Federal prosecutors arrest suspects in three states in various alleged schemes to defraud Medicare, Medicaid, employee health plans, and private payers.
Thirty-four people in three states–including 17 physicians and other licensed medical professionals– were charged this week with various counts of Medicare and Medicaid fraud, the Department of Justice announced.
Prosecutors said the suspects allegedly schemed to bill Medicare and Medicaid for services, testing and prescriptions that were not medically necessary or not actually provided.
Charges were brought against 26 suspects-including 14 physicians and other medical-professionals in California for attempting to scam Medicare and Medicaid out of $257 million, and eight people, including three licensed medical professionals, were charged in Arizona and Oregon for fraudulently billing those states' Medicaid programs for $1 million.
Those charged in the various fraud schemes include:
- Ronald Weaver, MD, 70, of Pacific Palisades, California, Sara Soulati, 49, of Santa Monica, California, John Weaver, MD, 75, of Alhambra, California, Ronald Carlish, MD, 78, of Pacific Palisades, California, Howard Elkin, MD, 68, of Whittier, California, Wolfgang Scheele, MD, 79, of Los Angeles, California, and Nagesh Shetty, MD, 74 of Huntington Beach, California.
Prosecutors said the seven suspects alleged billed Medicare for $135 million for medically unnecessary cardiac treatments and testing through Global Cardio Care of Inglewood, California.
- Hilda Haroutunian, 59, of Sun Valley, California, Keyvan Amirikhorheh, MD, 60, of Seal Beach, California, Lorraine Watson, 56, a physician's assistant, of Valley Village, California, Noem Sarkisyan, 63, of North Hollywood, California, and Edmond Sarkisyan, 40, a medical assistant, of North Hollywood, California, were charged for their alleged participation in a $10 million scheme to defraud Medi-Cal with bogus charges for family planning services, testing and prescriptions for non-existent patients in Los Angeles.
- Antonio Olivera, 78, of Downey, California, Emelita Cephass, 57, of Downey, California, and Martin Canter, 70, of Rancho Palos Verdes, California, were charged for their alleged participation in a hospice kickback scheme.
Olivera was also charged for his alleged participation in a scheme to defraud Medicare, all involving Mhiramarc Management LLC, a hospice located in Downey, California.
In a separate case, hospice owner John O'Brien was charged with healthcare fraud conspiracy for his alleged role in the fraud scheme.
- Navid Vahedi, 40, of Los Angeles, Vahedi's pharmacy "Fusion Rx Compounding Pharmacy," and Joseph S. Kieffer, 39, of Los Angeles, were charged for the alleged participation in a fraud and illegal kickback scheme. Vahedi, the operator of Fusion Rx, and Kieffer, a marketer, allegedly paid commissions to marketers and some patients to obtain medically unnecessary compounded drugs to allow Fusion Rx to bill healthcare providers for those compounded drugs, many of which were reimbursed at rates much higher than average medications.
To encourage patients to continue using the compounded drugs, Fusion Rx allegedly did not charge copayments to patients. To evade auditors, however, the suspects allegedly directed Fusion Rx staff to use gift cards to pay the patients' copayments for them so that it would appear they made the required copayments.
Prosecutors said the scheme resulted in $17 million in losses to healthcare providers while the defendants spent substantial sums of money on themselves, including Vahedi's purchase of a 1963 Ford Mustang Cobra.
Also charged in a related case was Joshua Pearson, 40, a marketer, of St. George, Utah, for his alleged receipt of illegal kickbacks from Fusion Rx, Vahedi, and Kieffer for patient referrals for compounded drugs.
- Amir Friedman, 54, MD, an anesthesiologist, of Calabasas, California, was charged for his alleged participation in a conspiracy to commit honest services mail and wire fraud and Travel Act violations involving approximately $800,000 in kickbacks for compounded pharmaceutical drugs involving New Age Pharmaceuticals, Inc., located in Beverly Hills.
- Susan H. Poon, DC, 54, of Dana Point, California, was charged for her alleged participation in an approximate $2 million scheme to defraud Anthem, Aetna, and other Blue Cross Blue Shield Association affiliates. Poon allegedly submitted false and fraudulent claims for chiropractic services never provided, medical diagnoses never given, and office visits that never occurred.
Poon also allegedly submitted false and fraudulent prescriptions to a provider of durable medical equipment—or in-home medical devices that can cost thousands of dollars each—that relied on those false prescriptions in its reimbursement claims.
Employees and employee-dependents of the United Parcel Service and Costco Wholesale Corp. who allegedly never received the services or sought the medical equipment were named as patients in Poon's false claims and prescriptions.
- Mahyar David Yadidi, DC, was charged with conspiracy to commit healthcare fraud for operating a scheme to defraud the International Longshore and Warehouse Union – Pacific Maritime Association healthcare benefit plan. Yadidi allegedly defrauded the ILWU-PMA Plan through his chiropractic clinic, San Pedro Philips Chiropractic, by offering kickbacks to patients for attending the clinic and by billing the plan for services that were not rendered to its patients, services that were not medically necessary, and services that were provided by unlicensed employees not qualified to perform them. Yadidi allegedly continued to operate his scheme after he was terminated as an authorized provider by the ILWU-PMA Plan.
- Ivan Semerdjiev, DC, a chiropractor working for Yadidi, and Julian Williams, a personal trainer working for Yadidi, were also both charged in connection with this fraud conspiracy. In total, Yadidi, Semerdjiev, and Williams submitted almost $5 million to the ILWU-PMA Plan in allegedly fraudulent claims.
- Darren Hines, DC, was charged with healthcare fraud for operating a scheme to defraud the International Longshore and Warehouse Union – Pacific Maritime Association healthcare benefit plan.
Hines allegedly defrauded the ILWU-PMA Plan through his chiropractic clinic, Advanced Alternative Health, by billing for bogus services and services provided by unlicensed employees, all after Hines was terminated as an authorized provider by the ILWU-PMA Plan. Hines submitted over half a million dollars in allegedly fraudulent claims over a short period of time
Charges were brought against 26 suspects-including 14 physicians and other medical-professionals in California for attempting to scam Medicare and Medicaid out of $257 million.
Eight people, including three licensed medical professionals, were charged in Arizona and Oregon for fraudulently billing those states' Medicaid programs for $1 million.