Medicare Fraud Probes Keep DOJ Hopping

LA Pastors Convicted in $14.2M Medicare DME Fraud

Two pastors of a now-defunct Los Angeles church and an accomplice have been convicted of conspiracy and fraud counts in connection with a $14.2 million Medicare fraud scheme involving durable medical equipment, the Departments of Justice and Health and Human Services said.

After a two-week trial in federal court in Los Angeles, a jury found Christopher Iruke, 60; his wife, Connie Ikpoh, 49; and Aura Marroquin, 30, guilty of multiple charges. Iruke, Ikpoh, and Marroquin billed Medicare for power wheelchairs, orthotics and other DME that were not medically necessary or never provided. The couple recruited parishioners from their now-defunct Arms of Grace Christian Center to help perpetrate the scheme, prosecutors said. 

Philadelphia Physician, Pharmacist Indicted in Drug Fraud Case

A 498-count indictment was unsealed this week charging 53 defendants, including a Montgomery County physician and a Northeast Philadelphia pharmacist, in a multi-million dollar drug conspiracy involving phony prescriptions, phony patients, and an alleged drug trafficking organization, federal prosecutors said. The indictment was announced by United States Attorney Zane.

In addition to charges of drug possession and drug distribution, the indictment contains 240 counts of healthcare fraud.

Named in the indictment and arrested were Norman Werther, MD, of Horsham, pharmacist Ihsanullah "Sean" Maaf, of Northeast Pharmacy in Philadelphia, and alleged drug trafficker William Stukes, of Philadelphia. According to the indictment, Stukes and his alleged drug trafficking organization recruited large numbers of pseudo patients and took them to Werther's medical office for fake examinations.

These "patients" paid an office visit fee, usually $150, to the office staff and Werther would write prescriptions for oxycodone-based drugs without there being a medical need. The "patients" were driven to various pharmacies to have their prescriptions filled, including Northeast Pharmacy where Maaf would fill the prescription.

The drugs were then turned over to Stukes or his drivers. Stukes and his organization would allegedly sell the narcotics to numerous drug dealers, who are also named in the indictment, who would also then resell the drugs on the street.

CA Clinic, MD, to Pay $7.5M To Settle Fraud Case 

An Orange County, CA physician and the clinic he operated will pay the federal government $7.5 million to settle whistleblower Medicare fraud civil claims related to billings for cancer treatments, the Department of Justice has announced.

Glen Justice, MD, an oncologist from Corona del Mar, CA, and the CEO of Pacific Coast Hematology, was sentenced last month to 18 months in prison after he pleaded guilty to submitting bills to Medicare for injectable cancer medications that were never administered to patients, DOJ said.

Federal prosecutors announced a settlement last week in the civil case against Justice, 66, which arose from a whistleblower lawsuit brought forward by former employees at the medical group.

The civil lawsuit essentially reiterates the allegations brought forward in the criminal trial.

The fraud, which prosecutors say began in 2003 and continued until late 2009, was brought by whistleblowers Dora Figueroa and Francisca Pages, who both worked for Justice at Pacific Coast Hematology, The women could receive up to 25% of the settlement, as part of the whistleblower statute.

MD Oncologist Pleads Guilty to Purchasing Misbranded Drugs

Isabella Martire, MD, age 52, of Laurel, MD, an oncologist in solo practice, has pleaded guilty to introducing a misbranded drug into interstate commerce.

According to Martire's plea agreement, in 2010, federal law enforcement investigators began investigating a pharmaceutical wholesaler based in England concerning allegations that the company was importing into the United States prescription drugs approved and labeled for use only outside the United States. Further investigation revealed that Martire purchased nearly $200,000 of misbranded prescription drugs from the company in 2010.

Martire used the misbranded drugs to treat her cancer patients. She sought reimbursement from Medicare, Medicaid, TRICARE, federal employee health benefit plans and private health insurers for reimbursement of the cost of those drugs. The cost savings Martire realized by purchasing the misbranded drugs was at least $790,600 in 2010.

Martire faces a maximum penalty of one year in prison followed by a year of supervised release when she is sentenced on Oct. 17, prosecutors said.

Miami Home Health RN Gets 10 Years for Fraud

Armando Santos, RN, of Miami, was sentenced last week to a statutory minimum of 10 years in prison following his conviction by a federal jury in May on several counts related to healthcare fraud, federal prosecutors said.

Santos, 46, was employed by a Miami-Dade based home healthcare agency called Ideal Home Health, and was paid to provide care for Medicare beneficiaries that were homebound, diabetic, insulin dependent, and so ill that they were unable to inject themselves with insulin.

Evidence at trial showed that at least two of the Medicare beneficiaries that the defendant claimed to be injecting with insulin twice daily, seven days per week, were neither in need of insulin nor homebound.

The owners of Ideal Home Health, Elizabeth Acosta Sanz and Luis Alejandro Sanz, both of Miami, were recently arrested and face related healthcare fraud and conspiracy charges.

Miami Woman Is 10th Person Arrested in $27M Healthcare Fraud Conspiracy

Elizabet Lombera, 39, of Miami Lakes, FL was indicted August 10 by a federal grand jury in Miami of conspiracy and fraud charges for her alleged role in a scheme to scam more than $27 million from Medicare. The indictment Lombera and her co-conspirators installed nominee presidents to hide her control of five durable medical equipment companies in Miami that submitted fraudulent claims to Medicare.

Collectively, the five companies submitted approximately $27,383,328 in fraudulent claims to Medicare and received $12,438,952 in reimbursements. The indictment alleges that Lombera used the money for personal gain, including paying for a trip to Japan. Six of Lombera's co-conspirators have already been sentenced for their roles in this conspiracy.