposed by the court after consideration of the applicable federal sentencing statutes and the Federal Sentencing Guidelines.

Ehler is facing a maximum of 15 years of incarceration and a $750,000 fine. Under the Federal Sentencing Guidelines, the court is also required to consider and weigh a number of factors, including the nature, circumstances and seriousness of the offense; the history and characteristics of the defendant; and the need to punish the defendant, protect the public and provide for the defendant's educational, vocational and medical needs. For these reasons, the statutory maximum penalty for the offense is not an accurate indicator of the potential sentence for a specific defendant.

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Helping survivors work through emotions

Veterans have a significantly higher suicide rate than other adults in the U.S. This means Veterans are also more likely to have known someone who took their own life. Uniting for Suicide Postvention (USPV) helps make sense of a suicide loss. The program connects survivors with resources to help them work through powerful and unique emotions specific to this type of grief.

Compared with many other kinds of loss, suicide can be particularly challenging for survivors. Specifically, they must wrestle with the difficult moral, societal and religious implications.

Shock at the suddenness of the death may compound their grief. Or they may feel a mix of shame, anger, guilt and, sometimes, relief.

Some survivors blame themselves for not noticing warning signs, even though such signs may not have been obvious. And the effects extend beyond close family members. Even first responders, who never personally knew the deceased person, can be affected emotionally by the suicide scene.

USPV provides postvention information and resources to assist survivors as they navigate their healing journey, both immediately after the loss and in the months and years that follow.

What is postvention, and who benefits from it?

Suicide prevention aims to avert incident, while postvention fosters healing afterward, for those touched by the loss. With tens of thousands of suicides every year in the U.S., coping with the aftermath is an unfortunate reality for more people than some might think. For every suicide, an estimated average of 135 people are affected.

Beyond the immediate circle of grieving family members and friends, those who regularly interacted with the person who died also can be affected. This includes coworkers, doctors, neighbors, bus drivers or a regular waitress at a favorite restaurant.

Quality postvention can facilitate survivors’ healing. It helps them understand and address the complex thoughts and emotions that make coping after a suicide loss particularly challenging. USPV offers a safe space where loss survivors can explore painful and challenging emotions. It strives to create a community of shared healing by improving education about postvention and access to support and resources.

VA’s Office of Mental Health and Suicide Prevention supports USPV. However, most USPV resources support anyone who has been touched by suicide loss regardless of their military, Veteran or military family status.

At the heart of USPV is a website that features multimedia resources designed to promote open dialogue. The site is structured to meet the needs of community members, health care providers and workplace colleagues. It offers videos, infographics and podcasts related to connecting and healing.

How is suicide postvention part of prevention?

Experts consider exposure to suicide a risk factor for suicide. Survivors are at greater risk for substance use disorders and mental health issues than those who haven’t experienced such a loss. This includes including thoughts of suicide. Those exposed to suicide in the workplace are 3.5 times more likely than others to take their own lives. In a military unit with five or more suicide attempts in a year, the risk for another attempt is double that of units that had no attempts.

Grief after loss can be so intense that it prevents survivors from seeking help at a critical crossroad. But by helping survivors heal after a suicide, postvention reduces the risk of additional suicides in the deceased person’s circle. In that way, postvention healing is a vital component of prevention. Postvention is so important that the Rocky Mountain Mental Illness Research, Education and Clinical Center (MIRECC) has established USPV as part of VA’s mission to develop, disseminate and implement a comprehensive prevention program.

To learn more about USPV at the Rocky Mountain MIRECC, visit https://www.mirecc.va.gov/visn19/postvention/.

Resources

If you know someone grieving after a suicide loss, you may wish to read about ways you can help and talk to them. To learn about mental health support for Veterans, visit mentalhealth.va.gov.

• If you or someone you know is in crisis, don’t hesitate to get help.
  • Call 9-1-1 immediately.
  • Contact the Veterans Crisis Line, which connects service members and Veterans in crisis, as well as their family members and friends, with qualified, caring VA responders. Call 1-800-273-8255 and press 1, text to 838255, or chat online at net/Chat.
  • Call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text TALK to 741741.
• The Tragedy Assistance Program for Survivors (TAPS) provides free, compassionate care and survivor support services for the families of America’s fallen military heroes. Services include peer-based emotional support, grief and trauma resources, grief seminars and retreats for adults, Good Grief Camps for children, casework assistance, connections to community-based care, online and in-person support groups and a 24/7 resource and information helpline for all who have been profoundly affected by the death of a military loved one. For more information, visit taps.org or call the toll-free information helpline at 1-800-959-TAPS (8277).
• See related story, Postvention is key to suicide prevention says surviving spouse, advocate

Sarra Nazem holds a doctorate and is a clinical research psychologist at the Rocky Mountain MIRECC. She serves as a consultant for the Suicide Risk Management Consultation Program and delivers evidence-based treatment for Veterans.

Laurel Gaeddert provides administrative support for USPV and has assisted in the development of USPV resources. She earned a bachelor’s in psychology, with a minor in biology and a concentration in cognitive neuroscience, from the University of Denver.

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A new online library documents the CIA-led campaign that made it the most bombed nation in history, the effects of which are still felt by Laotian Americans today.

A new initiative is aimed at raising awareness about a dark and often forgotten chapter of U.S. history: the secret bombing of Laos during the Vietnam War.

Nearly half a century later, most Americans — and even many young Laotian Americans — know little about the clandestine, nine-year, CIA-led military campaign informally called the “secret war.”

Unlike the Vietnam War, the secret war is seldom taught in U.S. schools. For Laotian elders, most of whom came to the U.S. as refugees during and after the war, the memories can be too traumatic to revisit. Some take them to the grave.

The mission of the Legacies Library, a project of the Washington, D.C.-based group Legacies of War, is to keep the secret war from being lost to time.

A small team of volunteers has begun compiling educational materials about the war, including documentaries, scholarly research and government documents, and uploading free digital versions online.

They’re just getting started, said Sera Koulabdara, executive director of Legacies of War.

“We’re trying to preserve this history so we can protect the future,” said Koulabdara, who was born in Laos but largely grew up in Ohio. “We wanted to encourage more people to write about it and take interest in their history, including the American public.”

It wasn’t called the secret war for nothing.

The Johnson and Nixon administrations each oversaw U.S. military operations in Laos — technically a neutral country — without informing Congress of the full scale of the American involvement.

U.S. bombers were pummeling communist supply lines on both sides of the Vietnam-Laos border, often with little regard for civilian casualties.

They dropped an estimated 2 million tons of ordnance during the conflict, making Laos, on a per-person basis, the most bombed nation in history.

Congressional hearings in 1971 made the campaign known to the public. But by 1975, the U.S. had withdrawn from Vietnam and a weary nation was ready to move on.

In Laos, the communist Lao People’s Revolutionary Party took power, which it has held ever since.

The impact of the secret war continues to be felt today, including the danger of unexploded ordnance.

About a third of the American bombs failed to explode on impact. Leftover explosives still saturate the Lao countryside, posing a threat to farmers and children. Some 50,000 people have been killed or injured by unexploded ordnance since 1964, according to AUSLAO-UXO, a company with Lao and Australian owners that provides clearance services.

As the war wound down, thousands of refugees left Laos, with a large share settling in the U.S.

According to U.S. government data, there are about 200,000 Laotian Americans, nearly all of whom trace their heritage to this time, while the Hmong American community, which also includes many refugees from Laos, numbers around 300,000. The Hmong are a separate ethnic group — with a language and cultural traditions distinct from Lao — who have over the last two centuries migrated from China into parts of Southeast Asia.

Southeast Asian immigrants from this era often bury war memories in a “culture of silence,” mental health advocates say.

Some research suggests this trauma can be passed down through generations, manifesting in a sense of rootlessness or a lack of Lao identity among descendants.

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Legacies of War, formed in 2004, spent years pushing Congress to increase funding for bomb clearance in Laos. Its efforts paid off in 2016, when then-President Barack Obama became the first sitting U.S. president to visit the country. He doubled annual support for ordnance clearance efforts to $30 million.

That started to address one legacy of the secret war, but another one loomed: Americans’ continuing lack of awareness about it.

The idea for the Legacies Library came in 2020, after Koulabdara found herself sharing memories with Jessica Pearce Rotondi, a journalist and author in New York she met through social media.

Both had spent years rifling through musty boxes, trying to make sense of the family histories their loved ones could never tell.

After her father died in 2017, Koulabdara found photos from his childhood, old journals and notes from his career as a surgeon in Laos.

Rotondi had been researching her memoir “What We Inherit,” about her family’s search for answers about her uncle, an American pilot during the Vietnam War who never came home.

Searching her childhood home, she found boxes of heavily redacted, declassified CIA documents concerning his service, as well as stacks of letters that chronicled the family’s quest to find him.

Their exchanges convinced them of the need for more transparency about the bombing campaign in Laos.

“Those bars separated families and continue to keep Americans from knowing their history,” Rotondi said in an email, referring to the blacked-out portions of the documents. “Our goal with Legacies Library is to stop the silence around the Secret War.”

Two years later, the Legacies Library is taking shape.

Fact sheets and congressional testimonies offer a crash course on the continuing problem of unexploded ordnance in Laos. There are also links to books and documentaries selected by a Legacies of War review committee.

One of the library’s crown jewels is a group of 32 drawings by Lao villagers.

Collected by an American volunteer, Fred Branfman, in the 1970s, they depict what the U.S. air war looked like from below. They represent one of the only forms of direct testimony about the war by the Lao people.

Down the road, organizers hope to find funding for the library — it’s now run by volunteers — and add new, unique holdings.

One area where the library is lacking, Rotondi said, is its resources about the Hmong people, many of whom were key U.S. partners during the war. A museum in Minnesota, a state that nearly a third of Hmong Americans call home, commemorates that part of the story.

As for government materials, Sens. Patrick Leahy, D-Vt., and Sheldon Whitehouse, D-R.I.,are supporting efforts to declassify more CIA documents.

Another prospect is to add oral histories. As they become grandparents, some immigrants from Laos have started to open up about their war experiences.

It’s the curiosity of younger generations, though, that may make a fuller reconciliation possible.

In February, Laotian Ambassador to the U.S. Khamphan Anlavan gave an award to siblings Hyleigh and Prinston Pan, high schoolers in California, for their work to commemorate the secret war.

Hyleigh Pan has gathered testimonials for Southeast Asia-related legislation and helped produce a documentary about unexploded ordnance in Laos. Prinston Pan has recorded more than a dozen oral histories and organized school fundraisers for bomb cleanup in the country.

He has also written a children’s book, “Kong’s Adventure,” based on the experience of his grandfather, who served as a police chief in Laos under the U.S.-backed government before fleeing the communist takeover with his family and starting a new life in Kansas.

All proceeds go to the Legacies Library.

In an interview, Prinston Pan said that talking to the ambassador felt familiar, like talking to his grandfather.

The award, he thinks, “comes from a mutual care for the Lao community in general.”

“Over time, someone has to take the step forward in healing those wounds from the past.”

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Miami, Florida – Today, a Miami federal grand jury returned an indictment charging two Lauderhill residents for their roles in a fraud conspiracy that sold fake nursing degrees to people who had not completed the required nursing coursework or clinicals.

According to the indictment and a previously filed criminal complaint affidavit, Geralda Adrien, 51, and Woosvelt Predestin, 35, worked for PowerfulU Health Care Services LLC. Adrien was Powerful U’s President and Predestin was an employee. PowerfulU advertises itself on social media as a group of nurses and doctors who want to empower men and women by helping them to become health care providers. It is alleged that Adrien and Predestin assisted various individuals in procuring fraudulent nursing diplomas and transcripts from two nursing schools in Florida by falsely documenting that the individuals had completed the necessary courses and/or clinicals to obtain nursing degrees.

On March 18, 2021, for example, Adrien and Predestin met with an individual at the PowerfulU office and offered to sell the person a false degree, according to the criminal complaint affidavit. It is alleged that during the meeting, Adrien explained that for $16,000, Adrien would process the applicant through a Florida nursing school that was either on probation or closed, making it appear as if the applicant had in fact attended the school. Adrien also offered to help the individual pass the nursing board certification exam, and recommended that they take the exam in New York, as that state allows for unlimited attempts to pass. Adrien offered to fill out the application for the individual and offered to complete two continuing education unit classes which were required to apply for admission to the New York nursing board, according to the affidavit.

After the individual paid for the false nursing degree, it is alleged that Adrien provided a backdated diploma indicating completion of an Associate Degree in Science of Nursing and a fraudulent transcript that falsely reflected that the individual had completed approximately 72 credit hours and achieved a grade point average of 3.4. The individual’s application for licensure, which Predestin helped complete, was later forwarded to the New York State Education Department, according to the affidavit. It included a certification of completion two continuing educations courses-Child Abuse: New York Mandated Reporter Training and Infection Control and Barrier Precautions-that the individual had never taken.

The indictment charges Adrien and Predestin each with one count of conspiring to commit wire fraud and mail fraud. They face up to 20 years in federal prison on each count.

Juan Antonio Gonzalez, Acting United States Attorney for the Southern District of Florida, George L. Piro, Special Agent in Charge, FBI Miami, and Omar Perez Aybar, Special Agent in Charge, U.S. Department of Health and Human Services-Office of Inspector General, announced the charges.  

FBI Miami and HHS-OIG investigated the case, with assistance from United States Postal Inspection Service. The case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark. Assistant U.S. Attorney Nicole Grosnoff is handling the asset forfeiture component of the case.

This case is being prosecuted in conjunction with a related criminal investigation being conducted in the District of Maryland.

An indictment is merely a charging document and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

If you have information to report regarding this case or any other case involving falsified medical degrees, please call the FBI hotline: (410) 277-6999.

A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida atwww.usdoj.gov/usao/fla.

Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or onhttp://pacer.flsd.uscourts.gov.

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President Donald Trump signed the FY 2020 National Defense Authorization Act (NDAA) on Dec. 20 in a ceremony at Joint Base Andrews, Md. This landmark legislation culminates the many efforts ranging from grassroots visits at home to coordinated campaigns on Capitol Hill over a period of time ranging from months to decades.

MOAA’s Storming the Hill in April, and the Summer Storm in August, were instrumental in increasing awareness and support for the military pay raise, repeal of the “widows tax,” and protecting TRICARE and military medicine. The NDAA represented success in all of these advocacy priorities.

These engagements and achievements led to MOAA being recognized for the 13th year in a row as a top lobbyist by The Hill, a news outlet based in Washington D.C.

Here’s what’s included in the NDAA, and a look at these critical issues moving forward:

Pay Raise

What’s In: A 3.1% raise effective Jan. 1, 2020. The raise matches the administration’s request and is the largest pay increase for troops in 10 years. A 3.1% increase equates to an annual raise of $1,200 for an O-3 with 10 years of service.

What’s Next: MOAA will again start working to ensure the president’s budget for the next fiscal year includes a pay raise based on the Employment Cost Index (ECI) report from October 2019. Based on that figure, next year’s raise should be 3.0%.

TRICARE

What’s In: Congress approved no new fees or pharmacy increases in 2020. Previously agreed upon increases for medical and pharmacy copays will take effect in January 2020.

What’s Next: MOAA will continue to lobby against any disproportional fee increases that may exceed cost-of-living adjustments.

Medical Billets

What’s In: MOAA’s extensive efforts on the medical billet reduction issue paid off with a provision that addresses concerns regarding both medical readiness and beneficiary access to high quality care.

What’s Next: The provision prohibits DoD and the services from reducing medical end strength authorizations until they complete a series of steps. MOAA will monitor and ensure DoD performs the following:

• A review of medical manpower requirements of each military department under all national defense strategy scenarios.
• An analysis of affected billets together with mitigation plans to address potential gaps in health care services.
• The creation of metrics to determine TRICARE network adequacy.
• The establishment of outreach plans for affected beneficiaries, including transition plans for continuity of health care services.

Survivor Benefits

What’s In: After nearly 50 years, MOAA’s efforts and the efforts of others finally paid off with the elimination of a financial penalty more than 65,000 military survivors face, known as the “widows tax.” Eliminating the widows tax has been a top legislative priority for MOAA for decades.

Earlier this year, more than 150 members from around the country came to Washington, D.C. to participate in MOAA’s annual Storming the Hill event. One of the main topics MOAA members raised with their elected officials was eliminating the widows tax.

What’s Next: According to the legislation, the offset will be phased out over a three-year period in this fashion:

2020: No changes. Current Special Survivor Indemnity Allowance (SSIA) and all current Survivor Benefit Plan-Dependency and Indemnity Compensation (SBP-DIC) offsets remain in place. MOAA will continue to follow the evolution of directives which will support the implementation and ultimate completion of this repeal.

2021: The SBP-DIC offset is reduced by one third. Annuitants will receive the amount that would exceed two-thirds of the Dependency and Indemnity Compensation.

2022: The SBP-DIC offset is reduced by two-thirds. Annuitants will receive the amount that would exceed one-third of the Dependency and Indemnity Compensation.

2023: The SBP-DIC offset is eliminated. Annuitants will receive the full amounts of both SBP and DIC. Further, on Jan. 1, 2023, survivor benefit eligibility is restored to those who previously elected to transfer payment of their annuity to a surviving child or children.

Guard and Reserve

What’s In: For those National Guard and Reserve servicemembers who served on 12304B orders, such service will now count toward their active duty time to lower the age when they receive their retirement pay.

What’s Next: MOAA will continue to work to identify and correct inequities in service and benefits borne by servicemembers and their families in the Guard and Reserve. MOAA recently engaged the Defense Finance and Accounting Service (DFAS) to address the inordinate delay for retiring reservists – many routinely having to wait over 6 months to receive their retirement pay. Additionally, MOAA will continue to seek a standardized service record for members of the reserve component.

Medical Malpractice

What’s In: To address non-combat related military medical malpractice, the NDAA directs DoD to develop a regulation for negligent malpractice to be addressed through the military legal system. Although this is not a repeal of the 1950s era “Feres Doctrine,” it provides a framework of redress for servicemembers who have suffered from medical malpractice. The NDAA authorizes a payment up to $100,000 by DoD judges and higher amounts by the Department of the Treasury.

What’s Next: MOAA will monitor implementation and ensure our members and prospects understand the procedures and policies to be written in support of this legislation.

Spouse and Family

What’s In: After identifying significant health and safety concerns in military housing, MOAA elevated these issues to DoD and Congress, culminating with congressional hearing that built the foundation of legislation to direct improvements. This bill underwrites the most comprehensive military housing reform since 1996.

What’s Next: MOAA will watch closely the implementation of this housing reform to ensure the results follow the rigorous efforts leading to the bill, ensuring compliance with the following legislated actions:

• Establish a tenant bill of rights and responsibilities.
• Ensure medical costs and relocation expenses are covered by landlords.
• Formalize a dispute resolution process.
• Ensures a proper work order system and complaint database are in place along with a number of other provisions correcting gaps and negligence in the Military Housing Privatization Initiative (MHPI) system.
• Expand direct hire authority for DoD for child care providers. Additionally, take a closer look at the capacity of child care centers on post and streamline hiring to ensure they are properly staffed.

The bill also expands spouse employment resources, such as an increase to $1,000 for licensure reimbursement as well as expansions to the My Career Advancement Account (MyCAA) program for any degree area and to include Coast Guard spouses.

This defense bill is a big win for servicemembers and their families. MOAA thanks Congress for its bipartisan work, and President Trump for endorsing the legislation and extending our nation’s streak of producing a defense bill to 59 years.

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One of the largest hospital systems in the nation and two of its doctors will pay $37.5 million to resolve violations of the False Claims Act and the California False Claims Act. The settlement is a joint resolution with the U.S. Department of Justice and the California Department of Justice.

The United States and California entered into a settlement agreement with the Prime Healthcare Services system (Prime), Prime’s Founder and Chief Executive Officer Dr. Prem Reddy, and California interventional cardiologist Dr. Siva Arunasalam to resolve alleged violations of the False Claims Act and the California False Claims Act based on kickbacks paid by Prime to Dr. Arunasalam for patient referrals. Prime includes Prime Healthcare Services Inc., based in Ontario, California; Prime Healthcare Foundation Inc.; Prime Healthcare Management Inc.; High Desert Heart Vascular Institute (HDHVI); and Desert Valley Hospital Inc. Under the settlement agreement, Dr. Arunasalam will pay $2,000,000; Dr. Reddy paid $1,775,000; and Prime paid $33,725,000. The United States will receive $35,463,057 of the settlement proceeds, and California will receive $2,036,943. Prime and Dr. Reddy paid $65 million to settle previous unrelated allegations of false claims and overbilling in 2018.

“Offering illegal financial incentives to physicians in return for patient referrals undermines the integrity of our health care system by denying patients the independent and objective judgment of their health care professionals,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “Today’s settlement demonstrates the department’s commitment to protect federal health care programs against such violations, as well as other efforts to defraud these important programs.”

“Doctors have a sworn duty to do no harm and to put their patients’ interests first,” said Acting U.S. Attorney Tracy L. Wilkison for the Central District of California. “Kickbacks designed to increase the number of patient referrals corrupt the doctor-patient relationship and needlessly waste this nation’s health care resources.”

“In our cities and neighborhoods, hospitals are where we go for healing and care, which means they have to be a place that the people they serve can trust,” said California Attorney General Rob Bonta. “Today’s settlement should send a message that schemes like those alleged here, that put profits before people and seek to defraud our Medi-Cal program, will not be taken lightly.”

The settlement resolves allegations that:

• Prime paid kickbacks when it overpaid to purchase Dr. Arunasalam’s physician practice and surgery center because the company wanted Dr. Arunasalam to refer patients to its Desert Valley Hospital in Victorville, California. The purchase price, which was substantially negotiated by Dr. Reddy, exceeded fair market value and was not commercially reasonable. Prime also knowingly overcompensated the doctor when HDHVI entered into an employment agreement with him that was based on the volume and value of his patient referrals to Desert Valley Hospital;
• For approximately two years between 2015 and 2017, HDHVI and Dr. Arunasalam used Dr. Arunasalam’s billing number to bill Medicare and Medi-Cal for services that were provided by Dr. George Ponce, even though they knew Dr. Ponce’s Medicare and Medi-Cal billing privileges had been revoked, and that billing Dr. Ponce’s services under Dr. Arunasalam’s billing number was improper; and
• Certain Prime hospitals billed Medi-Cal, the Federal Employees Health Benefits Program and the U.S. Department of Labor’s Office of Workers’ Compensation Programs for false claims based on inflated invoices for implantable medical hardware. Dr. Arunasalam was not implicated in this conduct.

The Anti-Kickback Statute prohibits offering, paying, soliciting or receiving remuneration to induce referrals of items or services covered by a federal health care program, such as Medicare, Medicaid or TRICARE. Claims submitted in violation of the Anti-Kickback Statute may give rise to liability under the False Claims Act.

In connection with the settlement, Prime and Dr. Reddy entered into a five-year Corporate Integrity Agreement (CIA) with the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG). The CIA requires, among other things, that Prime maintain a compliance program and hire an Independent Review Organization to review arrangements entered into by or on behalf of its subsidiaries and affiliates.

“Federal healthcare funds are integral to the provision of necessary medical services to beneficiaries across the country,” said Special Agent in Charge Timothy B. DeFrancesca of the Office of Inspector General for the U.S. Department of Health and Human Services. “Therefore, we will address any actions, including those alleged in this case, that could compromise the system on which many patients rely. We will continue working with federal and state prosecutors to guard taxpayer funds that support these vital programs.”

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act in two lawsuits filed in federal court in Los Angeles. One suit was filed by Martin Mansukhani, a former Prime executive. The second suit was filed by Marsha Arnold and Joseph Hill, who were formerly employed in the billing office at Shasta Regional Medical Center, a Prime hospital in Redding, California. Under the qui tam provisions of the False Claims Act, a private party can file an action on behalf of the United States and receive a portion of any recovery. Although the United States did not intervene in these cases, it continued to investigate the whistleblowers’ allegations and helped to negotiate the settlement announced today. Mr. Mansukhani will receive $9,929,656 as his share of the federal government’s recovery. The cases are United States and the State of California ex rel. Martin Mansukhani v. Prime Healthcare Services, Inc., et al., 5:18-cv-00371-RGK (C.D. Cal.); and United States and the State of California ex rel. Marsha Arnold and Joseph Hill v. Prime Healthcare Services, Inc., et al., 5:18-cv-02124-FLA (C.D. Cal.).

The resolutions obtained in these matters were the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section; the U.S. Attorney’s Office for the Central District of California; the California Attorney General’s Office’s Division of Medi-Cal Fraud and Elder Abuse; and HHS-OIG.

The investigation and resolution of this matter illustrate 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).

The cases were handled for the United States by Senior Trial Counsel Marie V. Bonkowski of the Civil Division and Assistant U.S. Attorneys Jack D. Ross and Abraham C. Meltzer of the Central District of California.  

The claims resolved by the settlement are allegations only, and there has been no determination of liability.

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An experimental vaccine designed to protect against many flu virus strains has yielded promising results in an efficacy trial. NIAID investigator Matthew J. Memoli, M.D., designed and led the trial, which involved administering one or two doses of the experimental vaccine or a placebo injection to healthy adults. All the volunteers were later exposed to a strain of seasonal influenza virus under carefully controlled conditions. The aim was to determine whether the experimental vaccine, FLU-v, lessened the chance that a volunteer would develop flu symptoms and viral shedding. Trial results were published March 13 in the journal npj Vaccines.

FLU-v is an example of a “universal” influenza vaccine candidate, a still-experimental vaccine that may provide long-lasting protection against most or all flu strains. Traditional seasonal flu vaccines trigger production of antibodies aimed at a part of a flu virus surface protein that varies widely from strain to strain and that changes continuously. Therefore, flu vaccines must be re-formulated and administered annually to match newly arising strains. In contrast, FLU-v is designed to prompt a response not by antibodies, but by a separate arm of the immune system—cellular immunity. Cellular immune responses include activity by white blood cells called cytotoxic T lymphocytes (CTLs). Recent research has shown that influenza-specific CTLs can seek out and remove virus-infected cells before and after flu symptoms arise. The FLU-v vaccine is designed to stimulate production of these flu-specific CTLs by targeting several proteins inside the virus that do not vary much from strain to strain, meaning that CTL responses against them may be effective against many virus strains. FLU-v is being developed by the London-based company PepTcell (SEEK).

In the recent trial, participants were randomly assigned to one of three groups and given two injections spaced 21 days apart. One group received two doses of FLU-v; a second group received one dose of FLU-v and one saline placebo; the third group receive two injections of placebo. The trial was blinded, meaning neither the volunteers nor any trial investigators were aware of group assignment. All volunteers were exposed via a nasal spray to live influenza virus either 43 or 22 days after the second injection. The flu challenge portion of this trial took place at Hvivo, London, UK.

Volunteers who received one or two doses of FLU-v were significantly less likely to develop mild to moderate influenza disease (MMID) than placebo recipients. In the placebo group; 23 of 42 volunteers (54.8%) experienced MMID, defined as virus shedding and clinical influenza symptoms, while 15 out of 41 (36.6%) volunteers in the two FLU-v doses group and 13 out of 40 (32.5 %) of those who received one dose of FLU-v experienced MMID. Dr. Memoli stated that the results of this study “suggest that cellular immunity may be a very important and necessary component of future broadly protective universal influenza vaccines.”

Dr. Memoli and his colleagues in NIAID’s Laboratory of Infectious Diseases developed both the challenge virus strain and model of human influenza challenge used in this trial. Previous human influenza challenge trials conducted in the NIH Clinical Center’s Special Clinical Studies Unit by Dr. Memoli demonstrated that the challenge virus reliably causes MMID in most recipients. In this video tour, Dr. Memoli shows special features of the unit where these trials were conducted.

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The Department of Veterans Affairs' $243.3 billion budget request for next fiscal year includes a $75 million increase for cancer treatment so the VA can "deliver the most up-to-date care as close to the patient's residence as possible."

The investment would go toward the VA's precision oncology program, which moves away from one-size-fits-all cancer treatments to personalized care that focuses on the patient's and cancer's DNA mutations to figure out the best treatment.

Retired 1st Sgt. Jeremy Kitzhaber, 49, considers it a great improvement.

"I'm all for it because I had to go outside of the VA to get it," he said.

Kitzhaber spent 22 years in the Air Force, where he worked in civil engineering. Before retiring in 2012, he deployed several times, including Incirlik Air Base, Turkey, for earthquake relief and Al Dhafra Air Base, United Arab Emirates, in support of Operation Iraqi Freedom.

While he prefers to receive care from the VA, it wasn't possible in 2014 when he was diagnosed with Pseudomyxoma Peritonei, or appendix cancer, which "leaks everywhere."

It was caused by exposure during his duties to radiation and chemical and biological hazards, he said.

Since there were no VA oncology physicians who specialized in his cancer, Kitzhaber went to a private provider in Omaha, Nebraska. The surgeon lifted Kitzhaber's organs out of a 13-inch incision in his abdomen and "washed his inner belly with chemo," he said.

When he returned to the VA, his medical team started him on traditional chemotherapy that was so severe he almost died. The cancer returned a few months later.

"Cancer care is changing rapidly and becoming increasingly complex," a VA spokeswoman said via email Thursday. "The overall mission of the Precision Oncology initiative is to improve the lives of Veterans with cancer through Precision Medicine by implementing a learning health care model to quickly transition new knowledge into clinical practice and to maximize learning from clinical practice."

Precision medicine is what ultimately saved Kitzhaber's life. The first genetic test he received from the Omaha physician showed nothing more could be done for his stage 4 cancer. But a second opinion and blood test from an oncologist in San Diego proved a breast cancer drug would drastically slow the cancer's progress.

"I tell people it was 60 miles an hour with no treatment; now it's 1 mile an hour," he said, adding that the drug has had few side effects: a little fatigue, slightly thinner hair and more brittle nails.

That's compared to 20 rounds of chemotherapy, which caused him to black out four times due to his heart going into atrial fibrillation.

Among the initiatives to be funded by the VA's budget request will be the National Precision Oncology Program (NPOP), which gives access to a tumor DNA sequencing database and a national molecular oncology tumor board. It will also fund "TeleOncology," a service to let patients access oncology specialists remotely through the internet.

There are about 40,000 cancer cases reported to the VA's Central Cancer Registry annually, according to a 2012 study. Though the database is not available to the public, the VA reports that the five most frequently diagnosed cancers among Veterans are prostate; lung and bronchial; urinary and bladder; colon; and skin.

Terrence Hayes from Veterans of Foreign Wars said in an email that his organization has heard from several Vets who have struggled to find the right care for their specific need and have had to undergo "rigorous" cancer treatments like Kitzhaber.

"It is encouraging to see VA institute this program and focus more on a personalized approach to cancer treatment for our Veterans," he said. "A one-size-fits-all approach to cancer treatment cannot be the way we look at treating our Veterans, especially many who developed these cancers due to the environmental hazards they have come in contact with during their service."

Hayes added the VFW hopes this means the VA will have quicker diagnoses and more thorough treatment measures to extend Veterans' lives.

William Goeren, CancerCare director of clinical programs, said he's found that, while precision oncology has fragmented care, it gives a lot more hope for patients.

"I will say that precision medicine does provide a patient with a greater sense of hope and individualized attention versus a one size fits all," he said. "[But] there are often so many [medical doctors] involved in a case that patients often don't know who is leading their treatment, especially if a patient has co-morbidities."

CancerCare is a national organization that provides free counseling and emotional support services to cancer patients. It's been studying how to work with Veterans with cancer as it tries to create a support group for them.

Goeren said he's found that, while Veterans have similar challenges as other cancer patients -- including financial strain and transportation difficulties, they have trust issues when it comes to getting care.

"In some ways, they feel betrayed by their own government. It was through their work that they have now come down with cancer," he said. "There's a sense of 'I've been burned once -- by an organization, the federal government -- so I'm not trusting of anything.'"

Goeren said this is similar to what black or LGBT patients feel when it comes to receiving health care treatment when they have historically been shunned.

Currently, the VA's options for cancer treatment include surgery, chemotherapy, immunotherapy, targeted therapy and hormonal therapy, among others, the VA spokeswoman said. A VA patient is tested for cancer when he or she has symptoms or abnormal test results. If the test shows cancer, the treatment approach will vary based on the patient and cancer.

"Cancer diagnosed at any age is scary," Kitzhaber said. "We have these life plans all that kind of go away."

Before his diagnosis at 43, he said he had his life planned out until the age of 80, looking forward to celebrating his 50th wedding anniversary and taking care of grandchildren. Now, his outlook is much shorter.

"It's not always easy to go outside the system," he said. "Seventy-five million dollars, to me, for people to have a better quality of life, live longer, is money well spent."

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The fall and winter flu season may bring out dishonest sellers hawking fraudulent products to unsuspecting consumers, who are already concerned about protecting themselves from coronavirus disease 2019 (COVID-19) and other infectious diseases.

Some of these sellers offer unproven products that claim to prevent, mitigate, treat, or cure the flu even though they have not been evaluated or approved by the U.S. Food and Drug Administration (FDA) for safety and effectiveness. These products might be dangerous to you and your family. The FDA urges consumers to avoid fraudulent flu products and offers some tips on how to spot them.

These products can be found online, including popular marketplaces, and in retail stores. They may be labeled as dietary supplements, foods, hand sanitizers, nasal sprays, or devices.

A Flu Vaccine Is the Best Prevention

Flu is a serious disease, caused by influenza viruses, that can lead to hospitalization and even death. Getting a flu vaccine is the best way to prevent this infectious disease and its serious complications.

The Centers for Disease Control and Prevention (CDC) recommend that all people, ages 6 months and older, get vaccinated against influenza – particularly those at an increased risk for serious complications, including young children, adults 65 years and older, and those with chronic medical conditions. For more information on vaccines, immunization and where to get vaccinated, visit https://www.vaccines.gov/.

The FDA has approved vaccines for the prevention of influenza. And if you do get the flu, there are FDA-approved antiviral drugs, available by prescription, to treat the illness. These medicines are recommended by the CDC for use against recently circulating influenza viruses. They work best if started soon after the onset of symptoms (within 48 hours).

Flu antiviral medications are used to prevent or treat flu and are available by prescription in the form of pills, liquids, inhalers, and intravenous infusion. The various products are all approved for adult use and differ in the ages for which they are approved to treat children, ranging from 2-weeks-old to age 12.

• If you get the flu, antiviral medications can make your illness milder and may make you feel better faster. Antiviral medications work best when started within the first two days of getting sick.
• If you are exposed to the flu, antiviral medication can help prevent you from becoming sick. Talk to your health care provider if you have been or may be near a person with the flu.

Types of Fraudulent Flu and Antiviral Products

There are no legally marketed over-the-counter (non-prescription) drugs to prevent, mitigate, treat, or cure the flu. But there are legal over-the-counter (OTC) drugs to reduce fever and to relieve muscle aches, congestion, and other symptoms typically associated with the flu.

Dietary supplements, conventional foods (such as herbal teas), or devices (such as certain air filters and light therapies) that fraudulently claim to prevent, mitigate, treat or cure the flu haven’t been evaluated by the FDA for safety and effectiveness.

During the COVID-19 pandemic, many of the same types of unproven products have been offered for sale with fraudulent claims to prevent, mitigate, treat, or cure COVID-19. Some products are sold with claims about antiviral effects, and others make claims about preventing or treating viral infections.

The FDA is particularly concerned that these fraudulent products might cause people to delay, forgo, or stop the medical treatment they need, leading to serious and life-threatening harm. The ingredients in them could lead to unexpected side effects and interactions with other medications people may be taking.

Protect yourself and your family by being on the lookout for potentially fraudulent flu and antiviral products being sold without a prescription, which may claim to:

• Reduce the severity and length of flu or other viral infections.
• Boost your immunity naturally without a flu vaccine.
• Act as a safe and effective alternative to the flu vaccine.
• Prevent catching the flu or viral infections.
• Be an effective treatment for flu or viral infections.
• Provide faster recovery from the flu or viral infections.
• Support your body’s natural immune defenses to fight off flu or other viruses.

Find Out if Your Online Pharmacy Is Safe

Websites appearing to be online pharmacies selling prescription drugs present an opportunity for fraudsters to take advantage of unsuspecting consumers. Legitimate online pharmacies do exist. But so do many websites that look like safe online pharmacies but are actually fraudulent and engaging in illegal activity. These websites may be selling unapproved drugs.

Unsure about an online pharmacy? Visit the FDA’s BeSafeRx to learn how to safely buy prescription medicines online. If you have a question about a treatment or product, talk to your health care provider or doctor.

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Physical distancing and face coverings key safety measures

More than 100 VA health facilities across the U.S. have started to offer in-person care again for many non-urgent needs and appointments. At the same time, COVID-19 cases continue to rise in many parts of the country.

As more Veterans begin to return for in-person care, safety is our top priority. That’s why we continue to monitor and adjust our in-person services, as needed, for each facility. It’s also why it’s more important than ever for everyone to follow the safety measures we’ve put in place. These include practicing physical distancing and wearing face coverings.

Pictured above with unique photo-only badges is the inpatient physical therapy team at VA’s North Las Vegas Medical Center. Left to right are Ismael Magoto, Courtney Haia and Kaitlyn Burns.

Physical distancing and face coverings are our best safety measures

The virus that causes COVID-19 spreads from person to person through the air. When an infected person coughs, sneezes or talks, droplets from their mouth or nose can travel through the air and into the mouths, noses or lungs of people nearby. Even people who are infected but show no symptoms of COVID-19 can likely still spread the virus.

Because of this, physical distancing and cloth face coverings are two of the best ways we can protect ourselves and others.

Physical distancing

We’ve made changes to our spaces and processes to help Veterans, caregivers and employees stay at least six feet (about two arms’ lengths) apart in our facilities, when possible. The farther apart you are from someone who’s infected, the less likely you are to have contact with their droplets that can carry the virus.

Changes include using remote check-in options by text or phone and creating more space in waiting rooms.

Face coverings

We now require everyone who enters a VA facility to wear a cloth face covering. This helps to keep the virus from spreading when a person coughs, sneezes or talks. Read more about our face covering policy.

We encourage you to follow these tips for wearing a face covering:

• Make sure your face covering fits snugly over your mouth and nose. You should be able to breathe without restriction.
• When you take your face covering off, don’t touch your eyes, nose or mouth. And don’t touch the outside of the face covering.
• As soon as you remove your face covering, wash your hands or use hand sanitizer.
• Wash or replace your face covering each day.

Focusing on your safety and comfort while providing the highest quality care

VA employees across the country are wearing their face coverings and other protective attire to help protect Veterans, caregivers and coworkers. And they’re coming up with creative ways to help Veterans feel comfortable in this new reality.

For example, employees at the North Las Vegas VA Medical Center found it harder to make a connection with some Veterans with their faces covered. To help, the team decided to get photo badges. This gives Veterans a face to put with the name of the caregiver behind the face covering.

“It’s hard to see a smile behind the mask and shield, but at least this way they can identify with us on a more personal level,” explained Courtney Hala. Hala is a supervisory physical therapist at the medical center.

We stand firm in our belief that all Veterans have the right to expect safe care when they come to VA. To learn more about our efforts to provide safe care, go to our VA.gov coronavirus FAQs.

To learn more about how to protect yourself and others, go to the CDC website.

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Physical distancing and face coverings key safety measures

More than 100 VA health facilities across the U.S. have started to offer in-person care again for many non-urgent needs and appointments. At the same time, COVID-19 cases continue to rise in many parts of the country.

As more Veterans begin to return for in-person care, safety is our top priority. That’s why we continue to monitor and adjust our in-person services, as needed, for each facility. It’s also why it’s more important than ever for everyone to follow the safety measures we’ve put in place. These include practicing physical distancing and wearing face coverings.

Pictured above with unique photo-only badges is the inpatient physical therapy team at VA’s North Las Vegas Medical Center. Left to right are Ismael Magoto, Courtney Haia and Kaitlyn Burns.

Physical distancing and face coverings are our best safety measures

The virus that causes COVID-19 spreads from person to person through the air. When an infected person coughs, sneezes or talks, droplets from their mouth or nose can travel through the air and into the mouths, noses or lungs of people nearby. Even people who are infected but show no symptoms of COVID-19 can likely still spread the virus.

Because of this, physical distancing and cloth face coverings are two of the best ways we can protect ourselves and others.

Physical distancing

We’ve made changes to our spaces and processes to help Veterans, caregivers and employees stay at least six feet (about two arms’ lengths) apart in our facilities, when possible. The farther apart you are from someone who’s infected, the less likely you are to have contact with their droplets that can carry the virus.

Changes include using remote check-in options by text or phone and creating more space in waiting rooms.

Face coverings

We now require everyone who enters a VA facility to wear a cloth face covering. This helps to keep the virus from spreading when a person coughs, sneezes or talks. Read more about our face covering policy.

We encourage you to follow these tips for wearing a face covering:

• Make sure your face covering fits snugly over your mouth and nose. You should be able to breathe without restriction.
• When you take your face covering off, don’t touch your eyes, nose or mouth. And don’t touch the outside of the face covering.
• As soon as you remove your face covering, wash your hands or use hand sanitizer.
• Wash or replace your face covering each day.

Focusing on your safety and comfort while providing the highest quality care

VA employees across the country are wearing their face coverings and other protective attire to help protect Veterans, caregivers and coworkers. And they’re coming up with creative ways to help Veterans feel comfortable in this new reality.

For example, employees at the North Las Vegas VA Medical Center found it harder to make a connection with some Veterans with their faces covered. To help, the team decided to get photo badges. This gives Veterans a face to put with the name of the caregiver behind the face covering.

“It’s hard to see a smile behind the mask and shield, but at least this way they can identify with us on a more personal level,” explained Courtney Hala. Hala is a supervisory physical therapist at the medical center.

We stand firm in our belief that all Veterans have the right to expect safe care when they come to VA. To learn more about our efforts to provide safe care, go to our VA.gov coronavirus FAQs.

To learn more about how to protect yourself and others, go to the CDC website.

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Do you know what will happen to your digital “stuff” when you die?

Do you know what happens to your email accounts, social media profiles, photos, videos, online bank accounts, documents and more when you pass away? A recent segment on CBS This morning sat down with Army National Guard Veteran Jennifer Sardam to talk about GoodTrust, an online digital-legacy service.

Sardam, who served with the 29th Mobile Public Affairs Department and who joined the Army National Guard in 2006, once lost all of her childhood photo memories during a devastating house fire. This heart-breaking loss, coupled with her parental instinct to plan ahead, got her thinking about better protecting her digital legacy.

That’s when Sardam turned to GoodTrust, an online digital-legacy service that gives you control over what happens to your digital accounts and memories when you pass. Think of it as a virtual safety-deposit box or a will for your digital accounts, photos, financial accounts, documents, last goodbyes and more. For her and countless others, it represents a peace of mind in today’s connected world.

“I have at least 13,000 photos on my phone and probably a few hundred videos,” Sardam told CBS. “It just feels really good and I want to be able to share that and keep it alive even long after I’m gone.”

Just as we arrange life insurance or wills for our physical possessions, we need to also plan for the post-life experience with our digital stuff. In today’s connected world, managing what happens to your digital stuff in the afterlife is often as important as deciding what happens to your physical assets when you die.

The GoodTrust digital-legacy platform gives you control over what happens to your digital assets and reputation when you pass away. Think of it like a virtual safety-deposit box for your digital accounts and information.

GoodTrust also now offers innovative ways to create your digital legacy, like bringing photos to life with AI and facial-recognition technology to animate them. It’s called GoodTrust Memories and only involves uploading a photo and clicking a button to see the magic in action. It works well with both historic and current photos, which can then be shared with loved ones or on social media. It’s just the beginning of how technology with GoodTrust can help preserve anyone’s memories and stories in new and meaningful ways.

GoodTrust – Protecting everyone’s digital legacy

Let’s be honest – no one likes thinking about death. But the reality, of course, is that it’s all around us, through popular culture and life events and perhaps never more so in recent memory than with the devastating impact of the Covid-19 pandemic. It’s also something never far from the minds of our military service people as they devote their lives to protect the country.

GoodTrust would like to extend two special cost-free offers to all Veterans to help preserve their digital legacy.

To help you get started, the new book – Digital Legacy: Take Control of Your Online Afterlife – will empower you with what’s important about your online afterlife and ensure that your important digital assets are treated according to your wishes. Given that the average person spends close to seven hours per day online, it’s an essential read for everyone.

For a limited time all Veterans will at no cost receive the GoodTrust Premium service plan for one year (value $70) when you create an account at MyGoodTrust.com/partner/GoodTrustVeteran (if you already have a free account then just follow that link and log in).

In addition, all Veteran families will receive a 50% discount on the GoodTrust service fee when helping to manage the digital accounts of a Veteran who has passed away. Just register as a free GoodTrust member through that link, click on For Someone Else, and redeem the discount code GoodTrustVeteran at checkout.

The first 100 Veterans who register in April will also get the new e-book – Digital Legacy: Take Control Of Your Online Afterlife. Instructions on how to download the Digital Legacy e-book from Amazon.com will be emailed to you.

How does GoodTrust work?

Once you’ve signed-up on www.MyGoodTrust.com, you’ll go through two simple steps:

1. Add your important digital media accounts and documents – your social media, email, online documents, photos, financial accounts, life insurance, will etc. For each account or document, you add instructions for what you want to happen if you pass away.
2. Assign “deputies,” or those friends, family or people you trust to manage your accounts to take action on your behalf. These folks are granted selective access to your accounts and documents, along with the instructions you left for them.

From there, it’s up to you to choose your digital legacy; GoodTrust keeps your data safe by using industry-leading security and two-factor authentication.

The time is now. Don’t let your digital legacy be lost; ensure that your family and friends find your accounts, documents and priceless photo memories. It’s the digital story of you.

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Lawmakers pledged more study and action now that a Pentagon study has shown elevated cancer risks for military aviators and aviation ground personnel. Completed in January, the study is among the most comprehensive analyses of military aviator cancer yet.

The Defense Department examined health records for 156,050 aviators and 737,891 ground crew for the period 1992 to 2007, concluding that aviators were 24 percent more likely to be diagnosed with cancers of all kinds than members of the general population, when adjusting for age, sex, and race. Ground crew personnel were 3 percent more likely to be diagnosed with cancer.

Congress ordered the study in the 2021 National Defense Authorization Act in response to growing concern among retired pilots concerned about an apparent rising incidence of cancer.

The new study found even higher rates with specific types of cancer. For example, aircrew were 87 percent more likely to suffer melanoma, 39 percent more likely to have thyroid cancer, and 16 percent more likely to contract prostate cancer. For ground crew, the most elevated rates were for brain and nervous system cancers (19 percent increased risk), thyroid cancer (15 percent higher risk), melanoma (9 percent higher risk), and kidney and renal pelvis cancers (also 9 percent higher risk).

Actual rates are probably higher, researchers acknowledged, as “data from VA and civilian cancer registries were not included.”

The Associated Press first reported the study’s findings earlier this month. A copy obtained by Air & Space Forces Magazine build upon a 2021 study from the Air Force’s School of Aerospace Medicine, part of the Air Force Research Laboratory, which studied the health histories of fighter pilots and backseat aircrew from 1970 to 2004. Among nearly 35,000 aviators studied, results also showed double-digit elevated risks for melanoma and prostate cancer.

“We have two, arguably, bellwether studies,” said retired Air Force Col. Vince Alcazar, head of the Red River Valley Fighter Pilots Association’s aviator medical issues committee, in an interview with Air & Space Forces Magazine. “Their exact conclusions are not the same, but they align on the basic themes of elevated aviator cancer, which as a headline seems to continue to surprise people in government, both lawmakers and leaders inside the Pentagon.”

At a House Appropriations Committee hearing on March 28, Rep. Betty McCollum (D-Minn.) challenged both Air Force Secretary Frank Kendall and Chief of Staff Gen. Charles Q. Brown Jr. to get to the bottom of these risks.

“Let’s get our arms around this. Let’s work together,” McCollum said. “We have a big military health budget … and I know that members are concerned about this. So what can we do to help you? There might be specific things you need to have us look at and direct the money to go there.”

Brown emphasized the need for more study to continue to better understand the issues.

“We will learn more and more as we collect more and more data and start asking more and more questions about particularly those that are flying in fighter cockpits,” Brown said. It’s important to understand what factors drive the cancers in order to design protection into aircraft to guard against future exposure. “Because you’re exposed to the sun more,” he said, but “you also have a radar in the airplane. [We’ll] try to understand what the causes may be associated with those and then how we may take some mitigation.”

Both studies focused on cancer rates, not causes. A range of possible factors, including galactic cosmic radiation, ultraviolet radiation, radar radiation, exposure to jet fuel and fumes, and non-ionizing radiation from radars and jamming equipment all pose potential risks. These hypotheses must be studied, however, to reach more advanced conclusions. Advocates say even more work can be done to capture all the necessary data.

“Databases that track diagnosis of cancer and death from cancer, those databases aren’t as old as we would like them to be, nor probably as we need them to be in a more ultimate sense,” Alcazar said.

Work on both fronts is set to unfold in the months ahead. Having found elevated cancer rates, the 2021 NDAA now requires the Pentagon to perform a Phase 2 study to identify what hazardous or carcinogenic materials, environments, or duties might be contributing to that elevated risk, and to examine time frames, dates and locations of service, and specific types of aircraft that might further indicate trends.

In addition, the DOD is looking at a follow-up to the original study to include more data from other databases.

On top of that, Alcazar said advocates are working with members of Congress to introduce legislation directing so-called “nexus” studies to determine if there is scientific evidence tying any particular exposure or carcinogen to a risk of cancer diagnosis or death.

Alcazar and the Red River Valley Pilots worked with Rep. August Pfluger (R-Texas), a former Air Force F-15 and F-22 pilot, and others to introduce legislation in the last session of Congress; now they intend to reintroduce a bill, Alcazar said.

“I’m optimistic in a guarded way that the aviator cancer study adds to not only the conversation but accelerates it in Congress,” said Alcazar, pointing to the successful passage of the PACT Act last year, which offered expanded benefits for Veterans exposed to toxins during their service.

“One of the things that [the PACT Act] did was it took the phrase ‘toxic exposure’ and injected it into conversation and stripped away the sort of skepticism and mythological elements, I think, that were present in a lot of people’s minds,” Alcazar said. “And I think this study kind of stands on that a little bit.”

Determining toxic exposures matters for both the Pentagon and Air Force, that can then take action to mitigate those exposures for those currently serving, and for Veterans’ advocates, who want to ensure those who become sick from their service get the care they need.

“We may not know how big this problem is,” Alcazar said. “And the size of the problem matters because we have to deploy resources that are solutions to match it. So particularly on the Veterans side, it’s important that we get to an a well-designed nexus study … and that multi-year study, we now transform that into law and policy, so that we can help the flyers that are sick today. We can’t bring back the ones that have succumbed. What we can do is create tracking and treatment that is more in-time oriented, so that we improve outcomes.”

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This case involves the failure of the Board of Veterans Appeals to address all evidence related to the Veteran’s possible exposure to asbestos in military service when it denied service connection for the cause of the Veteran’s death.

Our client appealed the BVA’s decision to the U.S. Court of Appeals for Veterans Claims (CAVC).

The appeal was resolved through a joint motion for remand: the government attorney agreed with Alexandra Curran’s arguments that the Board failed to address all relevant evidence of in-service asbestos exposure.

ISSUE ON APPEAL TO THE CAVC:

This appeal involved the BVA's failure to address all relevant evidence as it related to the Veteran’s cause of death.

Based on an alleged lack of evidence and the Veteran’s military occupational specialty, the Board determined that the Veteran did not establish in-service exposure to asbestos in his VA claim.

As a result, the BVA denied service connection of the cause of the Veteran's death, preventing his surviving spouse from receiving disability compensation in the form of Dependency and Indemnity Compensation (DIC). DIC and accrued benefits are two of the most common benefits sought by a Veteran's surviving spouse, but they are certainly not the only such benefits.

Service connection for cause of death may be granted if a service-connected condition was either the principal or contributory cause of the Veteran's death.

A principal cause of death means that the service-connected condition was the immediate or underlying cause of the death. A contributory cause of death means that the condition contributed materially or substantially to the death or aided in the death.

The Veteran’s death was caused by chronic obstructive pulmonary disease (COPD), lung cancer and brain cancer. His surviving spouse sought service connection for the cause of his death due to in-service asbestos exposure.

While most cases involving asbestos exposure in military service involve navy Veterans, Veterans from other branches of the military were exposed to asbestos.

The Board held that the Veteran was not exposed to asbestos in military service, explaining that the Veteran’s wife did not have personal knowledge of the exposure and relying on his military occupational specialty of truck driver.

However, the Board failed to address three pieces of important evidence: 1) his wife’s statement that her husband talked about performing repair work on the trucks he drove while in the military; 2) the Veteran’s DD 214 that listed auto mechanic training; and 3) an article explaining reasons for high risk of asbestos exposure in the automotive industry.

Ms. Curran argued that the BVA erred in failing to address this evidence regarding possible exposure to asbestos.  

RESOLUTION AT THE CAVC:

The Secretary agreed that the Board of Veterans Appeals erred when it provided an inadequate statement of reasons or bases to support its determination that the Veteran was not exposed to asbestos in military service, since the BVA did not address all the evidence of record related to his possible in-service exposure.

The parties identified at least 3 pieces of evidence that related to the Veteran's possible exposure to asbestos in military service, and (among other things) directed the BVA to address that evidence on remand.

The Veteran and the VA’s Office of General Counsel filed a joint motion to vacate and remand the appeal back to the Board to fix its errors.

If the BVA decision in this case sounds like yours, or if you have a BVA decision that involves clear and unmistakeable error, reach out to the law firm of Attig | Steel.

Click here to submit your BVA decision and one of our attorneys will see if there is anything we can do to help.

Link to the BVA Decision on CAVC Website.

Link to the Joint Motion to Remand the CAVC Website.

Case Details

OGC Attorney: Sarah Catherine Blackadar (link to attorney bio on LinkedIn)

Veteran Representation at CAVC: Alexandra Curran (link to bio)

Board of Veterans Appeals Veterans Law Judge: K. Parakkal

Vet's Rep at BVA: pro-se

Date of BVA Decision: June 21, 2018

Date of CAVC Judgment on Remand: May 10, 2019

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Many Veterans have illnesses or injuries that occurred while they were active duty but there are no records of the illness or injury. There can be many reasons; records get lost, the Veteran was treated at civilian medical installation and the records have been destroyed; the Veteran didn’t get treatment because they were worried, they might get medically discharged due to the illness or injury. Whatever the reason, just because there are no records does not always mean that the Department of Veterans Affairs won’t grant service connection. Here, we will cover how to prove a service-connected disability, and obtain VA disability benefits, without service treatment records.

What is Service Connection?

When a Veteran files for disability compensation, there are several types of claims the Veteran can file; direct service-connected; service-connection through aggravation, presumptive service-connection, secondary service-connection, and service connection for injuries caused by the VA Health System. These different types of service connection are explained in detail in our blog What is VA Service Connection and Establishing Service Connection and the VA. Basically what service connection means is exactly what it says, the injury or illness was connected to the active-duty military service. Now, that does not mean that the Veteran is limited to being harmed in combat or training. It also included any injury or illness experienced during the time the Veteran was Active Duty as long as the injury was not due to willful misconduct. They may also include diseases or injuries that occur after service but are secondary to an illness or injury that did occur in service (secondary condition).

If a Veteran qualifies for presumptive service connection, they won’t need to present the same evidence as those filing for other types of service connection to receive Veteran’s disability benefits. This is because the Veteran meets certain eligibility requirements. For example, Vietnam Veterans who served in specific locations during a specific timeframe are presumed to have been exposed to Agent Orange. If they’re living with one of the conditions presumed to be connected to this chemical exposure, they are automatically eligible for benefits. Gulf War Veterans have a similar set of presumptive conditions.

Evidence: Proving an In Service Injury or Illness

Every disability claim filed with the VA must have some type of evidence to corroborate the claim. Evidence requirements vary based on the type of claim and the issue being claimed. For an average claim, one without presumption or an injury caused by combat or being a POW, there are usually specific types of evidence a Veteran needs to show service connection.

1. The onset of the illness or an injury documented during active-duty service;
2. Treatment records that are relatively consistent between the time of illness or injury and the date of the claim; and
3. Records showing a current diagnosis of the illness or injury residual and how they cause disability, even if it is just pain or having to change something such as diet or lifestyle, adding weight gainers for people underweight and so on.

Sometimes, there are no records of treatment in service to serve as medical evidence. There are many reasons why, but one of the main reasons is that active-duty military members do not want to go to the doctor for fear of being medically discharged for a medical condition that is potentially going to limit them from doing their job. They will just put up with it until they retire or get out, then they will see a doctor. Several other reasons are that the records were destroyed, were not even kept (often this happens in the field such as deployed training exercises, survival training, or in combat situations, anywhere there is no official military medical installation).

The VA has a “duty to assist” by law. The law, the Veteran’s Claims Assistance Act (VCAA) defines the VA’s role and responsibilities in assisting Veterans in developing their claims by attempting to obtain evidence from Federal agencies and providing a VA medical exam or a medical opinion if deemed necessary.

Lay Evidence

Again, what if they don’t exist? This is where another type of evidence comes into play. Lay evidence is evidence that does not come from professional sources like health care providers. Rather, it comes from individuals like fellow service members, family members, and even coworkers. These are individuals who can speak about the in-service event and/or the effects of the current disability.

Getting people who knew the Veteran while in service who can attest to the condition of their health (no medical diagnosis, but personal observations), or who can recollect and corroborate an injury or event that caused an injury can also serve as evidence. Lay evidence must meet certain criteria to be considered by the VA. It must be credible and competent. This means that it must be believable and fit with any other evidence that is provided such as current medical records. If a fellow troop makes a buddy statement saying a Weteran, he served with broke his leg on a hike during training. However, the current X-rays do not show evidence of an old fracture. Therefore, that would not be a credible statement because the current evidence disputes the lay statement. If a mother makes a statement that her Veteran son, who was on a ship, had bronchitis. That would not be a competent statement as she is not a medical professional who can access the Veteran to make a diagnosis. What they can provide is a statement that the first Veteran hurt his leg when he fell and the second Veteran was coughing a lot. Only professionally licensed personnel can make a diagnosis. Moreover, exaggerations of events will only serve to ruin the credibility of any other evidence that person submits on the Veteran’s behalf, no matter how true it is.

Other Avenues of Research

Another way is to find other incidents that can show a probability that an injury or illness occurred. Deck logs, installation newspaper articles, Veteran newsgroups, ship yearbooks, and various other researchable places exist where evidence can be sought out. Proving that someone was injured in a car accident when the records were destroyed is much easier if something like an accident report, car insurance claim, or article in the paper can be found. Having a representative to assist with the claim can also help provide Veterans with researchers who can try to find that evidence to prove the claim. It does not always work, the road is not always smooth and straight, but if you do not try, the answer will always be no.

Have Questions About Your VA Benefits?

If you’re looking to prove a service-connected disability without service records, the team at Hill & Ponton is here to help. Our law firm is committed to helping disabled Veterans and their family members obtain VA disability compensation. If your VA disability claim was denied, our attorneys are available to support and represent you. Contact us today for a free case evaluation.

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A poll of 2,000 Americans has found that members of the military community -- active-duty personnel, Veterans and their family members -- are twice as likely than civilians to believe persons with post-traumatic stress disorder are violent or dangerous.

And 35% of these "military-connected" individuals believe that PTSD is not treatable, another finding that professionals who treat trauma-related mental health issues find disheartening, said Anthony Hassan, president of the not-for-profit Cohen Veterans Network.

"I was shocked at these percentages and then my mood went to disappointment," Hassan said. "I spent so much time in the military working on reducing stigma and educating our members to make sure they understood these diagnoses and that getting help wouldn't hurt their careers. Clearly we are not making much improvement."

Hassan and other organizations that help service members and Veterans want them to know that PTSD can be treated, an apt message to share for PTSD Awareness Month in June.

"PTSD's impact on mental health still hasn't hit mainstream understanding," said Teralyn Sell, a Wisconsin-based psychotherapist. "There are evidence-based trauma treatments that are available."

According to the survey of 2,000 people conducted by The Harris Poll, 67% of Americans believe that most Veterans have PTSD. Some 74% think most combat Vets have PTSD. One in four believe patients with PTSD are violent or dangerous, and nearly 60% believe that if a person experiences a traumatic event, they will develop PTSD.

In reality, however, studies show that between 13.5% and 20% of Iraq and Afghanistan Veterans meet the criteria for a PTSD diagnosis, as do 12% of Gulf War Veterans and 15% of Vietnam Veterans.

But the majority of those people do not engage in violence, according the the Department of Veterans Affairs.

Two surveys in 2014 of U.S. military personnel and Veterans diagnosed with PTSD found that 9% engaged in severe violence and 25% were involved in physical aggression in the prior year.

But alcohol misuse, younger age, financial instability, combat exposure and a history of violence before military service appeared to contribute to severe violence and aggression.

Veterans with PTSD who did not abuse alcohol were not at significantly higher risk of violence, data showed.

"PTSD is associated with an increased risk of violence," VA researchers have said. "[But] the majority of Veterans and non-Veterans with PTSD have never engaged in violence. When other factors like alcohol and drug misuse, additional psychiatric disorders, or younger age are considered, the association between PTSD and violence is decreased."

Hassan said he thinks perhaps military people think those with PTSD are violent because they hear about colleagues being booted from service for an incident, and if the colleague also has a PTSD diagnosis, they associate the condition with the violence.

He added that service members may believe the condition is not treatable because they know fellow Veterans who have a diagnosis and receive disability compensation for their condition, and then don't get treatment or actively engage in it out of concern they will lose their benefits.

"I don't know how [service members] get stuck on it, how they seem to relate PTSD with violence and reckless behavior, and how they make this assumption that treatment doesn't work when they're told in the military all the time that these aren't true," Hassan said.

According to the Department of Veterans Affairs, effective PTSD treatments include: prolonged exposure therapy, which has a patient confronting the trauma openly and working to tackle situations that have been avoided as a result; cognitive processing therapy, in which a therapist works with the patient to overcome negative thoughts through self-awareness and activities; and eye movement desensitization and reprocessing -- a therapy during which a patient tracks a provider's quick movements or other stimulus while thinking about a traumatic event or experiences.

The science also is evolving for PTSD. A stellate ganglion block -- an injection of an anesthetic into nerves at the base of the neck --reduced PTSD symptoms in 70% of combat Veterans who received it in one study. Providers are using ketamine infusions to treat chronic forms of the disorder. And most recently, a study using MDMA, or Ecstasy, when coupled with therapy, showed promise for treating the disorder.

Misconceptions of PTSD, the people who have it and its treatments can deter people from getting care, which can cause lifelong suffering, Hassan said.

Treatment can lead to a "more productive life," he added.

"Untreated, your life can be unmanageable. People who go for treatment can improve their quality of their life, they can regain pre-crisis or pre-diagnosis functioning and they improve their relationships, at work, at home and with family and friends," he said.

With the pandemic winding down in the U.S. Hassan said he has concerns for service members and Veterans with the diagnosis who have suffered in the past year.

According to the survey, 65% of Americans with PTSD said that the past year, including isolation resulting from the pandemic, the politically charged climate in the U.S. and civil unrest has negatively affected their recovery.

"I want to remind people that if you come and get help, we really can help you improve your quality of life, there's no doubt about it," Hassan said.

Options for seeking treatment in the military include contacting Military One Source at 1-800-342-9647 for guidance on where to seek further treatment, contacting a primary care provider or reaching to behavioral health providers at military clinics and hospitals or, depending on the unit, consulting with an embedded behavioral health team.

Veterans have access to mental health treatment at the VA for at least one year after they leave active duty. They also can seek assistance at a local VA medical center or Vet Center, their primary care provider or community specialists.

The Cohen Veterans Network announced earlier this year that it also has started offering treatment to active-duty personnel at most of their 19 locations with a referral from Tricare.

"Getting help today is certainly for a better tomorrow," Hassan said.

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When Hurricane Maria battered Puerto Rico two years ago this week, Pedro Díaz Márcanos' home in Guayama, a small city in the island's southeastern coast, was severely damaged. The 88-year-old Korean War Veteran's home still has a blue tarp for a roof, according to the House Veterans Affairs Committee.

The committee is urging the Trump administration to help the former member of the 65th Infantry Regiment, a decorated Puerto Rican outfit whose soldiers, known as "The Borinqueneers," have fought in most major conflicts since the early 20th century.

The Democratic-led panel's chairman, Representative Mark Takano of California, met Díaz Márcanos earlier this summer during an oversight trip to the island. Takano was outraged by the living conditions endured by Díaz Márcanos, who is one of many Puerto Ricans still living in damaged homes with makeshift roofs. His office set out to make some requests to the Federal Emergency Management Agency (FEMA) and the Department of Veterans Affairs on behalf of Díaz Márcanos — to no avail.

"Our requests for clarification — how an 88-year-old Veteran and survivor of the deadliest natural disaster in American history could be living under a plastic tarp in his own home for two years — have gone unanswered," Takano wrote in a letter this week to the heads of FEMA and the Department of Veterans Affairs.

According to the committee, Hurricane Maria — which pummeled Puerto Rico in the fall of 2017 days after Hurricane Irma struck the island — destroyed Díaz Márcanos' roof and damaged his door, windows and stove. The Veteran, the committee said, received a FEMA grant of $574.14 in the aftermath of the powerful storms. However, the estimated repairs for his home totaled nearly $1,400.

"Because of the conditions of his age, he is unable to work and has no means of getting the additional $791.04 to build a roof," Takano wrote in the letter.

Díaz Márcanos appealed the amount of the initial FEMA award but was rejected 10 months later, according to the committee.

Takano said the Department of Veterans Affairs told his committee that Díaz Márcanos is not eligible for homeless services because he often stays with family. FEMA declined to comment due to privacy concerns.

In his letter this week, Takano demanded that the Department of Veterans Affairs provide a "detailed explanation" as to why the Díaz Márcanos is not eligible for any housing assistance from the department. He also asked FEMA to explain why $574.14 was a "suitable amount to finance a new roof."

"It cannot be that there is nothing either of your offices can do," Takano said.

eached for comment, a Department of Veterans Affairs spokesperson told CBS News the agency has been in touch with Díaz Márcanos regarding his predicament, but noted that it "can only provide homeless assistance services to Veterans who are eligible for them."

FEMA declined to comment about the specific case but provided generic information about its housing assistance during natural disasters.

"Housing repair assistance available through FEMA is meant to provide the funds necessary to make the home habitable while permanent repairs are made. Again, this does not mean that a home is repaired to its pre-disaster state, just that survivors are able to meet the basic necessities," a FEMA spokesperson told CBS News.

According to figures accepted by the Puerto Rican government, about 3,000 people were killed as a result of Maria and the island incurred about $90 billion in damage. Since then, the approximately 3.2 million U.S. citizens on the island have endured a prolonged recovery process, hampered further by years of economic woes and political instability.

Takano finished his letter by saying his plea on the second anniversary of Maria is for the administration to help Díaz Márcanos.

"No American, especially our Veterans, should be living under plastic sheets," he wrote. "Pedro will turn 89 next month. My expectation is that this government can see to it he is safe in his home in time to celebrate."

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To survive, we need oxygen going from our lungs to the cells in our body. Sometimes the amount of oxygen in our blood can fall below normal levels. Asthma, lung cancer, chronic obstructive pulmonary disease (COPD), the flu, and COVID-19 are some of the health issues that may cause oxygen levels to drop. When the levels are too low, we may need to take extra oxygen, known as oxygen therapy.

One way to get extra oxygen into the body is by using an oxygen concentrator. Oxygen concentrators are medical devices required to be sold and used only with a prescription.

You should not to use an oxygen concentrator at home unless it has been prescribed by a health care provider. Giving yourself oxygen without talking to a doctor first may do more harm than good. You may end up taking too much or too little oxygen. Deciding to use an oxygen concentrator without a prescription can lead to serious health problems such as oxygen toxicity caused by receiving too much oxygen. It can also lead to a delay in receiving treatment for serious conditions like COVID-19.

Even though oxygen makes up about 21 percent of the air around us, breathing high concentrations of oxygen may damage your lungs. On the other hand, not getting enough oxygen into the blood, a condition called hypoxia, could damage the heart, brain, and other organs.

Find out if you really need oxygen therapy by checking with your health care provider. If you do, your health care provider can determine how much oxygen you should take and for how long.

What do I need to know about oxygen concentrators?

Oxygen concentrators take in air from the room and filter out nitrogen. The process provides the higher amounts of oxygen needed for oxygen therapy.

Concentrators may be large and stationary or small and portable. Concentrators are different than tanks or other containers supplying oxygen because they use electrical pumps to concentrate the continuous supply of oxygen that comes from the surrounding air.

You may have seen oxygen concentrators for sale online without a prescription. At this time, the FDA has not approved or cleared any oxygen concentrators to be sold or used without a prescription.

When using an oxygen concentrator:

• Do not use the concentrator, or any oxygen product, near an open flame or while smoking
• Place the concentrator in an open space to reduce chances of device failure from overheating
• Do not block any vents on the concentrator since it may impact device performance
• Periodically check your device for any alarms to make sure you are getting enough oxygen.

If you are prescribed an oxygen concentrator for chronic health problems and have changes in your breathing or oxygen levels, or have symptoms of COVID-19, call your health care provider. Do not make changes to the oxygen levels on your own.

How are my oxygen levels monitored?

Oxygen levels are monitored with a small device called a pulse oximeter, or pulse ox.

Pulse oximeters are placed on a finger, toe or forehead and use beams of light to indirectly measure the level of oxygen in the blood.

What do I need to know about pulse oximeters?

As with any device, there is always a risk of an inaccurate reading. If you are using a pulse oximeter to monitor your oxygen levels and are concerned about the reading, contact a health care provider. And do not rely only on a pulse oximeter. It is important to keep track of your symptoms, or how you feel. Contact a doctor if your symptoms are serious or get worse.

When using a pulse oximeter:

• Sit still and do not move the part of your body where the pulse oximeter is
• Do not use the device on your hands when your hands are cold
• Remove all fingernail polish if using the device on your hands.

If you experienced a problem or injury that you think may be related to a pulse oximeter or oxygen concentrator, you can voluntarily report it through the FDA’s MedWatch program.

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The VA Appeals Modernization Decision Review Quick Start Guide (QSG) provides clear and concise information for the next steps a Veteran can take when they disagree with the decision VA made on their disability compensation claim. Appeals Modernization offers Veterans more choice, clarity and control over the decision review process and helps them seek faster resolution of their disagreement.

DOWNLOAD

VA implemented The Veterans Appeals Improvement and Modernization Act of 2017 on February 19, 2019. As a result, Appeals Modernization transformed VA’s complex “legacy” appeals process.

Appeals Modernization benefits Veterans who disagree with the decision VA made on their compensation claims. Since February 19, 2019, Veterans have had a choice of three lanes for a review of the original VA decision. Previously, when a Veteran disagreed with a VA claim decision, the Veteran had to “appeal” the decision. That “legacy” appeals process was complex, inefficient, and often led to a lengthy wait for a second decision.

The new Quick Start Guide helps Veterans understand the new review lanes: supplemental claim, higher-level review, or direct appeal to the Board of Veterans’ Appeals.

The VA Appeals Modernization Decision Review guide covers:

• Understanding the three lanes of review
• How to start the new review process
• How to get additional help with the review processes
• Checking the status of a claim or appeal
• Contact information, how to get forms, and other potential questions

The guide helps Veterans understand the options and how to pursue the decision review lane that best suits their needs.

“We hope that the availability of this Quick Start Guide helps Veterans understand how to get started with the modernized process,” said Chairman of the Board of Veterans’ Appeals Cheryl Mason. “Clear information about the options available to submit a disagreement with a VA decision will enable our Nation’s Veterans to receive the benefits they deserve.”

More Information

For more information about VA’s implementation of the Veterans Appeals Improvement and Modernization Act or to access the applicable forms, go to: www.benefits.va.gov/benefits/appeals.asp and follow the instructions for submission.

Additional Quick Start Guides

Veterans can find additional VA Quick Start Guides on a variety of topics. Those include: VA Mental Health Services, VA Burial Services, community and urgent care; applying for disability compensation, education benefits, and caregiver and survivor benefits. Those guides can be downloaded here.

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RALEIGH, N.C. – A Raeford woman self-surrendered on charges of wire and mail fraud.

According to court documents, Tracey Cathey McNeill, Age 50, devised a scheme and artifice to defraud the Department of Veterans Affairs and the U.S. Office of Personnel Management by obtaining disability, retirement, and life insurance payments issued by those agencies for the benefit of W.R., an individual in McNeill’s care at the time of the alleged scheme. The documents allege that between April 2015 and February 2017, McNeill received over $90,000 in benefits from the agencies.

McNeill is charged with wire fraud, in violation of Title 18, United States Code, Section 1343, and mail fraud, in violation of Title 18, United States Code, Section 1341. She faces a maximum penalty of 240 months in prison if convicted.

Robert J. Higdon, Jr., U.S. Attorney for the Eastern District of North Carolina made the announcement. The Department of Veteran’s Affairs Office of Inspector General and U.S. Office of Personnel Management Office of Inspector General are investigating the case. Special Assistant U.S. Attorney Tamika Moses is prosecuting the case.

A copy of this press release is located on our website. Related court documents and information are located on the website of the U.S. District Court for the Eastern District of North Carolina or on PACER by searching for Case No.5:20-cr-474-D.

An indictment is merely an accusation. The defendant is presumed innocent until proven guilty.

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RANGER – Big things are coming for Big Country Veterans.

“I don't think there is much that's coming down that's going to be more profound than what the PACT Act is going to be doing,” James Douglas said. “It's very comprehensive.”

Douglas is the associate director for the Veterans Administration’s West Texas Health Care System. On Saturday, he was the keynote speaker for the 15th anniversary of the Ranger Vietnam Memorial and used the opportunity to educate his audience about the benefits coming their way.

The Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act, or PACT Act as it is known by shorthand, is expected to be signed this week by President Joe Biden. According to the VA, more than 3.5 million Veterans could've been exposed to toxic materials while serving overseas.

A PACT with Veterans

During military action in Iraq and Afghanistan, it was common to dispose of debris by digging a large hole, piling the refuse within and setting it on fire. Some of these burn pits were reported to be the size of Olympic swimming pools.

Without a landfill, just about anything would go into these pits. Plastics, rubber, human waste, carcasses, you name it. Often those pits burned for days.

Outside of that, there are still Vietnam Veterans living with a range of health problems caused by the defoliant Agent Orange. Add on the myriad other chances for exposure to toxic substances while serving and you can see how military life can be hazardous even for those not in a combat zone.

Michael Crouse, the executive director of the Waco Veterans Affairs Regional Office, described how the PACT Act will change the game for those Veterans affected by toxins.

“The biggest crux of this is it will open more gateways for those folks that were potentially exposed to toxins, where future or current healthcare conditions can be recognized and treated by VA,” he said.

Remembering the fallen and those who served

The Ranger memorial was dedicated August 4, 2007, with the inscribed names of nearly 200 Veterans who served during the Vietnam era, either in-country or stationed elsewhere.

Set aside on its own is the name of the only Ranger native killed in action during Vietnam, Marine Larry Joe Rogers, who died March 17, 1968 and received the Silver Star and Purple Heart for his actions.

“That’s my uncle,” Amanda Ponce de Leon said. “He manned a machine gun for his platoon for 10 minutes. Everyone in his platoon was able to get out except for him.

“From what I was told, he was the only one from Ranger to not come back alive.”

She held a photograph of an elderly woman - her grandmother Virgie Horton - in a chair flanked by two Marines in dress uniforms 15 years earlier when the memorial was dedicated. Sept. 4 will mark a year since her death.

"She was a Gold Star mom, she lost her son," Ponce de Leon said. "But she was proud of her son, even though he didn't come home, and loved anything to do with the Marines.

"And that meant a lot to me, you know?"

Remembering their buddies

Larry Monroe and his friend Joel Jimenez both grew up in Ranger, shipping off to Vietnam as young men.

Years later, with a plot of land along East Loop 254 sitting mostly idle, they were able to convince the city to create the memorial to honor the city’s Vietnam Veterans.

Monroe is also a member of the Disabled Veterans of America. His group, along with the Abilene Vet Center, also wanted to use the event to get the word out to Veterans about the benefits that are not only coming their way in the near future, but also the ones available to them right now.

“A lot of a lot of information they don't get in these rural areas, it was brought here today,” he said. “They came to a rural community to help us.”

A common problem for many Veterans is their own reluctance to participate in the VA system. According to Monroe, many think that when they file a claim, or look for some other kind of help, that they’re trying to get a hand-out.

“They’re not. If you're a Veteran, you earned that. Get your picture taken, get an ID card and get in the system,” he said. “The more people that file for what they really earned and deserved, the more money (VA) gets to help us.”

He added that any Veteran who hasn’t registered with VA needs to make sure their DD-214, the document stating they were discharged from the military, is copied and preferably registered in that Veteran’s county courthouse. You can’t do anything with VA without having proof of that document, and that includes military funerals.

VA to grow with Abilene

Abilene is set to experience notable growth in the coming years and according to Douglas, the VA is preparing to meet that moment.

As a Veteran using the VA Clinic next door to Target on Ridgemont Dr., I can tell you that while the care has been excellent, the space has lately begun to feel a little cramped.

“It is tight, you're absolutely right,” Douglas admitted. “So that building, it's a little over 11,000 square feet. We've got six Primary Aligned Care teams crammed in there.”

Currently there is a bid out for VA to build a new 28,000 square-foot facility at a site yet to be determined in Abilene. The clinic will then utilize both buildings as they prepare for their next move.

“We're going to get back to the table and talk about what our true need is in the Abilene market, because I think it's going to be something much bigger than the 28,000 and 11,000 combined,” Douglas said.

'Volume, volume, volume'

When the architecture and infrastructure review committee was stood up to assess the VA, Douglas said they noted VA was already occupying their three fastest-growing markets; San Angelo, Odessa-Midland and Abilene. Of those, the Key City is projected to grow the quickest.

To that end, Douglas preached “Volume, volume, volume” during his remarks.

“If you qualify for VA health care, I think we have a responsibility to get in and keep growing those numbers,” he said.

“A lot of Veterans don't know what is actually available for them out there, our doors are open. We want to actually serve Veterans, their family members and survivors out there.,” Crouse said.

Ronald Erdrich is the photojournalist and a columnist for the Abilene Reporter-News. If you appreciate locally driven news, you can support local journalists with a digital subscription to ReporterNews.com.

“Yeah, there's been so much change going on within VA for the better over the last 10-15 years,” Douglas added. “People who have sworn off going to VA, Veterans; I wish they'd come back in and give us another try.”

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Large study hints that taking metformin before conception could raise risk of birth defects

Metformin, a first-line diabetes drug used for decades, may boost the risk of birth defects in the offspring of men who took it during sperm development, according to a large Danish study. Sons born to those men were more than three times as likely to have a genital birth defect as unexposed babies, according to the paper, published in the Annals of Internal Medicine today.

The genital defects, such as hypospadias, when the urethra does not exit from the tip of the penis, were relatively rare, occurring in 0.9% of all babies whose biological fathers took metformin in the 3 months before conception. But epidemiologists say the findings are important because tens of millions of people worldwide take metformin, chiefly for type 2 diabetes.

“When I saw the paper … I thought: ‘Yup, this is gonna go viral,’” says Germaine Buck Louis, a reproductive epidemiologist at George Mason University who wrote an editorial accompanying the report. “[Metformin] is widely used even by young men because of the obesity issue that we have. So that is potentially a huge source of exposure for the next generation.”

However, Buck Louis and every other scientist interviewed for this article stressed that the paper’s findings are preliminary and observational and need to be corroborated; they add that factors besides metformin may have influenced the findings. The scientists cautioned men with diabetes against abruptly stopping metformin before trying to conceive.

“Metformin is a safe drug, it’s cheap, and it does what it needs to do” by controlling blood sugar levels, says the paper’s first author, Maarten Wensink, an epidemiologist and biostatistician at the University of Southern Denmark. Any change in medication “is a complex decision that [a couple] should take together with their physicians,” he says.

Use of metformin, a synthetic compound that lowers blood sugar by boosting insulin sensitivity, has skyrocketed with the obesity epidemic and attendant diagnoses of type 2 diabetes. In the United States in 2004, 41 million prescriptions for the drug were written; by 2019 that number was 86 million.

The drug has been in use since the 1950s, but this is the first large study to rigorously analyze any paternally mediated impact on human birth defects. Although metformin’s use skews toward older people, the rise in diabetes means more men in their reproductive years are taking the drug. In the United States, prescriptions to 18- to 49-year-olds with type 2 diabetes grew from fewer than 2200 in 2000 to 768,000 in 2015.

The researchers analyzed records from more than 1.1 million babies born in Denmark between 1997 and 2016, using the country’s comprehensive medical registries to connect data on births, paternal metformin prescriptions, and birth defects. In the 1451 offspring of men who filled metformin prescriptions during the 90 days before conception, the period when sperm are being made, the team found a 5.2% rate of birth defects, compared with 3.3% among unexposed babies. That translated to 1.4 times higher odds of at least one major birth defect, including genital, digestive, urinary, and heart defects, after adjustments for paternal age and other factors.

For genital defects alone, the increased risk—only seen in male infants—was much larger. Among exposed babies, 0.9% had genital defects, compared with 0.24% in unexposed babies.

The numbers were small—13 metformin-exposed boys were born with genital defects. But after the researchers adjusted for factors including parental ages and maternal smoking status, they found a 3.39-fold rise in the odds of a genital defect. “The rate per se was surprisingly high,” Wensink says.

Reassuringly, the researchers saw no effect in offspring of men who took the drug earlier in life or in the year before or after the 90-day window of sperm production. “It really has to do with taking it in that window when the sperm … is being developed,” says senior author Michael Eisenberg, a urologist at Stanford Medicine.

The team also found no additional risk in unexposed siblings of metformin-exposed babies, or in infants of diabetic fathers who took insulin or were not on metformin. All those findings suggest it’s the drug’s impact on sperm formation, rather than diabetes or another factor intrinsic to the men, that’s responsible.

But the researchers acknowledge that men with diabetes who took metformin and those who didn’t may have differed in attributes such as obesity or how well their disease was controlled—data that were not accessible to the researchers.

Nor are scientists sure exactly how the drug may be impacting sperm. Studies in fish and mice suggest metformin can disrupt the development of male reproductive organs, and one small study found metformin reduced serum testosterone levels in men.

The caveats make scientists cautious about drawing conclusions from the paper. “This paper is the first word, not the last word,” says Russell Kirby, a birth defects epidemiologist at the University of South Florida. “It’s definitely going to require additional research.”

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Two years ago, Jim Curran of Marshfield was diagnosed with obstructive sleep apnea, which is a serious medical condition affecting millions of people worldwide.

People with sleep apnea repeatedly stop breathing while they sleep, only to be partially or fully awakened when their brains don’t get enough oxygen. It deprives those who have it of restful sleep, and it is linked to a range of ailments, including high blood pressure, heart disease, type 2 diabetes, and liver dysfunction.

Using a machine known as a CPAP is the most widely used treatment for sleep apnea. Users wear a mask or nosepiece attached to the machine that provides a steady flow of pressurized air while they sleep.

But Philips Respironics, the world’s largest manufacturer of CPAPs, last month issued an urgent recall of as many as 4 million of its machines, including Curran’s.

Philips says the foam used in its machines for noise reduction can break down and be ingested by users, causing serious, even life-threatening, injury, though no deaths have been reported.

Curran, 70, a retired federal worker, contacted me in frustration as he tried to figure out what to do. Here’s what I found out:

Q. What is the problem with the Philips CPAP machines?

A. Philips says it has received “a limited number” of reports of users complaining of headaches, upper airway irritation, cough, chest pressure, and sinus infection.

After investigation, Philips says it determined that patients exposed to the degradation of the foam also risk much more serious consequences, including “asthma, adverse effects on other organs (e.g., kidney and liver) and toxic carcinogenic effects.”

Q. How did Philips become aware of the problem?

A. Philips says it first discovered the breakdown of the foam and its risks to patients through its own quality management system. After “extensive ongoing analysis,” Philips decided to issue the recall.

Q. What is Philips promising to do about the problem?

A. It says it will repair or replace affected machines.

Q. What’s the first thing Philips CPAP users should do?

A. Register your Philips machine online. By doing so you will find out if your model is affected. To get to the online registration page, type “Philips and CPAP recall” into your browser. You will be asked for the serial number listed on the bottom of your machine (be sure to use the one for the machine, not the humidifier).

Q. How long will it take to fix or replace my machine?

A. It’s been weeks since Philips made its announcement on June 14. And, unfortunately, more delays are likely, given the size of the recall. In reply to questions from me, a Philips spokesman declined to provide a time line, saying the company is “working to address this issue as expeditiously as possible.” He pointed out Philips has already begun the process of getting approval from the Food and Drug Administration for its repair and replacement program.

“Right now, all of our attention is focused on starting” that program, the spokesman said. On its website, Philips says “affected devices may be repaired under warranty.”

Q. Should I use my Philips CPAP machine while I wait?

A. The Philips spokesman said patients should follow the advice of their physicians “as they are the most familiar with a patient’s medical history.”

Q. What do experts say about using the Philips CPAP machines?

A. I contacted the Sleep Disorders Center at Beth Israel Deaconess Medical Center, which logs more than 10,000 patient visits a year, many of them sleep apnea patients.

Dr. Anjali Ahn, medical director of the center, said her staff is telling patients to follow the recommendation of the American Thoracic Society, a nonprofit that specializes in sleep disorders, among other issues.

It says only high-risk patients should continue to use their Philips CPAP devices while they await repair or replacement. A high-risk patient is anyone with severe breathing or cardiac problems; patients who can’t sleep well without their device or have a lot of daytime sleepiness; or patients who work in high-risk occupations, such as commercial drivers or pilots.

Those who are not at high risk should discontinue use of their CPAP machines.

Ahn said any patient who has a cough, sore throat, or headache after using their Philips CPAP machine should speak with their doctor.

Q. How difficult is it for people with sleep apnea to give up their CPAP machines, even temporarily?

A. It’s a big deal. Ahn said patients who regularly use CPAP machines “often do not want to stop using them,” even temporarily, because of concerns about their sleep and about their management of related health issues such as high blood pressure and certain cardiac and respiratory disorders.

Q. What steps can patients take after discontinuing use of their Philips CPAP machines?

A. Patients can try sleeping on their side or with the head of their bed elevated to improve breathing during sleep, Ahn said. Patients should avoid alcohol close to bedtime as it can worsen breathing during sleep. Patients should also be watchful for any increased sleepiness or fatigue when driving.

Q. Are there treatment alternatives?

A. Mouth guards have been used to treat sleep apnea for decades. Contact a dentist or oral surgeon to discuss. Surgery is another option.

Q. What causes sleep apnea?

A. It happens when the soft tissue at the back of the throat collapses and blocks the airway during sleep. It can happen hundreds of times a night.

Q. How many people have sleep apnea?

A. Sleep apnea is very common in the general population but especially common in patients with high blood pressure, obesity, heart disease, and stroke, according to the Sleep Disorder Center. Studies suggest as many as 24 million people have undiagnosed sleep apnea in the United States.

Q. How big is Philips’ market share for supplying CPAP machines?

A. Philips, a Dutch multinational with an array of health care technology products and more than $20 billion in annual sales, accounts for about 37 percent of the CPAP market, more than any competitor, according to the firm BCC Research. Philips estimates that as many as 2 million of its CPAP machines are in use in the United States. Other brands of CPAP machines are not affected by the Philips recall.

The CPAP market, valued at $3.3 billion in 2019, is projected to grow to $4.5 billion by 2024, BCC Research says.

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BOSTON – A Dighton registered nurse was sentenced today in federal court in Boston for drug tampering.

Marietta Strickland, 61, was sentenced by U.S. District Court Judge Indira Talwani to 15 months in prison and three years of supervised release. In October 2020, Strickland pleaded guilty to one count of tampering with a consumer product, specifically the Schedule II controlled substance oxycodone, which is used for pain relief.

While working as a registered nurse at Dighton Care and Rehabilitation Center, Strickland tampered with three blister card packages of oxycodone prescribed to an 89-year-old hospice patient who suffered from Alzheimer’s disease, severe dementia and breast cancer. To avoid detection, Strickland replaced the stolen oxycodone pills with other prescription drugs disguised to look like oxycodone. As a result of Strickland’s tampering, the victim was deprived of her prescribed oxycodone for at least a month and ingested at least 77 unnecessary prescription tablets.

Acting United States Attorney Nathaniel R. Mendell; Jeffrey Ebersole, Special Agent in Charge of the Food and Drug Administration, Office of Criminal Investigations; Phillip M. Coyne, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of the Inspector General; and Acting Commissioner Margaret Cooke, of the Massachusetts Department of Public Health made the announcement today. Assistant U.S. Attorney Elysa Wan of Mendell’s Health Care Fraud Unit prosecuted the case.

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It's when Maurice Imhoff dons his vintage Union Army soldier uniform that he feels most connected to history. With his navy-blue wool jacket, a wooden rifle with a bayonet fixed into the muzzle and a gold eagle breastplate across his chest, he represents an often-forgotten group of soldiers – the United States Colored Troops.

"These men, once they got the opportunity, they stood up and took the call to action," Imhoff said. "They picked up the rifle, picked up the flag, and they led the way towards freedom and to free others."

Though Civil War reenactors are most often thought of as older men, Imhoff, 19, is a high school senior who graduates in June. He is a member of the 102nd U.S. Colored Troops Company C, a reenactment group in Jackson, Michigan, composed of mostly high school students.

They honor Michigan's only regiment in the colored troops, which was comprised of nearly 1,000 Black soldiers from Detroit, including men who were born in slave states. The original 102nd engaged with Confederate forces numerous times in the Deep South.

As the nation marks Memorial Day and pays tribute to those who died during military service, some remember the Black soldiers who fought on the Union side during the Civil War. Undeterred by racism, thousands of Black soldiers answered President Abraham Lincoln's call to fight for the United States and their freedom.

When the Civil War began in 1861, Black men throughout the free states were eager to volunteer, but federal law prohibited them from serving in the Army, said Kelly Mezurek, a history professor at Walsh University in North Canton, Ohio. Mezurek is a leading expert on African American service in the Civil War.

It wasn't until Lincoln signed the Emancipation Proclamation on Jan. 1, 1863, that Black men could participate in combat. This federal legislation freed slaves living in Confederate states and permitted African Americans to fight in the U.S. military.

Ulysses Grant, the Union's commanding general, wrote a letter to Lincoln expressing his support of African American troops. He and Lincoln understood that liberating Black people from slavery gave the Union an advantage on the battlefield.

"By arming the negro we have added a powerful ally," Grant wrote to Lincoln in August 1863. "They will make good soldiers and taking them from the enemy weaken him in the same proportion they strengthen us."

Even after federal law allowed African Americans to fight in the war, there were white citizens who were displeased with their participation. To make the transition more palatable, Lincoln established segregated regiments with white officers overseeing the Black units.

In May 1863, four months after Lincoln signed the Emancipation Proclamation, the War Department created the Bureau of Colored Troops, which established more than 100 African American regiments.

Even after they were accepted into the Army, Black soldiers had to prove their valor on the battlefield to win the respect of white America, said Joseph Glatthaar, a professor at the University of North Carolina who specializes in American military history.

They played critical roles in pivotal battles, including at New Market Heights, where 14 soldiers in the colored troops were awarded Medals of Honor; and the Battle of Appomattox, also in Virginia, which effectively ended the Civil War.

"We saw courage and determination in their coal-black faces," Army Capt. Luman H. Tenney, who fought alongside the colored troops at Appomattox, wrote in his diary in April 1965. He said the Black men deserved the right to vote because of their service. "Give them the ballot, for they [ensured] victory that day."

The value of the colored troops extended beyond their gallantry on the battlefield. Many of the Black regiments protected wagon trains, railroad cars and prisoners of war, Mezurek said.

"The contribution of these men is so significant that if we only look at what battles did they turn the tide of, we miss everything," she said. "The contributions were they showed up, they were there, and they did their job, and they did it well for the United States of America. We need to do better at recognizing why we have this country today is partly because of those men."

By the end of the Civil War, there were almost 200,000 colored troops, roughly 10% of the Union Army.

After the Civil War, Lincoln acknowledged the role the colored troops had in securing a Union victory. "Without the military help of the black freedmen, the war against the south could not have been won," he said.

Reenactors work to preserve those soldiers' legacies, said Algernon Ward Jr., president of the 6th Regiment United States Colored Troops Reenactors New Jersey. Though reenactments stalled during the pandemic, the group travels to schools to talk about the colored troops and participated in a flag placement ceremony to honor colored troops buried in New Jersey.

Ward worries that there aren't many young people interested in the history of the colored troops. The Michigan high school group does more than don uniforms for re-created battle scenes. The students raised $3,200 for a highway sign in Detroit honoring the original 102nd regiment.

"If it wasn't for us reenactors, who would be around to commemorate them?" Ward said. "We need the next generation to keep their memories alive."

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101 housing units in modern apartment community

While the halls of Old Main have rung hollow for more than 30 years, they are now weeks away from filling with life.

The former Milwaukee Soldiers Home (pictured above) and other nearby buildings are being transformed into housing for homeless Veterans. An effort to find Veterans to live there is underway.

“This is a great opportunity to build a community for Veterans and provide easy access to medical and mental health care,” said Amy Mauel, assistant program manager for homeless prevention programs at the Milwaukee VA Medical Center. “It’s very exciting.”

On March 1, Veterans will move into the buildings that have been under renovation since fall 2019. From then on, Old Main, the Administration Building, and nearby houses will be akin to a modern apartment community with a variety of residences and a myriad of amenities:

• 101 housing units, ranging from single-room occupancies with shared living spaces and kitchens to one- and two-bedroom apartments, three-bedroom duplexes and one four-bedroom house.
• Fitness room, business center and various lounge areas.
• A separate wing for female Veterans.
• Complimentary internet and basic cable television.
• On-site support services, ranging from counseling, sobriety maintenance and mental health care to recreational activities and employment assistance.

Targeted to homeless or at-risk-of-becoming-homeless Veterans

Mauel, her staff and VA partners have been working to connect with Veterans eligible to live in the new complex. It specifically targets Veterans who are homeless or at risk of becoming homeless.

“All Veterans living in the Soldiers Home have to come through the HUD-VASH program,” Mauel said. “HUD-VASH is the front door for Veterans looking to secure housing.”

HUD-VASH – Housing and Urban Development-Veterans Affairs Supportive Housing – specifically helps Veterans secure permanent housing.

“It’s a clinical treatment program with housing as a benefit. Veterans in the program receive supportive services from a social worker or registered nurse.

“We’re here to help any Veterans at risk for homelessness if they want to live in the Soldiers Home or the community,” Mauel said.

Veterans who qualify to live in the Soldiers Home will pay about 30% of their income in rent. The rents are set by the Housing Authority and are variable based on the type of unit.

Soldiers Home not a domiciliary or transitional housing

“This is permanent, supportive housing. A multidisciplinary team of HUD-VASH staff members will be available to provide supportive services, based on Veteran need,” Mauel added.

A doctor, nurse or social worker can help Veterans with the HUD-VASH connection. Or they can call the National Homeless Hotline at 877-424-3838.

Thirty Veterans have started application process

So far, more than 30 Veterans have initiated the application process through the property management company.

“As we get closer to opening the facility, I think we’ll have even more interest,” Mauel said. “We’re trying to spread the word to Veterans who are interested in taking advantage of this incredible opportunity.”

Dustin Koonce, real estate portfolio manager in the VA Office of Asset Enterprise Management, agreed.

“I feel good about this project,” he said. “Once the doors open, you’ll hear a lot more from Veterans. We’re really excited about this program.”

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Massive migrant surge expected when Title 42 ends in late May

More than 50 House Republicans Wednesday are pressing Customs and Border Protection (CBP) over the possibility it may use Veterans Affairs (VA) medical personnel to stem an expected migrant border surge.

The letter comes a little over a month before the May 23 end date for the Title 42 policy — a Trump-era public health order that allows for the expulsion of most migrants entering the U.S. because of COVID-19.

After President Biden announced earlier this month he would end the order, fears grew over a potential surge of migrants to the southern border as a result. Fox News reported shortly before Biden's announcement that CBP was considering the idea to have VA personnel assist in taking care of the migrants.

"On March 29, 2022, a CBP report indicated a surge of border crossings was imminent due to the rescinding of this authority. The report presents a dire situation that may result in as many as 18,000 possible encounters per day. If this number proves accurate, this could result in over 540,000 encounters in a single month," the GOP letter, led by Rep. Jody Hice, R-Ga., said. "Currently, CBP does not have the facilities or manpower to handle the anticipated massive surge."

The letter, addressed to Homeland Security Secretary Alejandro Mayorkas, stated that any consideration of moving VA medical personnel to the border would be "deeply troubling."

"Moving VA medical staff away from our Veteran’s healthcare needs to examine illegal immigrants is a recipe for disaster," the letter said. "Wait times for a Veteran to see their doctor can average 22 days and reach as high as 42 days. This is unacceptable mismanagement of federal government resources by the Biden administration."

Hice was joined by 53 other House Republicans on the letter, including GOP Conference Chair Elise Stefanik, R-N.Y., and Reps. Kat Cammack, R-Fla., Dan Crenshaw, R-Texas, and Andy Biggs, R-Ariz.

According to a CBP source who's worked in law enforcement for over 20 years and is familiar with the process, using personnel from the VA to assist in medical care and COVID-19 shots for migrants is not being ruled out yet.

"It does not seem to be off the table with a whole of government response" to handle the surge at the border, the source said. The source added that such an arrangement would likely be part of a "voluntary force" asking federal agencies to help respond to the surge.

A CBP spokesperson Wednesday told Fox News that it did not have any evidence such conversations were taking place but could not definitively rule it out.

A "whole of government response" could mirror a very broad strategy outlined in a March 30 press release from the Department of Homeland Security (DHS), which oversees CBP. Titled, "Preparations for a Potential Increase in Migration," DHS said in the release it would "Ready to surge personnel and resources to the Southwest Border."

"DHS has moved officers, agents, and DHS Volunteer Force personnel to rapidly decompress points along the border and more efficiently process migrants," DHS said in the press release.

It notably did not mention the VA, which is not part of DHS. The press release also said it would implement "COVID mitigation measures" including handing out PPE. But it again did not mention the possibility of VA personnel assisting in that.

"Biden's failed open border policies are no excuse to funnel resources away from our Veterans. Our men and women who put their lives on the line to protect our liberties and our country's sovereignty deserve the best resources for their health care needs," Hice said in a statement separate from the GOP letter. "The Biden Administration must provide the American people answers. Even the thought of abandoning our Veterans' care for the needs of illegal aliens is disgraceful."

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Remote eye screening helps rural and underserved Veterans

In 2015, VA launched the Technology-based Eye Care Services program, or TECS. The tele-eye screening program now serves 22 VA facilities across the country.

TECS brings remote eye screening services to rural or underserved Veterans who might otherwise have limited access to a screening eye exam or new glasses. It is not intended to replace an in-person eye exam and is one of several options that Veterans can choose for their eye care.

Researchers study possible enhancements

VA’s Dr. April Maa and coauthors recently published a study that tested the impact of adding of a special imaging test to the TECS screening exam. They found that adding optical coherence tomography (OCT) did not improve remote providers’ accuracy in detecting glaucoma or retinal disease.

The researchers recommend further study. They believe OCT results might change with remote glaucoma or retinal specialists who are well-versed in reading OCT images.

Maa is the clinical director for regional telehealth services in VISN 7 Center, and section chief for TECS. The ophthalmologist divides her time among treating eye disease and performing surgery, helping Veterans preserve their vision, and training ophthalmology residents. TECS is her brainchild.

Maa and her team saw a need for tele-eye services within the VISN 7 catchment area, which includes many rural communities in Alabama and Georgia. She says that prior to TECS, Veterans at the Atlanta VA had long waits to see an eye doctor.

Passionate about eliminating disparities

“My entire team is passionate about health care disparities. Just because you live in [rural] Blairsville, Georgia, doesn’t mean you should get less care than other people,” says Maa. “Those system-based barriers are reduced with telemedicine. We can bring the patient a huge amount of subspecialty care that they might not otherwise have access to.”

In TECS, technicians see patients at their primary care clinic. They gather a medical history, take vision measurements, and conduct a manifest refraction test. That test measures nearsightedness, farsightedness, and astigmatism.

In the photo above, Nguyen Walker demonstrates the use of a digital retinal camera—an important part of remote eye screening—with Army Veteran Bill Beverley-Blanco (Photo by Lisa Pessin).

The technicians also measure eye pressure and photograph the retina. Once the visit is complete, the patient’s data and photographs are shared with a remote eye specialist. The specialist reviews the results, makes referrals, and prescribes eyeglasses or medication, if necessary.

Recommendation: Alternate with in-person exams

If patients need a follow-up visit, they receive a call from the provider. If everything is good, the patient receives a notice informing them of their results. Maa says the TECS screening should be alternated with regular in-person eye exams.

She says both rural Veterans and their health care providers value TECS.

“The patients love it and the primary care providers appreciate having eye services at the primary care clinic. We have been able to pick up a lot of very serious eye disease in our Veterans to prevent blindness and get them timely access to care.”

Read about other vision research on the VA research website.

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After nearly 30 years of trying to prove a theory -- that an environmental toxin was responsible for sickening roughly 250,000 U.S. troops who served in the 1990-91 Persian Gulf War -- Dr. Robert Haley says new research confirms that sarin nerve gas caused Gulf War Illness.

Following the Gulf War, nearly one-third of all who deployed reported unexplained chronic symptoms such as rashes, fatigue, gastrointestinal and digestive issues, brain "fog," neuropathy, and muscle and joint pain. Federal agencies spent years broadly dismissing the idea that troops may have been suffering from exposure to chemical agents, with many Veterans experiencing symptoms sent to mental health providers.

But a study published last week in the journal Environmental Health Perspectives used genetic research and survey data to determine that U.S. service members exposed to sarin were more likely to develop Gulf War Illness, and those who were exposed and had a weaker variant of a gene that helps digest pesticides were nine times more likely to have symptoms.

"Quite simply, our findings prove that Gulf War illness was caused by sarin, which was released when we bombed Iraqi chemical weapons storage and production facilities," said Haley, director of the Division of Epidemiology in the Internal Medicine Department at University of Texas Southwestern Medical Center.

"There are still more than 100,000 Gulf War Veterans who are not getting help for this illness and our hope is that these findings will accelerate the search for better treatment," Haley said.

Originally developed as a pesticide, the chemical weapon sarin was known to have been stockpiled by Iraqi President Saddam Hussein prior to and after the 1990-91 Persian Gulf War. The synthetic nerve agent attacks the central nervous system and brain, killing victims by triggering an overreaction of neurotransmitters that causes convulsions and asphyxiation.

Thousands of coalition troops likely were exposed to sarin and cyclosarin, an organic phosphate also used as a chemical weapon, when the U.S. destroyed a bunker housing chemical weapons at the Khamisiyah Ammunition Storage Depot in southern Iraq, sending a plume of contaminants that spread across a 25-mile radius. Others may have been subjected to low levels of contaminants, as troops frequently reported that chemical weapons alarms went off in the absence of any apparent attack.

In the years following the war, Veterans who sought medical help at the Department of Veterans Affairs were greeted with skepticism and sent to psychiatrists for mental health treatment. Health surveys conducted by the VA in the early 2010s of Gulf War Veterans focused mainly on questions about psychological and psychiatric symptoms.

And in 2013, Veterans' suspicions of the lack of concern at the VA were confirmed when VA whistleblower and epidemiologist Steven Coughlin came forward to say that the department buried or obscured research findings that would link physical ailments to military service -- a concerted effort to deny Veterans health care and benefits.

Coughlin's charges were later confirmed by an email sent to staff from former Undersecretary for Benefits Allison Hickey expressing concern that changing what the VA still calls "chronic multisymptom illness" to "Gulf War illness" might "imply a causal link between service in the Gulf and poor health which could necessitate legislation for disability compensation for Veterans who served in the Gulf."

Research Confirms Earlier, Smaller Studies

For the new study into sarin, Haley and colleagues randomly selected 1,116 Veterans who completed a U.S. Military Health Survey, including 508 who deployed and developed Gulf War Illness and 508 Veterans who went but never developed symptoms. They collected blood and DNA samples from each participant and asked the Veterans whether they heard nerve gas alarms during their deployment, and if so, how often.

The researchers also tested for variants of a gene that helps the body metabolize pesticides, called PON1. Some people have variants of this gene that are more effective in breaking down sarin while others have a variant that helps process chemicals like pesticides but is less efficient against sarin.

The study found that those who reported hearing nerve agent alarms and who also had the least robust form of the gene had a nine-fold chance of having Gulf War Illness. Those with a genotype that is a mix of the two variants had more than four times the chance of having Gulf War Illness, while those who just heard nerve agent alarms, which the researchers used as a proxy for exposure, raised the chance of developing the condition by nearly four times, although to a lesser degree of those who have a mix of genes.

According to the researchers, the data "leads to a high degree of confidence that sarin is a causative agent for Gulf War Illness."

"Our hypothesis was, if you have the strong form of the gene, then when you're exposed to low-level sarin, that gene makes a strong isoenzyme that destroys sarin in your blood. If you have the weak form of the gene, the enzyme that it makes is not very strong, so it goes through your blood into your brain and you get sick," Haley said in an interview with Military.com. "You've heard the expression 'correlation does not equal causation,' right? That's true, unless you are dealing with a gene-environment interaction."

A Mysterious Malady

The mysterious symptoms experienced by thousands of service members, which came to be known as Gulf War Syndrome and, later, Gulf War Illness, generated hypotheses of the possible cause, including an additive in anthrax vaccines, preventive medicines given to troops such as the anti-nerve agent pyridostigmine bromide, ciprofloxacin, depleted uranium, and exposure to nerve gas, pesticides or smoke from oil well fires.

A congressional investigation in 1997 concluded that the Departments of Defense and Veterans Affairs had very little interest in finding a cause and blamed the symptoms as related to stress or other mental health disorders.

In its report, the Committee on Government Reform and Oversight found that the DoD and VA were "plagued by arrogant incuriosity and a pervasive myopia that sees a lack of evidence as proof" that the illness didn't exist.

"Sadly, when it comes to diagnosis, treatment and research for Gulf War Veterans, we find the Federal Government too often has a tin ear, a cold heart and a closed mind," the report noted.

As Congress investigated the issue, Haley was studying possible causes, funded by Ross Perot, the Texas billionaire and Navy Veteran known for donating to Veterans' charities and resources, including efforts to help U.S. prisoners of war in Vietnam.

Haley's early work pointed to sarin as a possible cause, but other scientists, including the medical body of the National Academies of Sciences, Engineering and Medicine, found his studies to be insufficient in size and suffering from selection or "recall bias," meaning that Vets may or may not remember whether they heard nerve gas alarms and how often.

Haley said the new research links Veterans with Gulf War Illness with their genotype and "cannot be explained away by errors in recalling the environmental exposure or other biases in the data."

Others now concur. In an editorial accompanying the study, Marc Weisskopf, a professor of environmental epidemiology and psychology at the Harvard T.H. Chan School of Public Health, and Kimberly Sullivan, a research associate professor with Boston University School of Public Health, said the study makes a strong case for a causal link and explains, to some extent, why some troops got sick and some did not.

"The authors' exploration of a gene-environment interaction between presumed nerve agent exposure and the PON1 gene offers some strong arguments that there is a true causal effect at work," they wrote in their opinion piece.

The VA has established service connection for Gulf War Veterans with certain chronic, unexplained symptoms, which the department calls "chronic multisymptom illness" or "undiagnosed illness."

Those who have certain symptoms, such as chronic fatigue syndrome, fibromyalgia and some gastrointestinal disorders, and served in the 1990-1991 conflict do not have to prove service connection and are eligible for benefits including a health exam, health care and disability compensation.

Historically, however, the VA has been strict in determining service connection. A 2017 Government Accountability Office report found the VA denied 83% of 102,000 claims filed for Gulf War Illness between 1994 and 2015.

New Hope

Haley said the research could pave the way for more Veterans to access health care and benefits and open up research into possible treatments. He said that the symptoms are caused by brain inflammation, which may be treatable once scientists figure out exactly how sarin works.

"Once we know, we could come up with treatments to reverse it," Haley said. "I really believe this is optimistic and that it means this is not brain damage. This is not loss of neurons and like a stroke or something that you're never going to recover from."

Among the Veterans excited about the new study is Paul Sullivan, a Persian Gulf War Veteran who works as director of Veteran outreach at the law firm Bergmann & Moore and deployed to Iraq as an Army cavalry scout with the 1st Armored Division in 1991.

He said the results provide evidence that affected Veterans need to access care from the VA.

"This landmark study provides a clear path for VA to presume sarin exposure for all 1991 Gulf War Veterans," Sullivan said Thursday. "The study provides a compelling missing scientific link for treatment research for my fellow Gulf War Veterans disabled since our exposures during Desert Storm."

Haley said he has received letters from Veterans asking if they could get tested for the different types of the PON1 gene and whether it would be helpful. Routine genetic testing does not include PON1, but further research may lead to a diagnostic test that would provide peace of mind to Veterans, he said.

The research was conducted in collaboration with a survey research team from North Carolina-based RTI International and funded by the DoD and VA, both of which have funded thousands of studies on Gulf War Illness despite long-standing skepticism.

"This is the scientific process. Nobody's bad. Nobody's good. People have their theories. Skepticism is the name of the game. That is what makes it fun," Haley said.

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Over the past decade there has been growing awareness of the limitations of pharmacological approaches to pain management and the risks associated with opioid pharmacotherapy in particular,” said Dr. Diane Flynn, a primary care pain management adviser at the Interdisciplinary Pain Management Center at Madigan Army Medical Center Aboard Joint Base Lewis-McChord in Washington. Aligning to this awareness, the Military Health System is also changing the conversation on treating and managing pain among beneficiaries.

As a result, within the Military Health System pain management is shifting – and improving. By implementing the Stepped Care Model of pain management first adopted by the U.S. Department of Veterans Affairs, the MHS is exploring nondrug interventions such as acupuncture, chiropractic, massage, physical therapy, occupational therapy, yoga, nutrition, and behavioral health management. “We’re trying to reorient our culture away from the idea that pain equals pills,” said Dr. Chester Buckenmaier, director of the Uniformed Services University’s Defense & Veterans Center for Integrative Pain Management.

Part of that change includes the introduction of behavioral health consultants or BHCs in the primary care clinic to provide evidence-based behavioral health treatments and brief cognitive behavioral therapy for pain, said U.S. Public Health Service Capt. Anne Dobmeyer, Ph.D., a clinical health psychologist. Cognitive-behavioral therapy for pain helps patients develop coping strategies for managing pain that could include stress management and mood management. BHCs also work with patients on pacing physical activity, developing skills in relaxation, and altering thought patterns that can worsen the pain experience.

“Sometimes the way we think about our situation or about our pain can really turn the dial up on pain by increasing the stress that we’re feeling and magnifying the experience of pain,” said Dobmeyer. “Being able to change the way we are looking at or thinking about our pain or experience can help turn the dial down on the pain level, and help improve quality of life, despite the presence of an ongoing chronic pain condition.”

Pain management involves a mind-body and social connection; cognitive coping strategies can help address the whole patient in treating pain.

“We’re not asking people to put on rose-colored glasses and just think positive thoughts,” Dobmeyer said. “But we want patients to evaluate whether the way they are thinking about pain or their situation is really helping them get where they want to be in life, or whether it’s getting in the way.”

In a pioneering move, the Defense Health Agency issued guidelines and regulations in January 2020 on the use of acupuncture for beneficiaries. Buckenmaier called the guidelines historic and an example of federal medicine providing leadership in the health care community.

“Oftentimes people will say, well, acupuncture is alternative medicine, but what’s really being made clear in these documents is it’s not alternative,” he said. “[Acupuncture] is medicine and it’s an equal partner with the things we’ve been using.”

That’s not to say integrative interventions such as acupuncture can or should replace medication, including opioids, said Buckenmaier. “I don’t mind saying to you opioids aren’t bad,” he added. “If you’ve been in a war zone and just been blown up, you’re not screaming for acupuncture. In that situation, opioids can be very useful.”

The problem is how the health care community has relied on opioids to treat pain. “Opioid pain medications can have a role in helping manage acute pain, but they are less effective at helping treat chronic pain problems,” said Dobmeyer.

Still, patients want simple, fast relief. “There is usually no one treatment that will eliminate chronic pain,” said Dr. Flynn. “The best approach to chronic pain involves a variety of approaches.”

The DoD’s new pain scale implemented last year is helping better define a patient’s pain and, as a result, better treat it through a variety of approaches. Using the new pain scale, Buckenmaier treated a patient suffering from chronic pain after he had been severely wounded. The patient commented his pain level was a 6 out of 10 and fully expected it to remain so into the following week. Through the pain scale, he revealed he was sleeping and happy to be reunited with his wife. “He said, ‘My pain is a 6, but I’m OK,’” Buckenmaier recalled. “When you ask that sort of detailed information, that’s not a patient who needs another prescription; that’s a patient who may want to double down on other successes like acupuncture, physical therapy, or behavioral health modification.”

People living with chronic pain don’t need to suffer. “Comprehensive pain management focuses on helping people with pain live active, meaningful lives despite pain,” said Flynn. “With a willingness to try different pain management approaches and a commitment to a daily pain management practice, it is possible to lead a satisfying, productive life despite pain.”

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When Jennifer Mackinday became a full-time caregiver for her brother, James, after he was injured in a roadside bomb attack in Iraq in 2005, the two siblings found themselves thrust into an unfamiliar situation without much support.

“When my brother returned, I needed to spend most of my time caring for him,” she said. “That meant I separated from my civilian community, and he was separated from his support group, which was the military.

“I didn’t have those touch points in my community and I didn’t know really where to turn to get my questions answered. I spent a number of years doing everything by myself.”

Veterans advocates for years have emphasized the importance of community help in recovery and reintegration for wounded troops. But a new survey released this week by the Military Family Advisory Network and Wounded Warrior Project suggests that Veterans who spend only a few years in the ranks may have an even more difficult time finding those support networks than their retired peers.

“Every time we went into one of these questions, we found a difference between the [retired and non-retired] populations,” said Shelly Kimball, research director for MFNA. “For us, that gives us a pathway forward for where we need to be.”

The survey, which polled 1,276 post-9/11 Veterans and caregivers last fall, found less satisfaction with health care access among non-retirees than with retired troops (22 percent negative vs. 11 percent).

Fewer non-retiree families had adequate financial savings than their retired peers, with 43 percent of retirees reporting $5,000 or more in emergency funds on hand compared to 18 percent for non-retirees.

Traditional military retirees receive a pension from their service, and both they and medically retired individuals can receive some health care benefits for life. But other questions showed unexpected transition issues hitting non-retirees harder than their peers.

For example, about 29 percent of post-9/11 Veterans who left before retirement said they have concerns about their own alcohol use or a family member’s excessive drinking, compared to 15 percent of retirees with those concerns. Researchers also saw similar splits on the issues between caregivers of each group.

Retirees were more likely to live close to military bases and less likely to be divorced, according to the survey. Nearly 30 percent of non-retirees said they lived at least 20 miles from their primary care doctor, as opposed to only 17 percent of military retirees.

The survey sample relied heavily on WWP and MFAN members, which may have resulted in a higher proportion of respondents with serious medical issues and significant transition challenges.

But researchers said that the results “make it clear that post-9/11 Veterans, retirees, and their family members have different needs that cannot be met with one-size-fits-all solutions. Taking into account their unique perspectives and experiences illuminates the most e!ective ways to give this population the best opportunity to thrive.”

In Mackinday’s case, she said the lack of other young Veterans in the community where she lived with her brother caused numerous complications. Her lack of military knowledge made navigating military and Veterans Affairs benefits difficult, and both siblings struggled with increased stress and loneliness.

“I didn’t know how to ask for help. And I didn’t know how to accept it when it was being offered,” she said. “Ultimately that led me to a really dark place in my life when I felt so isolated and alone that I thought about taking my own life.”

Mackinday said they eventually connected with Wounded Warrior Project, where they each found their own support networks and sense of community. WWP officials said that’s a common refrain from their members

“In conversations I’ve had with Veterans, they share how they struggled to find that social support and that connection,” said Amanda Peterson, senior researcher for WWP. “So it’s really important that we develop additional ways for post-9/11 Veterans and their families to connect with each other, and get the resources that they need.”

The full report is available at the MFAN web site.

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James Grazioplene, the retired Army major general who last year pleaded guilty to sexual battery, has been reduced in rank to second lieutenant.

Grazioplene was indicted by a Virginia grand jury on multiple charges, including rape, incest and aggravated sexual battery, allegedly involving his daughter in 1987 and 1988. He pleaded guilty to a single count of sexual battery last July in a deal that saw the rest of the charges dismissed.

In an email Tuesday morning, Pentagon spokeswoman Lisa Lawrence said Defense Secretary Lloyd Austin reduced Grazioplene's rank to the lowest possible for an officer in retirement.

"The Secretary of Defense changed the retired grade of then-Major General James J. Grazioplene, United States Army retired, to second lieutenant after determining that second lieutenant was the highest grade in which he served on active duty satisfactorily," Lawrence said. "This action may not be appealed. Second Lieutenant Grazioplene will maintain any benefits or privileges authorized for retired officers in the grade of second lieutenant."

Army Times first reported the reduction in rank.

Grazioplene's daughter, Jennifer Elmore, identified herself as his victim and chose to speak publicly about her story.

The Army originally charged Grazioplene in 2017 with violating Article 120 of the Uniform Code of Military Justice, including six specifications of rape of a minor on multiple occasions between 1983 and 1989.

However, the U.S. Court of Appeals for the Armed Forces ruled that there should be a five-year statute of limitations on rape charges, and the Army dismissed the case.

The case then moved to civilian court in Prince William County, Virginia. Grazioplene was arrested in December 2018 after a grand jury indictment. After several delays, he was slated to face trial last September.

But in July 2020, Grazioplene pleaded guilty to the single charge in exchange for a 20-year suspended sentence and supervised probation. By that point, he had been incarcerated for 18 months and served no additional jail time as part of the plea agreement.

Elmore's attorney said at the time that she supported the plea agreement "because at the end of the day, the truth was more important than the punishment for her."

The reduction in retired rank means, among other things, that Grazioplene's retirement pay will be slashed by more than two-thirds.

He retired from the Army in 2005.

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PROVIDENCE, R.I. – A Warwick woman who is alleged to have (1) fraudulently claimed to be a wounded United States Marine Corps (USMC) veteran and recipient of a Purple Heart and Bronze Star, and (2) schemed to collect hundreds of thousands of dollars in veteran benefits and charitable contributions, was arrested today by federal agents and made her initial appearance in federal court in Providence, announced United States Attorney Zachary A. Cunha.

Sarah Jane Cavanaugh, 31, is charged by way of a federal criminal complaint with using forged or counterfeited military discharge certificates, wire fraud, fraudulently holding herself out to be a medal recipient with intent to obtain money, property, or other tangible benefit, and aggravated identity theft.

Charging documents allege the following:

• Cavanaugh used the personal identifying information of an actual Marine, and falsely claimed that she served in the USMC from 2009-2016; was honorably discharged; achieved the rank of Corporal; and was wounded in action in Iraq/Afghanistan.
• Cavanaugh used an official Veterans Administration (VA) email account, which was issued to her as a VA employee, to purchase and later display on a Marine uniform a Purple Heart and Bronze Star. She had not been awarded either award. In fact, a search of the Defense Personnel Records Information Retrieval System, a database containing military-service records, provided no records or information pertaining to Cavanaugh.

         It is further alleged that Cavanaugh:

• Created and submitted falsified military discharge documents, medical diagnosis, and medical bills to “HunterSeven,” an organization that provides monetary aid to veterans in need. Cavanaugh did so to request financial assistance and falsely claim that she was being treated for cancer from exposure to burn pits in Iraq/Afghanistan and inhaling particulate matter in the aftermath of an Improvised Explosive Device.
• Posing as a combat veteran, Cavanaugh contacted “Code of Support,” and collected $18,472 in financial assistance for mortgage payments, repairs to her home furnace, a gym membership, and for other unspecified bills,
• Posing as a combat veteran diagnosed with cancer related to her military service, Cavanaugh collected approximately $4,700 from an internet-based fundraising website,
• Claiming to be a Purple Heart and Bronze Star recipient, Cavanaugh collected approximately $16,000 from a charity that provides therapy for veterans through art programs, and
• Posing as a wounded combat veteran, Cavanaugh collected $207,000 from the Wounded Warrior organization to pay for groceries and physical therapy sessions.

A federal criminal complaint is merely an accusation. A defendant is presumed innocent unless and until proven guilty.

Cavanaugh was arrested by federal agents on Monday and appeared before U.S. District Court Magistrate Judge Lincoln D. Almond. She was released on $50,000 unsecured bond.

The matter is being prosecuted by Assistant U.S. Attorney Ronald R. Gendron and investigated by the U.S. Department of Veterans Affairs Office of Inspector General, U.S. Department of Veterans Affairs Police Service, and the FBI, with the assistance of the U.S. Defense Criminal Investigative Service, U.S. Naval Criminal Investigative Service, U.S. Postal Inspection Service, and Internal Revenue Service Criminal Investigations.

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Spokane – Joseph H. Harrington, Acting United States Attorney for the Eastern District of Washington, announced today that Dr. Janet Sue Arnold, age 63, of Benton City, Washington, pleaded guilty to conspiracy to distribute and possess with intent to distribute opioid pain medications (specifically, fentanyl, oxycodone, methadone, hydromorphone, methylphenidate, and amphetamine mixture) and other controlled substances (carisoprodol and alprazolam), without a legitimate medical purpose and outside the usual course of professional practice. Dr. Arnold faces a maximum term of imprisonment of twenty years. United States District Judge Edward F. Shea accepted Dr. Arnold’s guilty plea and scheduled a sentencing hearing for December 7, 2021, at 1:15 p.m. in Richland, Washington. Dr. Arnold is the final defendant to plead guilty in the case. Four other defendants, Danielle Corine Mata, age 44, of Richland, Washington, David Barnes Nay, age 43, of Kennewick, Washington, Lisa Marie Cooper, age 55, of Prosser, Washington, and Jennifer Cheri Prichard, age 46, of Prosser, Washington, previously pleaded guilty to conspiracy to distribute and possess with intent to distribute opioid pain medications and other controlled substances, and are scheduled to be sentenced on October 19, 2021, November 2, 2021, and November 9, 2021, in Richland, Washington.

According to court documents and information disclosed during court proceedings, Dr. Arnold owned and operated Desert Wind Family Practice, at 431 Wellsian Way in Richland, Washington. Beginning in approximately March 2016, and continuing until May 3, 2017, Dr. Arnold pre-signed hundreds of blank prescription forms and provided them to Mata, Prichard, and Cooper, who were drug addicts. These individuals then provided the illegal prescriptions to individuals seeking opioids and other controlled substances or used the prescriptions to get their drugs of choice. Dr. Arnold allowed Mata, who also acted as Desert Wind Family Practice’s office manager, to fill in all the required prescription information (patient name, drug type, dosage, and quantity) on the pre-signed blank prescriptions. Dr. Arnold’s practice of pre-signing blank prescription forms enabled the conspirators, including Nay, a drug dealer and addict, to distribute significant quantities of opioid medications and other controlled substances.

Acting United States Attorney Joseph H. Harrington said, “Dr. Arnold abandoned her role as a medical doctor by essentially turning over her prescription pad to her office manager and others. Today’s guilty plea should serve as a warning to all medical professionals that if you abuse your medical license by prescribing opioids and other drugs without a legitimate medical purpose and outside the usual course of professional practice, you will be held accountable. I commend the U.S. Drug Enforcement Administration and the U.S. Department of Health & Human Services, Office of the Inspector General, agents who investigated this case.”

This investigation was conducted by the U.S. Drug Enforcement Administration and the U.S. Department of Health & Human Services, Office of the Inspector General. This case is being prosecuted by George J.C. Jacobs, III and Dominique J. Park, Assistant United States Attorneys for the Eastern District of Washington.

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Richland, Washington – Judith K. Caporiccio, N.D., a Richland-based naturopathic doctor, has agreed to pay $70,096 to resolve allegations under the Controlled Substances Act and the False Claims Act, which allege that she improperly prescribed controlled substances between July 2016 and July 2021. The Controlled Substances Act regulates certain drugs that pose a risk of abuse and dependence. To protect public safety and prevent misuse and diversion, the Act requires practitioners to register with the Drug Enforcement Administration (“DEA”) to prescribe these controlled substances.

During the relevant time period, Dr. Caporiccio was a naturopathic doctor licensed in the State of Washington and practicing in Richland, Washington. Under state and federal law, as a naturopathic doctor, Dr. Caporiccio was only authorized to prescribe two types of controlled substances: codeine and testosterone products. In the settlement agreement recently reached between the United States and Dr. Caporiccio, she admitted issuing at least 421 prescriptions for controlled substances that she was not authorized to prescribe. These controlled substances included the sleep aid zolpidem (often sold under the brand name Ambien); the anti-anxiety drug alprazolam (sometimes sold under the brand name Xanax); the benzodiazepine lorazepam; the stimulant modafinil (typically prescribed for narcolepsy and sleep apnea); and the sedative pregabalin (sold by Pfizer under the brand name Lyrica).

The settlement agreement also indicates that Dr. Caporiccio ceased her improper prescribing practices in 2021 after being contacted by the DEA, and that she voluntarily surrendered her DEA registration. Additionally, the settlement agreement requires Dr. Caporiccio to implement additional controls and procedures to ensure that this conduct does not recur.

“My office is committed to protecting our community from drug misuse and diversion. I am relieved that it appears no patient was seriously harmed by the medications improperly prescribed by Dr. Caporiccio, but when a healthcare practitioner prescribes controlled substances that she is not licensed or qualified to prescribe, the public is placed at serious risk of potentially dangerous side effects, drug interactions, and contraindications,” said Vanessa R. Waldref, United States Attorney for the Eastern District of Washington. “This resolution demonstrates our commitment to protecting public health, keeping our families safe, and building strong communities. In particular, I commend the excellent investigative work conducted by DEA’s Diversion Group and the Department of Health and Human Services Office of Inspector General. We will continue to work with our law enforcement partners to hold health care practitioners accountable to their patients and the public.”

“Doctor Caporiccio’s careless and irresponsible prescribing habits are a violation of federal law and in serious breach of her naturopathic license, presenting a clear and present danger to our nation’s health and security,” said Frank A. Tarentino III, Special Agent-in Charge of the DEA’s Seattle Field Division. “The DEA is working closely with our federal partners in a joint effort to increase community outreach and education, while simultaneously using our civil and administrative enforcement authorities to hold accountable pharmacies who fail to exercise their corresponding responsibility and prescribers who are writing prescriptions outside their scope of practice. Today’s settlement sends a strong message that we will seek justice and hold those accountable, like Dr. Caporiccio, who intentionally distribute highly addictive drugs to patients with reckless abandon and no concern for their safety.”

The settlement was the result of a joint investigation conducted by DEA’s Seattle Field Office, Diversion Group, the U.S. Department of Health and Human Services, Office of Inspector General, Seattle Field Office, and the U.S. Attorney’s Office for the Eastern District of Washington. Assistant United States Attorneys Dan Fruchter and Tyler H.L. Tornabene handled this matter on behalf of the United States.

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Variety of treatment options for Veterans with chronic pain

Coast Guard Veteran Osretta Miller came to the Veterans Integrative Pain (VIP) Center at the Central Virginia VA Health Care System to find relief from her chronic pain and depression. She struggled to walk and often didn’t want to leave her house. As a result, her primary care doctor at VA recommended the VIP Center as an option for further treatment.

At 58, Miller’s pain was the result of inflammation and fibromyalgia.

“I could barely walk. My hands were very tender,” Miller said. “I was really messed up when I first began.”

Miller tried biofeedback, among other treatments, at the VIP Center. Biofeedback is a body-based treatment that teaches Veterans to improve control over their nervous system. In turn, the nervous system is often out of balance due to chronic pain.

“The stress or fight-flight response can be turned on all the time when someone has chronic pain. This results in a host of physical and emotional issues over time,” said Natasha Mroczek, a clinical health psychologist in the VIP Center. “They can include worsening pain, depression and insomnia to name a few.”

“I can do things on my own now”

Mroczek says biofeedback helps people gain better control over their stress response. They can wind down the stress response and engage the relaxation or recovery response.

The biofeedback machine has sensors attached to the body providing real time vitals like heart rate, breathing, skin temperature, perspiration, muscle tension and brain waves.

“I can do things on my own now,” Miller said. “The program worked for me. My family has seen a big difference. I’m nowhere near where I was.”

Elmer Ligh, a physical therapist and lead biofeedback provider in the VIP Center, used biofeedback to treat over 100 Veterans last year, including Miller.

“I have seen how chronic pain affects Veterans more than just physically,” said Ligh. “Using biofeedback, I’m able to address the biopsychosocial aspects of chronic pain and empower Veterans by teaching them new skills which will help them experience their pain from a new perspective.”

Ligh’s outcomes have been overwhelmingly positive. After about eight weekly biofeedback sessions, Veterans have reported significant improvements in their activity level, sleep, mood and stress.

“Everything in the program really does work, if you apply it,” Miller said.

When Miller first came to the clinic, she said she experienced a pain level of 10. Now, her pain level stays around four or less.

The VIP Center has a variety of treatment options available to Veterans with chronic pain. Movement-based treatments include tai chi and sarete aikido. There also are education and psychotherapy-based modalities, such as mindfulness meditation, cognitive behavioral therapy and one of Miller’s favorites, the anti-inflammatory diet group.

From a size 18 to a 10

“I lost at least 20 pounds from changing my diet and learning how to read food labels,” Miller said. She graduated from the program in November 2018 and went from a size 18 in clothing to a size 10.

Care providers can add complementary treatments to a Veteran’s care plan, such as medical acupuncture, chiropractic care, music therapy and support groups, if needed.

The goals are to improve the quality of life for Veterans with chronic pain, restore daily functioning, improve emotional health and increase healthy coping strategies.

If you want to improve your quality of life, take charge and visit www.va.gov/wholehealth.

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Rick Perry is returning to politics in an unlikely fashion.

The former Texas governor, two-time presidential candidate and Trump Cabinet secretary threw his support behind a bill that would create a research study into using psychedelic mushrooms to treat Veterans dealing with post-traumatic stress disorder.

The bill was introduced by Democratic state lawmaker Rep. Alex Dominguez and calls for further research into the medical benefits of psilocybin, which is the hallucinogenic chemical found in so-called "magic mushrooms."

In an interview Tuesday with the Texas Tribune, the former state governor admitted that he's "historically been a very anti-drug person" but that he believes psychedelic drugs, provided in medical doses, can be effective in treating depression and PTSD.

"All of that properly done in the right type of clinical setting will save a multitude of lives," Perry, 71, told the Tribune. "I'm convinced of it. I have seen it enough of these young men."

Perry, who served as an energy secretary under President Donald Trump from 2017 to 19, said the bill "may be one of the most hopeful pieces of legislation" Texas lawmakers consider this year.

Dominguez's bill would call for a three-and-a-half year research study into the benefits of psilocybin.

The legislation would also call on the Texas Health and Human Services Commission to collaborate with one university hospital and one Veterans Affairs hospital in conducting its own research while also doing a review of past studies on the medical benefits of the drug.

Psilocybin is still illegal and classified as a "Schedule I" drug by the Justice Department, alongside drugs like heroin and LSD.

However, there's been increased interest in recent years about psilocybin's potential medical benefits when taken in small doses. Medical schools at universities like Johns Hopkins University and University of California-Berkeley have opened research centers in recent years dedicated to studying it.

Oregon became the first state to legalize psilocybin in November.

"We need options. And this is a valid therapeutic option that could help thousands of people," psychotherapist Thomas Eckert, who pushed the state for years to pass the legislation, told The Oregonian after the measure passed last year.

Some U.S. cities — like Oakland, California — have legalized the psychedelic drugs, as well.

The Tribune reports that Texas has been slow to rethinking some drug use, noting the state has cautiously approached legalizing medical uses for marijuana compared with other states.

Perry told the outlet he's had talks with the offices for current Gov. Greg Abbott and Lt. Gov. Dan Patrick about the potential benefits of psilocybin.

The former Texas governor said he hopes Republicans in the state can "get comfortable [that], 'Hey, this is not some recreational drug thing' " but instead is a potential new medication to aid Veterans and others with PTSD.

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Aquablation therapy treats Veterans’ enlarged prostate symptoms with reduced risk of unwelcome side effects

A procedure called aquablation offers a new approach to treating an enlarged prostate.

In the photo above, Dr. Gopal Badlani uses a robot-guided water jet to treat enlarged prostate.

The medical term is “benign prostatic hyperplasia,” or BPH. Most men know it simply as “enlarged prostate,” and hope to avoid it as they grow older.

More than 12 million American men, most of them 60 or older, are being treated for non-cancerous enlargement of the prostate gland. Symptoms include a frequent need to urinate, increased nighttime urination and an inability to completely empty the bladder.

For more severe cases, pills might not give much relief. Surgery can help symptoms but can also cause sexual problems. So, many men simply avoid treatment.

Relief in sight for hundreds of Veterans

At Salisbury VA Health Care System in North Carolina, VA offers Veterans with BPH another option called aquablation. It’s more effective than pills but has fewer side effects than surgery.

The U.S. Food and Drug Administration (FDA) recently approved it for use with patients.

The doctor removes excess prostate tissue with a robot-controlled water jet, using 3D imaging to guide it. The procedure relieves symptoms with less risk of sexual side effects.

“As Salisbury Chief of Urology, I was part of the two trial studies that led the FDA to approve aquablation,” said Dr. Badlani. “The symptoms of an enlarged prostate can be frustrating and upsetting. There are hundreds of Veterans suffering from BPH in our area. That’s why we are so pleased by the results we see from this new treatment.

“One older Veteran who recently had the procedure said, ‘I’m glad I did it. I’m a blessed man, I’ll put it that way.’ When I told him that he would no longer have to take drugs for his symptoms he said, ‘That sounds pretty good. I got rid of two pills right there.’

“We believe this treatment has the potential to change the way we treat men with BPH in a very basic way.”

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The Rotary Club of Lubbock will dedicate a granite bench at the Veterans War Memorial at Huneke Park at 1:30 p.m. Wednesday, May 11, commemorating the club’s recent centennial and honoring all healthcare and front-line people who helped Lubbock during the COVID-19 pandemic.

“When we were looking for something that would still be here in 2121 – a century after our centennial – and tell the story of our club’s first 100 years, we realized a granite bench should hold up over time,” said Rotary Past-President Ben Lock, who led the bench project.

The club’s plans to celebrate its centennial were pushed back to this year due to the pandemic.

The project started during the Rotary year under Past-President Joe Puckett, who explained why the club decided to honor those who gave so much during the pandemic.

“During our club’s first 100 years we’ve focused on ‘Service Above Self’ to our community. During our centennial year, our community’s healthcare and other frontline workers showed us all how to put ‘Service Above Self’ into practice as they gave countless hours at great risk to themselves,” said Puckett.

Members of the healthcare community, city officials, police and fire departments and local school districts will all be represented at the ceremony.

The bench sits at the head of the walkway to the Rotary Meditation Circle, honoring the brave men and women of our Armed Forces that was donated by the club in 2005 to honor Rotary International’s centennial.

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Student veterans hoping for resolution in a court case which could open an extra year of GI Bill education benefits to hundreds of thousands of individuals won’t get any resolution before the start of the fall semester.

But may see some legal progress in time for the spring.

The case — Rudisill v. Wilkie, pending before the U.S. Court of Appeals for the Federal Circuit — has gained the attention of numerous education and veterans advocacy groups in recent months due to its potential impact on veterans education benefits.

Last year, a lower appeals court ruled that the Department of Veterans Affairs’ practice of requiring veterans to give up their Montgomery GI Bill eligibility to receive Post-9/11 GI Bill payouts was improper.

That means that veterans who use up their 36 months of Post-9/11 GI Bill education benefits should still have access to 12 months of Montgomery GI Bill benefits if they paid into the program while they were serving. Under existing federal statute, any government higher education payouts are capped at 48 months.

Department of Veterans Affairs officials appealed that ruling earlier this year, and are scheduled to file additional motions early next week. After that, court officials are expected to schedule oral arguments in late August or September.

That pushes any resolution of the case later into the fall, well after classes for the upcoming semester have already begun.

Attorneys for the plaintiff had pushed for a quicker timeline, but with no success. Hunton Andrews Kurth Associate Tim McHugh, an Army veteran and co-counsel on the case, said he is optimistic a final decision by the federal circuit court could come before the end of the year.

In recent weeks, a pair of veterans advocates — National Veterans Legal Services Program and Veterans Education Success — filed briefs of support in the case, arguing the more generous interpretation of GI Bill payouts should be upheld based on past congressional intent and court precedents.

“The court should turn to the pro-veteran canon and adopt the interpretation that furthers Congress’s purpose of providing more generous education benefits to veterans,” they wrote.

David DePippo, senior counsel for Dominion Energy Services and co-counsel on the case, called their support “a big deal” in furthering the argument.

“These are two groups that are big players in this area,” he said. “They really have moved the ball in terms of veterans benefits in the past. So to have them take a look at this and sign on is significant.”

VA’s opposition stems from an argument that the use of both benefits programs amounts to “double-dipping” for veterans, and the potential extra costs of tens of billions of dollars in new education payouts in coming years.

Under current rules, the Post-9/11 GI Bill provides 36 months of tuition assistance and living stipends to veterans (or their family members) who served at least three years on active-duty after Sept. 10, 2001. The total value of those payouts can top $20,000 a year, depending on where individuals attend school.

That benefit was finalized in 2010 and largely replaced the Montgomery GI Bill, which requires servicemembers to pay $1,200 in their first year after enlisting to be eligible for payouts after separation from the service. Individuals who used that education program last semester received payouts of about $2,000 a month.

The federal circuit court’s decision can be appealed to the Supreme Court, a process that could take several more years to complete.

In the meantime, VA officials have declined to recognize the lower court ruling and start awarding the extra GI Bill benefits to eligible veterans. McHugh said his legal team believes that represents a serious violation of federal rules, but enforcement of the issue would likely require a secondary lawsuit to force the issue.

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The Trump administration has for nearly two years ignored mounting evidence that Russian operatives and other foreign actors were deliberately targeting U.S. troops and Veterans with online disinformation amplified on a massive scale, a leading Veterans group said.

American Veterans and service members enjoy a high degree of social respect, and ongoing manipulation campaigns aimed at them could be weaponized to sow social discord in their communities, Vietnam Veterans of America warned officials at the Defense and Veterans Affairs departments in March 2018, among other agencies.

But those agencies have brushed off VVA since they were presented with evidence that eventually became a detailed report and congressional testimony, said Kristofer Goldsmith, the Veteran service organization’s chief investigator.

And their plea to President Trump for help has similarly been ignored, Goldsmith said — suggesting the problem may be perceived as too complex or politically fraught for U.S. officials concerned to cross Trump, who has downplayed Russia’s role in election interference.

“It’s easy to say ‘let’s send Javelins to Ukraine.’ People get that,” Goldsmith told The Washington Post. “It’s much more difficult for the secretary of VA to say ‘this is our plan to educate 9 million Veterans who use our health care on how to spot a deep fake or falsified news.’ ”

The group asked Trump to intervene in a Dec. 18 letter because no federal agency responded to their evidence of foreign “fraudulent activities ranging from identity theft to election interference,” according to a copy of the letter obtained by The Post. It was emailed to Jennifer Korn, Trump’s liaison to Veterans groups, according to an obtained email message.

VVA has not received a response. It is not clear whether any of those agencies have taken the lead or are focused on the exploitation of Veterans in foreign disinformation campaigns, Goldsmith said, and none of them has asked for more information on the subject after he has become the Veteran community’s most prominent cybersleuth.

White House officials received the letter but declined to describe what, if anything, they did with it and would not comment on the report.

But the administration “works every day to counter malign foreign influence, from identifying and exposing foreign actors to disrupting and imposing costs for these actions,” a senior official said, adding that “any attempt to undermine our democracy is a matter of national security.”

The FBI said it does not comment on tips but takes the issue of foreign influence “very seriously” and provides information to the public on how to protect itself from online foreign influence.

VA declined to discuss a perception of inaction. Susan Carter, an agency spokeswoman, issued a generic statement saying “Veterans are the targets of many of the same types of fraud as the rest of society.”

The Defense Department “has broad guidance and training about service member activity on social media,” including cyber-awareness training, said spokeswoman Air Force Lt. Col. Carla M. Gleason. She did not mention any training specific to identifying foreign misinformation aimed at service members.

The Pentagon provided the letter to U.S. Cyber Command “upon receipt,” Gleason said, and referred further questions to it. Cyber Command then referred back to the Pentagon’s statement.

Memes, over-the-top political comments and false news articles created by adversarial governments and foreign troll farms intentionally sowed social chaos by championing Veterans and denigrating liberals and minorities, VVA’s report found, and many carry pro-Trump messages aided by common perceptions that the military leans conservative.

“Veterans as a cohort are more likely than others to participate in democracy. That includes not only voting but running for office and getting others to vote,” Goldsmith told The Post in September.

The pages are often wildly popular, with some followings numbering in the hundreds of thousands. One fake VVA page generated about a quarter-million fans, which quickly dwarfed the real group’s Facebook following, Goldsmith said.

In response to Goldsmith’s findings, a bipartisan group of lawmakers in March asked the FBI to investigate the “shadowy figures” behind the pages.

The House Veterans' Affairs Committee held a hearing on foreign disinformation in November, but “none of these agencies have done enough to stop it,” committee spokesperson Jenni Geurink said. The committee will privately meet with the FBI this month on the issue, Geurink added.

But a tepid response from officials has frustrated VVA, which called for a whole of government response on the heels of its congressional testimony and its report, which found persistent, aggressive targeting of Veterans originating from at least 32 countries.

For instance, the Russian Internet Research Agency — a troll factory with Kremlin ties and the target of U.S. indictments and cyberattacks — bought at least 113 online ads aimed at U.S. Veterans and followers of Veterans advocacy groups during and after the 2016 election, according to VVA’s report.

Many pages are operated from Asia and Eastern Europe, and some even have Iranian ties, Goldsmith said. One popular page created in the United States — “Vets for Trump” — was hijacked by an administrator in North Macedonia.

The murky world of these pages unveils the direct and indirect relationship with Russian operations and their effective saturation on social media.

One page, “Being Patriotic,” was cited in former special counsel Robert S. Mueller III’s investigation as a product of the Internet Research Agency. It amassed 200,000 fans at one point, the Mueller report found. But other pages, like one focused on Veterans but run from Vietnam, shared identical memes created by the IRA but with the page title cropped out.

One common theme is referencing Colin Kaepernick’s kneeling protest of police brutality as an attack on troops and Veterans. Others suggest using resources for Veterans at the cost of immigrants and refugees.

Both mimic the language of conservative Americans attacking liberals. One image of a military widow used to attack Kaepernick was shared by Trump on social media in 2018. Similar photos have been used by foreign administrators masquerading as Veterans.

Some pages deceive Veterans into believing they are American-run but have a clear financial goal, like accumulating fans as a customer base for challenge coins and T-shirts, Goldsmith said.

But Goldsmith said some pages generate similar disinformation with no clear financial incentive, while other sophisticated campaigns may sell items to appear innocuous as a smokescreen for more nefarious operations, such as Russian election interference.

Facebook and Twitter were pressed by lawmakers in the November hearing about their response. “We know that we are fighting against motivated adversaries in this space, and that we have to iterate and improve our approach to stay ahead,” Nathaniel Gleicher, Facebook’s chief of security policy, said in his prepared remarks.

Goldsmith is concerned that Russia’s constant barrage is designed to elicit sympathy and downplay their activities around the world, and neutralizing criticism from troops and Veterans could be a strategy to undercut the Pentagon’s message that Russia and China top the list of global adversaries.

“When you have service members believing Russia is not a threat to the elections, and didn’t interfere, they have friends and family convinced, it helps Russia get away with a serious attack on our democracy,” he said.

Those concerns are echoed by the Pentagon. Russia peddles “false narratives about its ongoing aggression against Ukraine, the war in Syria and the use of chemical weapons by the Assad regime,” among other issues, Gleason said.

But Goldsmith sees a reluctance in the administration to aggressively pursue this issue, speculating that getting out front would draw fire from Trump — who has rejected the intelligence community’s assessment of Russia’s role in election interference and helped advance a conspiracy theory that Ukraine was responsible.

Some lawmakers have taken interest, but Goldsmith said he stared at empty chairs at the House VA Committee hearing in November as he testified about the his findings.

“There are not a lot of issues that people pretend to be bipartisan on,” he said. “But this is one everyone can agree is worth addressing. ”

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Tips to refill your VA prescriptions

As COVID-19 spreads, people who regularly take prescription drugs for chronic conditions such as diabetes or high blood pressure may be wondering what will happen with their refills. VA wants you to know we're working hard to make sure you get your prescriptions on time, and when you need them.

We ask that you request refills of your VA Prescriptions as soon as possible. VA will process your refill request and have it sent to you before you're scheduled to run out.

How do Veterans request refills of their prescriptions?

To prevent waste and reduce the risk that unneeded medications could fall into the wrong hands, VA does not automatically refill medications. To receive a medication refill authorized by your VA prescriber, you must actively request a refill using one of the methods described below:

• Online with My HealtheVet: You can request refills of your refillable VA-issued prescriptions, track VA prescription deliveries, view VA prescription history online.

• The NEW Rx Refill Mobile App: You can request refills of your refillable VA-issued prescriptions, track VA prescription deliveries, view VA prescription history from the convenience of your mobile device.

• Telephone Call: Most VA Pharmacies have automated telephone refill lines. You can find the phone number of your local VA Pharmacy on your prescription label. To order refills by phone, you will need the prescription number (shown as RX # on the prescription label) and your Social Security Number. For many prescriptions that are no longer refillable, this automated system may allow you to send a request for more of this medication to be sent to you. For some medications, the healthcare team will need to contact you first.

• By Mail: VA Pharmacy provides a refill request form with each prescription filled. To refill by mail, please complete the request form and mail it to your VA pharmacy at the address listed on the paperwork that arrives with your prescription.

The COVID-19 situation is changing fast. Try not to forget to take your medications or refill your prescriptions. Not having certain medications could cause health problems that require medical attention, putting you at risk of exposure with a facility visit. Veterans who forget to re-order their medications in time have three options. You can contact your VA medical center pharmacy, call the phone number on the prescription label, or use My HealtheVet's Secure Messaging (sign in required) to get in touch with your health care team, especially if your prescription is no longer refillable.

As a last resort, you may visit your VA pharmacy in person to request a refill. You may be subject to screening before entering the facility. You might also have a very long wait to have your prescription refilled. Visiting in person can unnecessarily put you and others at risk of infection.

Delivery times can be affected by weather and the COVID-19 pandemic. Using the Track Delivery feature on My HealtheVet (sign in required), you can obtain the tracking number in use by either the U.S. Postal Service or UPS.

Keeping yourself healthy is one of the best ways to defend yourself against COVID-19. VA knows that this can be a stressful time for Veterans, make sure you're doing everything you can to keep your immune system strong and healthy.

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Sen. Jon Tester (Mont.), Chairman of the Senate Veterans’ Affairs Committee and Sen. John Boozman (Ark.) introduced S. 10—the VA CAREERS Act of 2023, legislation to bolster efforts to recruit and retain strong clinical and managerial leadership in the Department of Veterans Affairs (VA) health care system and make other important improvements to attract clinicians in scarce medical specialties.

In the wake of COVID-19, physicians, nurses and other clinical and administrative executives are in short supply throughout the health care industry. In addition, the Veterans Health Administration (VHA) has been hampered with salary caps which prohibit them from effectively recruiting and retaining critical health care professionals in their local markets. In addition to modification of pay limitations for specialty medical positions and increasing pay caps for certain leadership positions in VHA, the bill would allow VA to pay for licensure costs for recipients of VA scholarship programs; require additional staff training on care models for managing older veterans’ health care needs; expand leave options for clinicians during national emergencies; provide reimbursement for continuing medical education costs for certain employees; and modernize VA’s human resources program.

DAV supports the VA CAREERS Act of 2023, in accordance with DAV Resolution No. 056, which urges our support of efforts to recruit and retain a robust VA clinical workforce. We commend Senators Tester and Boozman for their bipartisan leadership in ensuring the VA health system can remain competitive with the private sector in attracting and retaining health care professionals who are able to provide the highest quality care to our nation’s veterans.

Please use the prepared email to ask your senators to support S. 10—the VA CAREERS Act of 2023 or to thank them for their support.

Thank you for participating in DAV CAN—the Commander’s Action Network.

TAKE ACTION

The Justice for ALS Veterans Act would provide the survivors of veterans who die of amyotrophic lateral sclerosis (ALS) the DIC (Dependency and Indemnity Compensation) “kicker” amount without meeting the required eight-year total disability rating time period.

Current law allows an additional DIC monthly payment of $331.84 to survivors in the case of a veteran, who at the time of death was in receipt of or was entitled to receive compensation for a service-connected disability that was rated totally disabling for a continuous period of at least eight years immediately preceding death. This extra compensation installment is commonly referred to as the DIC “kicker.”

ALS is an aggressive disease that leaves many veterans totally incapacitated and reliant on family members and caregivers. VA already recognizes ALS as a presumptive service-connected disease and, due to its progressive nature, automatically rates any diagnosed veteran at 100% once service-connected. Individuals diagnosed with ALS only have an average lifespan of between two to five years meaning that, sadly, many veterans are unable to meet the existing eight-year total disability requirement to become eligible for the additional “kicker” compensation benefit.

In accordance with DAV Resolution No. 162, DAV strongly supports S. 1590 and H.R. 3790—the Justice for ALS Veterans Act, which would provide increased DIC payments to surviving spouses of veterans who die from ALS regardless of how long they had been rated as totally disabled prior to death.

Please use the prepared email to contact your Senators and Representative to co-sponsor the Justice for ALS Veterans Act. Thank you for supporting service-disabled veterans, their families and survivors through the DAV Commander’s Action Network.

TAKE ACTION

Please add your support for S. 326—the Veterans Programs Improvement Act of 2023. This legislation includes provisions from five bills unanimously approved by the Senate Veterans' Affairs Committee (SVAC) in February. All of these bills are in alignment with at least one DAV resolution. This bipartisan legislative package is expected to be considered in the Senate on Wednesday, April 26, and includes the following bills:

• S. 106, the Commitment to Veteran Support and Outreach Act (Resolution Nos. 014 and 059)
• S. 141, the Elizabeth Dole Home Care Act (Resolution No. 427)
• S. 185, the Native American Direct Loan Improvement Act of 2023 (Resolution No. 251)
• S. 216, the RESPECT Act of 2023 (Resolution Nos. 059, 082 and 427)
• S. 326, the VA Medicinal Cannabis Research Act of 2023 (Resolution No. 128)

This legislative package will help improve outreach and assistance to veterans and their families to ensure they are informed about veterans benefits and services; expand long-term care options for aging veterans and improve services for veterans and caregivers in VA's comprehensive caregiver program; offer better home loan options to Native American veterans and require the VA to conduct a study on the effects of cannabis on veterans with chronic pain or post-traumatic stress disorder. DAV supports this legislation in accordance with the resolutions listed above.

Urgent action is needed because this could be voted on as soon as tomorrow. Please send the prepared email urging your Senator to support and pass S. 326—the Veterans Programs Improvement Act of 2023. We appreciate your continued support through the DAV Commander's Action Network.

TAKE ACTION

Sen. Jon Tester, Chairman of the Senate Veterans’ Affairs Committee, recently introduced S. 42, the Build, Utilize, Invest, Learn and Deliver (BUILD) for Veterans Act of 2023, which would improve staffing to manage construction of VA assets and ensure that there are concrete plans to improve planning, management, and budgeting for construction and capital asset programs at the Department of Veterans Affairs (VA).

The legislation would also ensure VA completed climate resilience surveys for all of its facilities and projected needs for capital assets into the future. Importantly, the bill would assure that VA’s infrastructure planning considers the needs of women Veterans and Veterans’ needs for dental and long-term care services.

With the growing number of Veterans expected to enter the VA health care system in the coming decades, it has become increasingly imperative that Congress take the lead in strengthening VA’s health care infrastructure, and S. 42—the BUILD for Veterans Act is a critical first step toward achieving that goal.

TAKE ACTION

Visiting Vietnam is something not many Sailors will experience in their Navy career. The aircraft carrier USS Theodore Roosevelt (CVN 71) is only the second carrier to visit Vietnam in more than 40

years. This historic port visit comes 25 years after diplomatic relations began between the United States and Vietnam.

Theodore Roosevelt arrived in Da Nang, Vietnam, March 5, 2020. Sailors experienced the culture and met with the people of Vietnam through tours, professional exchanges, and community relations events.

They volunteered at multiple establishments, including the Agent Orange Center of Da Nang, a vocational school for people affected by Agent Orange, and Dorothea’s Project Legacies Center, a children’s orphanage in Da Nang.

AGENT ORANGE CENTER

Agent Orange is a chemical that was used during the Vietnam War, and was harmful to anyone

who came into contact with it. The children of Agent Orange victims often have mental and physical disabilities. The Agent Orange Center helps these children learn in a fun and welcoming environment.

Phan Phanh Pien, the vice president of the Agent Orange Center said more than 30 children attend the school, where they learn general education, as well as vocational skills to help them later in life.

“We teach them special education living skills, and we give some of them vocational training,” said Pien. “We want to enlighten the children so they can be better, confident, and find a job in the future.”

As a gift to the children, who were not at school, Sailors painted a mural to celebrate the 25 years of diplomatic relations between the U.S. and Vietnam.

“We painted this beautiful 25th anniversary mural for them,” said U.S. Navy Retail Services Specialist Seaman Keeshma Singh. “The mural was to commemorate our peace with them. It was amazing, knowing that they’re going to come back and see our gift to them.”

Sailors also spent the day beautifying the school, doing yardwork and general clean-up to surprise the children when they return to class.

“I was heartbroken when I heard they wouldn’t be there,” said Singh. “But knowing that I was still able to make an impact to them had my heart racing.”

DOROTHEA’SPROJECT LEGACY CHARITY CENTER

Dorothea’s Project Legacy Charity Center is a children’s orphanage that provides schooling and shelter for children in need to ensure a better future for all involved.

U.S. Ambassador to Vietnam Daniel Kritenbrink; Adm. John C. Aquilino, commander, U.S. Pacific Fleet; and his wife, Laura Aquilino, joined Sailors from Theodore Roosevelt and USS Bunker Hill (CG 52)

for a community relations event at the center March 6, 2020,.

According to U.S. Navy Aviation Ordnanceman 3rd Class Khaden D. Vaughn, when the Sailors approached the facility they were met by the excited, smiling children living at the charity center. They could not wait to talk and spend time with the people who came to visit them.

“Interacting and playing with the children felt great,” said Vaughn. “It was a very humbling experience being able to interact with those less fortunate.”

The children at the charity center spent the day with Sailors playing games, sports and making arts and crafts. They also listened to a performance by U.S. Navy musicians from the U.S. Pacific Fleet

Band.

“The kids were great, it seems like they really enjoy themselves here,” said U.S. Navy Operations Specialist 1st Class Kimberly Loughridge. “Being able to make them smile was one of my favorite parts of Vietnam.”

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WWII Veteran William Christoffersen was 93

World War II Veteran and 75-year legionnaire William E. Christoffersen will be remembered as a man who fought for his country and his fellow Veterans. It was his life’s mission.

“We’ve lost one of our greatest champions,” Terry Schow said. “We lost a guy who was a beacon to many of us in the Veteran community. He was beloved.” Schow is a long-time friend and former Utah Department of Veterans Affairs executive director.

“He was a great mentor, great advisor and just a great man. We will never see his likeness again.”

Christoffersen died May 31 at the Utah state Veterans home named in his honor. The Cache Valley native was just days shy of his 94th birthday.

Christoffersen served as an Army infantryman, fighting throughout the Philippines in WWII. He returned home and founded a Logan-based construction business. But his real calling, Schow said, was serving Veterans.

Veteran nursing home was his mission

Soon after leaving the military, Christoffersen joined the American Legion and became department commander in 1959. A born leader and tireless advocate, Christoffersen served on the American Legion’s National Executive Committee – the highest state post within the Legion and part of its national board of directors – just four years later.

He made it his mission to bring a Veterans’ nursing home to Utah.

Describing him as “an impressive man with an imposing stature,” Schow first met Christoffersen over 30 years ago. Schow pressed governor Mike Leavitt to add Christoffersen to the home’s construction advisory committee. The state built the first Veterans nursing home in 1998.

But Christoffersen did more than bring a Veterans home to Utah. He brought three national conventions to the Beehive State, and with them, roughly 10,000 visitors, including dignitaries, senators, and in 2006, President George W. Bush.

“Bill was a legend,” Schow said. “There wasn’t an elected official at the federal level who did not know Bill Christoffersen.”

He also used his clout to better Utah’s Veteran landscape. One of his initiatives rose to the level of federal law. He was one of the promoters of the Transition Assistance Program. The program provides service members leaving the military with a weeklong course on how to create resumes, apply for benefits and more.

“Is it worth it? Yes it is.”

Even in his 80s, he continued advocating for Veterans. In March 2013, VA renamed the facility he helped create the William E. Christofferson Salt Lake Veterans Home.

After serving the Legion for more than a half-century, Christofferson retired in August 2013. Schow recalled how Christoffersen apologized for not doing more.

“There are times when you ask, ‘Is it worth it?’” Christoffersen then told the Legion. “I say yes, it is.”

In tribute for his decades of service, the flags outside the William E. Christofferson Salt Lake Veterans Home flew at half-staff June 5 – in honor of Christofferson’s 94th birthday.

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LOS ANGELES – Authorities today arrested a physician and a marketer on federal charges stemming from a scheme that bilked Medicare out of more than $30 million for medically unnecessary hospice services provided to patients who were obtained through illegal kickbacks.

Dr. Victor Contreras, 66, of Santa Paula, and Callie Jean Black, 63, of Lancaster, are scheduled to be arraigned this afternoon in United States District Court.

A 14-count indictment unsealed today also names the former Pasadena resident who controlled the hospices, Juanita Antenor, 59, who remains at large and is believed to be in the Philippines.

According to court documents, Antenor owned a Pasadena hospice company called Arcadia Hospice Provider, Inc., and she controlled a second, Saint Mariam Hospice, Inc., that billed Medicare and Medi-Cal for hospice services for patients who were not terminally ill. In some case, the companies submitted bills for services that were never provided.

Contreras, who was on probation imposed by the California Medical Board while he was part of the scheme, provided fraudulent certifications for some of these patients, including patients he claimed to have examined, but never actually saw, according to the indictment.

Antenor allegedly paid marketers, including Black, illegal kickbacks for the patients referred to Arcadia and Saint Mariam.

From approximately September 2014 until April 2019, Arcadia submitted to Medicare nearly $23 million in claims for hospice services provided to beneficiaries and was paid approximately $18,853,757 for those claims, according to the indictment. Between February 2015 and April 2019, St. Mariam submitted to Medicare approximately $13,742,116 in claims for hospice services and was paid approximately $11,395,849 for those claims. Contreras is linked to about $5.1 million of the total claims paid by Medicare.

Additionally, Arcadia and St. Mariam submitted more than $5.5 million in claims to Medi-Cal, which paid the companies a total of just over $1.35 million.

Antenor and Contreras are charged in the indictment with health care fraud – six counts name Antenor, and Contreras is charged with five counts. Additionally, Antenor is charged with four counts of paying illegal kickbacks for health care referrals, and Black is charged with four counts of receiving illegal kickbacks.

An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed innocent until and unless proved guilty beyond a reasonable doubt.

If convicted of the charges in the indictment, Contreras would face a statutory maximum sentence of 50 years in prison, while Black would face up to 40 years. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

The United States Department of Health and Human Services, Office of the Inspector General; the FBI; and California Department of Justice investigated this matter.

Assistant United States Attorney Kristen A. Williams of the Major Frauds Section is prosecuting this case.

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Veterans Affairs officials are warning about an uptick in scam attempts targeting Veterans’ pensions that could result in serious financial problems for elderly or infirm individuals.

“Fraudsters are getting smarter, more deliberate and more engaged. They’re getting better,” said Charles Tapp II, chief financial officer for the Veterans Benefits Administration.

“We are seeing a lot more instances where Veterans — particularly seniors — are getting fraudulent calls … So we certainly are making our senior Veterans more aware about pension poaching.”

Earlier this year, the Federal Trade Commission reported that about 2.8 million Americans filed fraud complaints in 2021, the most on record. The agency estimated that consumers lost more than $5.8 billion to scams last year.

VA officials said older Veterans with military pensions or other regular department payouts can be attractive targets for would-be-thieves.

Pension theft can occur when an outside party — a stranger or someone known to a Veteran, such as a caregiver — convinces Veterans to shift their payouts to a new bank account or a separate financial product (annuities or trusts, for example), preventing them from accessing the money.

Tapp said when Veterans’ bank accounts are changed without explanation, it triggers an internal check within VA to ensure that fraud is not occurring. But other theft schemes are more difficult to detect, and may only be corrected after months of malfeasance have already occurred.

In a series of recent outreach efforts, department officials are reminding Veterans that VA does not charge to process applications for benefits and services, and it is against the law for an outside group or attorney to charge claimants for preparing benefits applications.

“No one can guarantee that the VA will award you a benefit or service, not even someone who is VA accredited,” a department fact sheet on pension poaching states. “Only the VA can determine eligibility and award benefits and services.”

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