U.S. GOVERNMENT FILES $150 MILLION SUIT AGAINST UNIVERSAL IMAGING INC., FOR VIOLATION OF FALSE CLAIMS ACT

The following excerpt is from the U.S. Department of Human Services website:

“DETROIT – The government has filed suit seeking $150 million in damages and penalties under the False Claims Act against Universal Imaging, Inc. and its current and former owners, Phillip J. Young and Mark Lauhoff, United States Attorney Barbara L. McQuade announced today. The complaint alleges that Universal and the owners, who are not medical professionals, conducted a medical radiology business in violation of numerous Medicare rules relating to adequate supervision of diagnostic tests and generated 90% or more of their business by paying kickbacks to physicians. Also named in the complaint is Gwendolyn Washington, a primary care physician who received kickbacks for referrals from Universal and as a result ordered dangerously high levels of tests involving injection of radioactive material into patients.
The complaint alleges that although Universal was required under Michigan law to be organized as a non-profit corporation to ensure the health and safety of patients, it surreptitiously continued to operate as a for-profit corporation by transferring its equipment to a for-profit entity, MRI Leasing LLC, with the same owners. Universal then made “lease” payments to that for-profit entity for Universal’s equipment, profiting the owners in circumvention of the laws relating to Michigan non-profits.
U.S. Attorney McQuade also announced settlements totaling $1.56 million with fourteen physicians or physician groups who were paid for their referrals by Universal. The settling physicians include Dr. David Schaefer; Drs. Vladimir and Albert Klemptner; Dr. Corey Haber; Drs. John and Andrew Zazaian; Partners in Internal Medicine, PLLC; Drs. Eric Straka, Sara Hashemian and Peter Paul; Drs. Gregory Stevens and Teresa Wargovich-Stevens; Dr. Steven Hartz; Dr. David Leszkowitz; Dr. Alexander Vertkin; Dr. Keith Pierce; Dr. Corrine Adler; Dr. Namir Stephan; Dr. Carmen Bogdan; and Dr. James B. Hayner.
"Doctors should be aware that we are scrutinizing records and detecting fraud and kickbacks," McQuade said. "We hope that our aggressive enforcement will deter doctors from cheating the taxpayers and endangering patients.
McQuade praised radiologist Dr. Richard Chesbrough and his wife Kim Chesbrough, who formerly worked at Universal and who filed a qui tam whistleblower suit under the False Claims Act bringing many of the facts in the case to the government’s attention. “We urge other physicians with knowledge of these inappropriate relationships to come forward, either by calling our office and asking to speak to the criminal or civil health care fraud coordinators, or through the qui tam whistleblower mechanism,” she said.
U.S. Attorney McQuade added, “A great example of the coordination between our civil and criminal enforcement efforts is the case of United States v. Dr. Gwendolyn Washington. Dr. Washington was sentenced in November, 2011 to 120 months imprisonment on charges of public corruption, health care fraud, and conspiring to illegally distribute prescription drugs.”
The case is being handled by Assistant United States Attorney Joan Hartman of the U.S. Attorney's Office for the Eastern District of Michigan and was investigated by Special Agent Steve Rinaldi of the Office of Inspector General of the Department of Health and Human Services."

6TH INDIVIDUAL CONVICTED IN CORPORATE MEDICARE KICKBACK SCHEME

The following excerpt is from the Department of Justice Web site.  This is an example of the fraud and abuse that could be a major part of the solution to saving Medicare:

"Houston Federal Jury Convicts Patient Recruiter of Medicare Fraud Involving Claims of Hurricane Damage to Power Wheelchairs

To Date, Six Individuals Guilty of Federal Crimes for Roles in Scheme

WASHINGTON – Marion Beverly Metoyer, a patient recruiter for a Houston durable medical equipment (DME) company, was convicted today by a Houston federal jury of health care fraud related to a power wheelchair fraud scheme, the Departments of Justice, Health and Human Services (HHS) and the FBI announced.  

After a four-day trial, Metoyer, 57, of Dayton, Texas, was convicted on one count of conspiracy to commit health care fraud, three counts of health care fraud, one count of conspiring to receive illegal kickbacks for referring Medicare beneficiaries, and two counts of receiving illegal kickbacks for referring Medicare beneficiaries. 

According to evidence presented at trial, Helen Etinfoh was the owner and operator of Luant & Odera Inc., a Houston-area DME company doing business as Tonni Medical Equipment & Supplies.  Metoyer was a recruiter for Luant who was paid kickbacks in exchange for providing the company with beneficiaries in whose names bills could be submitted to Medicare.   Etinfoh and other co-conspirators submitted false and fraudulent claims to Medicare for medically unnecessary DME, including power wheelchairs, wheelchair accessories and motorized scooters.

Evidence at trial showed that, based on representations from Metoyer and other recruiters, Luant would bill Medicare under a special code that designated the power wheelchairs as replacements for wheelchairs lost during hurricanes that hit the Houston area in fall 2008.  In fact, the hurricanes did not damage the wheelchairs.  Certain beneficiaries testified that they did not even have a power wheelchair before receiving the ones provided to them by Luant.   Luant used the hurricane code because it allowed the company to submit claims to Medicare without a doctor’s order.

At trial, beneficiaries in whose names claims were submitted to Medicare testified that recruiters whom they had never met, including Metoyer, came to their homes and offered them free power wheelchairs in exchange for their Medicare information.  The power wheelchairs were often billed to Medicare at more than $6,000 per chair.

Etinfoh was previously convicted by a federal jury of health care fraud in April 2010, and was sentenced to 41 months in prison.   Paula Whitfield, a patient recruiter for Luant, was also convicted by a federal jury in April 2010, and was sentenced to 21 months in prison.   Melvin Barnes, Johnnie Lee Andrews and Monica Rene Perry, each a patient recruiter for Luant, pleaded guilty to conspiracy to commit health care fraud and await sentencing.

At sentencing, Metoyer faces maximum penalties of 10 years in prison for the health care fraud conspiracy; 10 years in prison for committing health care fraud; five years in prison for conspiring to receive illegal kickbacks for referring Medicare beneficiaries; and five years in prison for receiving an illegal kickback for referring a Medicare beneficiary.  A sentencing date has not been set.

Today’s guilty jury verdict was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney José Angel Moreno of the Southern District of Texas; Acting Special Agent-In-Charge Russell D. Robinson of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG), Office of Investigations; and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).

The case was tried by Trial Attorney Laura Cordova and Assistant Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.

Since their inception in March 2007, Strike Force operations in nine locations have obtained indictments of 1,000 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers."

The attorneys and investigators have done a great job in this case.  They are certainly heros and have the best interest of the country at heart.