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Compounding Pharmacy, Two of Its Executives, and Private Equity Firm Agree to Pay $21.36 Million to Resolve False Claims Act Allegations


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Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE
Wednesday, September 18, 2019

Compounding Pharmacy, Two of Its Executives, and Private Equity Firm Agree to Pay $21.36 Million to Resolve False Claims Act Allegations

The Department of Justice announced today that compounding pharmacy Diabetic Care Rx LLC, or Patient Care America (PCA), PCA’s Chief Executive Officer Patrick Smith, PCA’s former Vice President of Operations Matthew Smith, and private equity firm Riordan, Lewis & Haden Inc. (RLH) have agreed to resolve a lawsuit alleging that they violated the False Claims Act through their involvement in a kickback scheme to generate referrals of prescriptions for expensive pain creams, scar creams, and vitamins, regardless of patient need, which were reimbursed by TRICARE, the federal health care program for military members and their families. PCA and RLH have agreed to pay $21,050,000, Patrick Smith has agreed to pay at least $300,000, and Matthew Smith has agreed to pay at least $12,788. These settlement amounts were based on defendants’ ability to pay.

“Kickback schemes taint decision-making and cause taxpayer-funded health care programs to pay for items or services that patients may not need,” said Assistant Attorney General Jody Hunt for the Department of Justice’s Civil Division. “We will hold accountable health care providers involved in such schemes designed to induce referrals of prescriptions that are reimbursed by federal health care programs.”

“The prosecution and resolution of this case demonstrates the U.S. Attorney’s Office continuing commitment to hold all responsible parties to account for the submission of claims to federal health care programs that are tainted by unlawful kickback arrangements,” said United States Attorney Ariana Fajardo Orshan. “Kickback schemes lead to unnecessary medical services and drive up the cost of health care for all.”

“This settlement sends a clear message about the Defense Criminal Investigation Service (DCIS) and its law enforcement partners’ unwavering commitment to protect the integrity of TRICARE, the Department of Defense’s health care program which serves to protect our U.S. military, their family members, and military retirees,” said Special Agent in Charge Cyndy Bruce of the DCIS Southeast Field Office. “Health care providers who manipulate and abuse the TRICARE program in order to seek financial gain by submitting false claims and demonstrating a lack of regard for TRICARE patients and the health care plan which is charged to provide their medical care, will be diligently investigated and held accountable for their actions.”

This settlement resolves a lawsuit pursued by the United States against PCA for allegedly paying kickbacks to outside “marketers” to target military members and their families for prescriptions for compounded creams and vitamins, which were formulated to ensure the highest possible reimbursement from TRICARE. The United States alleged that the marketers paid telemedicine doctors who prescribed the creams and vitamins without seeing the patients, or in some cases, even speaking to them. The settlement also resolves the United States’ allegations that PCA and a marketer routinely jointly paid the copayments owed by patients referred by the marketer, without any verification of the patients’ financial needs, and then disguised the payments as coming from a sham charitable organization, which was affiliated with the marketer. Finally, the settlement resolves the United States’ allegations that PCA continued to claim reimbursement for prescriptions referred by the marketers despite regularly receiving complaints from patients that revealed the prescriptions were being generated without patient consent or a valid patient-prescriber relationship. RLH, the private equity firm that managed PCA on behalf of its investors, allegedly knew of and agreed to the plan to pay outside marketers to generate the prescriptions and financed the kickback payments to the marketers. Patrick Smith and Matthew Smith were executives of PCA who allegedly executed the scheme. 

The lawsuit resolved by the settlement was originally filed under the whistleblower (or “qui tam”) provisions of the False Claims Act by Marisela Medrano and Ada Lopez, two former employees of PCA. The qui tam provisions permit private individuals to sue on behalf of the government for false claims and to share in any recovery. The False Claims Act authorizes the United States to intervene and take over such lawsuits, which the United States did here, in part. The share to be awarded in this case has not been determined yet.

This civil settlement was the result of a coordinated effort by the Civil Division’s Commercial Litigation Branch (Fraud Section), the United States Attorney’s Office for the Southern District of Florida, the Defense Criminal Investigative Service, and the U.S. Food & Drug Administration’s Office of Criminal Investigations. 

The lawsuit is captioned United States ex rel. Medrano and Lopez v. Diabetic Care Rx LLC, d/b/a Patient Care America, et al., No. 15-CV-62617 (S.D. Fla.). The claims resolved by the settlement are allegations only and there has been no determination of liability.


Source: https://www.justice.gov/opa/pr/compounding-pharmacy-two-its-executives-and-private-equity-firm-agree-pay-2136-million



Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE
Tuesday, July 9, 2019

Substance Abuse Treatment Center Owner Pleads Guilty to $57 Million Money Laundering Conspiracy in Connection with Hospital Pass-Through Billing Scheme

The owner of a Jacksonville, Florida-area substance abuse treatment center pleaded guilty today for his role in a $57 million money laundering conspiracy associated with a pass-through billing scheme involving laboratory testing services.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Maria Chapa Lopez of the Middle District of Florida, Special Agent in Charge Rachel Rojas of the FBI’s Jacksonville Field Office, Deputy Assistant Inspector General Thomas W. South of the U.S. Office of Personnel Management-Office of Inspector General (OPM-OIG), Special Agent in Charge Rafiq Ahmad of the U.S. Department of Labor-Office of Inspector General (DOL-OIG) and Special Agent in Charge Basil P. Demczak of the Amtrak Office of Inspector General (Amtrak-OIG) made the announcement.  

Kyle Ryan Marcotte, 36, of Jacksonville Beach, Florida, pleaded guilty before U.S. Magistrate Judge Joel Toomey of the Middle District of Florida to a one-count information charging him with conspiracy to commit money laundering.  As part of his guilty plea, Marcotte agreed to a forfeiture judgment of $10,220,281.42.  Sentencing before U.S. District Judge Timothy Corrigan of the Middle District of Florida has not yet been scheduled.

According to admissions made as part of his guilty plea, Marcotte was the owner of a substance abuse treatment facility in Jacksonville Beach, Florida.  In approximately 2015, Marcotte entered into an arrangement with a laboratory owner to send urine samples for the facility’s patients to the owner’s lab for urine drug testing (UDT), in exchange for receiving 40 percent of the insurance reimbursements.  The lab owner, in turn, arranged with the managers of Campbellton–Graceville Hospital (CGH) and Regional General Hospital Williston (RGH), rural hospitals in Florida, to have the testing billed to private insurers through CGH and RGH and reimbursed at favorable rates under the hospitals’ in-network contracts with insurers.  Marcotte also admitted that he brokered deals with other substance abuse treatment centers to have their UDTs billed through CGH and RGH in exchange for Marcotte receiving 10 percent of the insurance reimbursements, while the other substance abuse facilities would receive 30 percent of the insurance reimbursements.

The lab owner subsequently acquired Chestatee Hospital, in Dahlonega, Georgia, and other rural hospitals.  Marcotte admitted that he continued to supply samples from his substance abuse treatment facility and continued to broker deals with other substance abuse treatment centers to have UDTs tested at the lab and billed to insurers through Chestatee and the other hospitals, all in exchange for a percentage of the insurance reimbursements.  The reimbursements were transmitted from the hospitals to the lab, which then transmitted them to two companies Marcotte controlled, North Florida Labs and KTL Labs using financial transactions and bank accounts that Marcotte had established to facilitate the payments.  Marcotte arranged to transfer a portion of the reimbursements from KTL Labs as kickbacks to the individuals and companies that controlled the substance abuse treatment centers in order to further the fraudulent scheme.  Marcotte also transferred a portion of the reimbursements to himself and to purchase real estate and items of real property, he admitted.

Marcotte caused $50 million in payments to be made from KTL Labs’ bank accounts to at least 88 companies and individuals associated with substance abuse treatment centers that supplied urine samples for testing.  The total amount of money that was part of the money laundering  scheme was $57.3 million, Marcotte admitted.

The case was investigated by the FBI, OPM-OIG, DOL-OIG and Amtrak OIG.  Trial Attorneys Gary A. Winters and James V. Hayes of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Tysen Duva of the Middle District of Florida are prosecuting the case.

The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.




Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE
Thursday, April 4, 2019

Former CEO of Tennessee Pain Management Company Convicted for Role in Approximate $4 Million Medicare Kickback Scheme

A federal jury sitting in Nashville, Tennessee found the former CEO of a Tennessee pain management company guilty today for his role in an illegal kickback scheme involving approximately $4 million in tainted durable medical equipment (DME) claims to Medicare.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Don Cochran of the Middle District of Tennessee, Special Agent in Charge Derrick Jackson of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Atlanta region, Special Agent in Charge John F. Khin of the Department of Defense, Defense Criminal Investigative Service's (DCIS) Southeast Field Office, Special Agent in Charge Matthew D. Line of the IRS Criminal Investigation (CI) Charlotte Field Office – Nashville Division and Director David Rausch of the Tennessee Bureau of Investigation made the announcement.

After a seven-day trial, John Davis, 41, of Franklin, Tennessee, the former CEO of Comprehensive Pain Specialists (CPS) of Gallatin, Tennessee, was convicted of all counts including, one count of conspiracy to defraud the United States and violate the Anti-Kickback Statute, and seven counts of violating the Anti-Kickback Statute.  Sentencing has been scheduled for later this year before U.S. District Judge William L. Campbell Jr. of the Middle District of Tennessee, who presided over the trial.


    
   
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According to evidence presented at trial, Davis abused his position as CEO of CPS to arrange for referrals of Medicare DME orders to his co-conspirator Brenda Montgomery and her company, CCC Medical, located in Camden, Tennessee.  Evidence showed that Davis operated a shell company called ProMed Solutions (ProMed), which he had registered in the name of his wife.  Despite having no involvement with ProMed and performing no work, Davis’ wife and ProMed received over $770,000 in illegal kickbacks.  Together, Davis and Montgomery pocketed over $2.4 million dollars in improper reimbursement from Medicare.  Davis used company funds from CPS to pay bonuses to CPS providers who ordered DME for Medicare beneficiaries and referred those orders to CCC Medical.  Davis would receive 60 percent of the Medicare profit from those referrals, while the company he ran footed the bill. 

Evidence at trial also showed that in April and May of 2015, concerned about the size of the kickback payments CCC Medical was making to Davis, he and Montgomery concocted the sham sale of ProMed.  ProMed had no assets, no employees, no equipment, no office space and no customers other than CPS.  Evidence further showed that Davis and Montgomery set the price for the sham sale based upon the average monthly kickbacks that Davis had been paid for the previous eight months.  When CPS referrals slowed, Davis agreed to reduce the purported “purchase price” from $200,000 to $150,000.  Once Davis had received the last check for the sham sale, he went about cutting off referrals to CCC Medical. 



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Brenda Montgomery pleaded guilty in January to one count of conspiracy to defraud the United States and violate the Anti-Kickback Statute, and seven counts of violations of the Anti-Kickback Statute.  She is currently scheduled to be sentenced on May 3, 2019.

This case was investigated by HHS-OIG, DCIS, Internal Revenue Service-Criminal Investigation and the Tennessee Bureau of Investigation Medicaid Fraud Control Unit and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Tennessee.  The case was prosecuted by Trial Attorney Anthony Burba of the Fraud Section and Assistant U.S. Attorney Henry Leventis of the Middle District of Tennessee.

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.








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Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE
Thursday, April 4, 2019

Former Administrator of Two Houston Home Health Companies Sentenced to Prison in $20 Million Medicare Fraud Scheme

The former Director of Nursing and Administration of two Houston, Texas-based businesses was sentenced today to 10 years in prison for her role in a $20 million Medicare fraud scheme involving false and fraudulent claims for home health services.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ryan K. Patrick of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office and Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG) Dallas Region made the announcement. 

Evelyn Mokwuah, 54, of Pearland, Texas, former Director of Nursing and Administration of Beechwood Home Health (Beechwood) and Criseven Health Management Corporation (Criseven), both located in Houston, was sentenced by U.S. District Judge Gray H. Miller of the Southern District of Texas.  Judge Miller also ordered Mokwuah to pay $20,462,607.21 in restitution to Medicare.  On Aug. 10, 2017, following a four-day trial, a jury found Mokwuah guilty of one count of conspiracy to commit health care fraud and four counts of health care fraud. 


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According to evidence presented at trial, from 2008 to 2016, Mokwuah and others engaged in a scheme to defraud Medicare of approximately $20 million including the submission of  fraudulent claims for home health services at Beechwood and Criseven that were not provided, not medically necessary or both.  According to the trial evidence, Mokwuah falsely certified and billed for patients who were not homebound or did not qualify for home health services.  Along with others, Mokwuah also falsified patient records to show that patients were homebound when they were not; paid patient recruiters to recruit Medicare beneficiaries to Beechwood and Criseven; and paid doctors to certify false plans of care for Medicare beneficiaries so that Beechwood and Criseven could bill Medicare for those services.  

The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Texas.  The case is being prosecuted by Trial Attorneys Scott Armstrong and Kevin Lowell of the Fraud Section.

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.


Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE
Thursday, April 4, 2019

State Department Contracting Officer Indicted for Bribery and Procurement Fraud

A 17-count indictment was unsealed today charging Zaldy N. Sabino, a contracting officer with the U.S. Department of State, with conspiracy, bribery, honest services wire fraud, and making false statements. 

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney G. Zachary Terwilliger of the Eastern District of Virginia, Inspector General Steve A. Linick of the U.S. Department of State and Assistant Director in Charge Nancy McNamara of the FBI’s Washington Field Office made the announcement.



According to the indictment, between November 2012 and early 2017, Sabino and the owner of a Turkish construction firm allegedly engaged in a bribery and procurement fraud scheme in which Sabino received at least $239,300 in cash payments from the Turkish owner while Sabino supervised multi-million dollar construction contracts awarded to the Turkish owner’s business partners and while Sabino made over a half million in structured cash deposits into his personal bank accounts.  Sabino allegedly concealed his unlawful relationship by, among other things, making false statements on financial disclosure forms and during his background reinvestigation.

The case is being investigated by the Department of State’s Office of Inspector General and the FBI’s Washington Field Office.  Trial Attorney Edward P. Sullivan of the Criminal Division’s Public Integrity Section and Assistant U.S. Attorney Jack Hanly of the Eastern District of Virginia are prosecuting the case. 

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












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