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Palm Beach County Doctor Charged in $681 Million Substance Abuse Treatment Fraud Scheme

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national-cancer-institute-L8tWZT4CcVQ-unsplash-300x200A doctor in Palm Beach County, FL, was arrested and charged for allegedly participating in a massive health care fraud scheme that involved billing recovering drug and/or alcohol addicts for fraudulent treatments and tests.

Dr. Michael J. Ligotti, 46, of Delray Beach, was charged with conspiracy to commit health care fraud and wire fraud. Attorney information was not available.

According to the criminal complaint, Ligotti is the owner of a Delray Beach-based private clinic called Whole Health that offered, among other things, urgent care, family care, and addiction treatment. He is accused of fraudulently billing private insurers and Medicare for an estimated $681 million in laboratory tests and other services, for which they paid approximately $121 million.

Ligotti was purportedly the “medical director” for more than 50 addiction treatment facilities or sober homes for a fee. He allegedly authorized over 136 “standing orders” for urinalysis tests, which were billed by medical laboratories that reportedly paid kickbacks to sober homes. In exchange for authorizing the orders, he required the facilities to supply Whole Health with patients who he and his staff treated, allowing him to bill private insurers and Medicare for additional treatments, the complaint alleges.

“The substance abuse treatment fraud allegedly perpetrated by the defendant sacrificed the genuine care of vulnerable patients at a time when they urgently needed a trusted health care provider,” said U.S. Attorney Ariana Fajardo Orshan. “Health care providers who allow greed to take precedence over their Hippocratic Oath and participate in these schemes are criminals and will be held accountable for their unscrupulous conduct.”

The alleged treatments Ligotti and his staff provided at Whole Health included expensive blood tests, urinalysis tests, and other unneeded services. The complaint claims Ligotti never reviewed the results of the tests in any meaningful way and he never used them to treat the patients. He also allegedly billed insurers for therapy sessions and psychiatric services that never happened, and that neither he nor his staff were qualified to perform. Some of the patients were allegedly billed between $10,000 and $20,000 for a single day’s visit.

The complaint further alleges that Ligotti inappropriately prescribed patients controlled substances, including large quantities of Suboxone/buprenorphine, often exceeding the number of patients he was legally authorized to prescribe drugs to. He allegedly provided these drugs to patients who did not need them.

“The treatment of addiction helps restore an individual’s independence from drugs and good health, so they can go back to their families and be productive members in our society,” said Kevin W. Carter, Special Agent in Charge of the U.S. Drug Enforcement Administration Miami division. “Physicians and other medical professionals who hold positions of trust within our communities, will absolutely be held accountable for violations of that trust.”

Medical billing fraud is the most common form of health care fraud. Many of these cases are based on the assumption that a healthcare clinic deliberately submitted fraudulent billing to Medicaid, Medicare, or a private insurer. However, billing mistakes can occur, and the alleged fraud scheme must be significant before the government steps in.

If your business is being investigated for health care fraud, then you should immediately consult an experienced fraud defense attorney. The sooner you reach out to an attorney, the easier it will be to resolve the allegations.

South Florida Fraud Defense Attorney

Are you accused of committing health care fraud in Palm Beach County? Contact Brian Silber, P.A. for a free initial consultation with one of South Florida’s most experienced fraud defense attorneys.

Source: 7.31.20 Florida doctor charged in massive $681 million substance abuse treatment fraud scheme.pdf

Feds Charge Washington, D.C. Dentist, Two Others for Involvement in Plot to Defraud Medicaid

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quang-tri-nguyen-VxVO1zrY5F8-unsplash-300x200A federal grand jury has indicted a Maryland dentist, his business partner, and another man on federal charges related to an alleged plot to fraudulently obtain millions of dollars in Medicaid payments.

The indictment, which was unsealed on July 22, names Edward T. Buford III, 68, of Silver Spring, Maryland; Kasandra Vilchez-Duarte, 44, of Fort Washington, Maryland; and Donnie Amis, 63, of Washington, D.C., as the defendants. They are each charged with conspiracy to commit health care fraud and mail fraud, and conspiracy to violate the federal Anti-Kickback Statute. They were released after their initial court appearances last Wednesday. Attorney information was not available.

According to the indictment, the trio conspired to defraud Medicaid of more than $8 million in claims collectively submitted between January 2013 and May 2018. Buford was a licensed dentist in Washington, D.C., where he was the owner of International Dental Associates (IDA). Vilchez-Duarte was his business partner and manager of the company. IDA was reportedly a Medicaid provider from July 2011 to present day, and Buford and Vilchez-Duarte are accused of fraudulently billing Medicaid for dental services provided to Medicaid beneficiaries.

The indictment claims that from January 2013 to May 2018, they paid Amis kickbacks to recruit Medicaid beneficiaries for their dental practice. To convince the beneficiaries to receive dental services from IDA, Amis allegedly offered them cash bribes. The defendants typically paid $20 to beneficiaries who agreed to be fitted for dentures, and approximately $10 to beneficiaries who received dental cleaning. The beneficiaries were only paid for the initial visit and many of them never returned after receiving the cash payment, the indictment claims. As a result, IDA stored hundreds of undelivered dentures which had already been billed to and paid for by Medicaid.

The indictment further claims that in April 2016, Buford and Vilchez-Duarte lied in IDA’s application for re-enrollment into Medicaid by failing to disclose Buford’s suspension from Medicaid. Buford was reportedly enrolled as an individual Medicaid provider until April 2015, when Medicaid suspended payments to his provider number. After the suspension, Buford and Vilchez-Duarte continued to submit claims to Medicaid using IDA’s Medicaid provider number.

From January 2013 to February 2015, Buford and Vilchez-Duarte submitted claims totalling $5.2 million to Medicaid using Buford’s individual provider number, sources indicate. Medicaid paid approximately $2 million of those claims. From February 2014 to May 2018, the defendants submitted $12 million in claims through IDA, and Medicaid paid an estimated $6.4 million.

If convicted, the defendants each face a maximum of 20 years in federal prison for conspiracy to commit health care fraud and mail fraud, and a sentence of up to five years in federal prison for conspiracy to violate the federal anti-kickback statute.

Fraud charges are a serious offense with severe penalties. Anyone accused of committing fraud should immediately consult an experienced defense attorney who can review the evidence and determine the best course of action.

South Florida Fraud Defense Attorney

Are you accused of committing financial crimes in South Florida? Contact Brian Silber, P.A. to set up a free initial consultation and work with one of South Florida’s most experienced fraud defense attorneys.

Source: 7.22.20 dentist and two others facing federal charges related to scheme to defraud medicaid.pdf

Florida Man Arrested, Charged with COVID-19 Relief Fraud and Healthcare Fraud

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kendal-L4iKccAChOc-unsplash-300x200The U.S. Attorney’s Office for the Southern District of Florida announced the arrest of a Coconut Creek man accused of using his businesses to fraudulently obtain federal loans meant for small businesses affected by the coronavirus (COVID-19) pandemic and bilking the Medicare system of at least $5 million.

Carlos Belone, 37, was arrested Friday and charged with wire fraud, payment of health care kickbacks, conspiracy to commit health care fraud, and making false statements to a financial institution. His bond was set at $150,000. It is unclear if he has acquired legal representation.

According to the criminal complaint, Belone is the owner of a durable medical equipment company in Coral Springs called R&S Pharmacy Inc. He is accused of applying for several loans through the Small Business Administration’s Payroll Protection Program (PPP) using falsified tax documents and phony profit and loss statements.

The PPP is a federal initiative that was designed to provide funding for job retention and other business-related expenses to small American businesses affected by the coronavirus pandemic. It allows qualifying small businesses to receive two-year loans with a one percent interest rate. Over $650 billion in forgivable loans were authorized by Congress as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act passed in March 2020.

Belone reportedly received over $22,000 in loans and immediately transferred $12,000 to a bank account under his personal control. He used the rest of the money to further a Medicare fraud scheme he was running through his businesses. The complaint claims Belone submitted false and fraudulent claims to Medicare for orthotic braces that were medically unnecessary. Patients interviewed by investigators allegedly stated that they did not need or want braces and had not authorized their Medicare number to be used by Belone’s pharmacy to submit claims for the devices. Several patients also stated that they did not receive the braces as represented in the claims Belone purportedly submitted to Medicare.

Investigators also interviewed the doctors who prescribed the medical equipment in the claims. The doctors allegedly admitted they wrote the prescriptions for orthotic braces in exchange for kickbacks. One doctor said Belone paid him between $150 and $325 per prescription, depending on the type of braces noted in the order, the complaint alleges.

In total, R&S Pharmacy’s claims totaled more than $5 million between May 2018 and December 2019. Belone allegedly submitted similar fraudulent claims through another company, R&S DME Services LLC, between July 2019 and January 2020. Those claims totaled more than $680,000, the complaint states. He continued the alleged scheme in April 2020 after he received his PPP loan proceeds.

Belone’s case was investigated by the Health and Human Services Office of the Inspector General in conjunction with the FBI. The press release announcing his charges noted that a criminal complaint is only an allegation and that a defendant is presumed innocent until proven guilty.

Fraud is one of the most commonly prosecuted crimes in South Florida. Any business owner accused of committing fraud should immediately consult an experienced attorney who can review the evidence and build a strong defense.

South Florida Fraud Defense Attorney

Accused of committing health care fraud? Contact Brian Silber, P.A. for a free initial consultation with one of South Florida’s most experienced fraud defense attorneys.

Source: 7.10.20 Florida man charged with COVID-19 relief fraud, healthcare fraud.pdf

Three Individuals Charged in New Jersey for Alleged Involvement in $6 Million Health Care Fraud Conspiracy

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thermometer-headache-pain-pills-139398-300x200Three individuals were indicted in New Jersey on Thursday for their alleged involvement in a $6 million prescription fraud scheme that targeted state healthcare plans in South Jersey.

The U.S. Attorney’s Office for the District of New Jersey announced a 33-count indictment against Dr. Brian Sokalsky, 42, of Margate; Vincent Tornari, 46, of Linwood; and Ashley Lyons-Valenti, 63, of Swedesboro, for their role in conspiracy schemes to receive kickback payments for medically unnecessary compounded medications. It is unclear if they have acquired legal representation.

Sokalsky and Tornari were charged with multiple counts of conspiracy to commit health care fraud and wire fraud. Lyons-Valenti was charged with wire fraud and five counts of making false statements. She was additionally charged with obstruction of justice for allegedly tampering with a federal grand jury witness. A fourth conspirator, Dr. Michael Goldis of Stratford, pleaded guilty to four counts of making false statements for writing fraudulent prescriptions for patients he never met.

According to the indictment, the defendants are accused of recruiting patients in New Jersey to obtain expensive and medically unnecessary compounded medications from pharmacies in Louisiana and Pennsylvania. Compounded drugs are non-FDA-approved specialty medications mixed by a pharmacist to meet the specific needs of a patient.

The alleged fraud scheme centered on billing state and local government employees—police officers, firefighters, state troopers, teachers—covered by the state health benefits program for compounded drugs. The conspirators purportedly discovered that certain compound medication prescriptions, such as vitamin combinations and creams for pain, scars, and libido, were reimbursed for thousands of dollars for just a one-month supply.

Sokalsky reportedly had an arrangement with Matthew Tedesco of Northfield, who is awaiting sentencing after pleading guilty to conspiracy to commit health care fraud. Tedesco allegedly sent new patients to Sokalsky’s medical practice. Sokalsky would then prescribe them compounded drugs from the Louisiana pharmacy. The state paid the pharmacy over $5 million for compounded medications he prescribed, according to the indictment. Sokalsky profited by billing insurance for over 30 new patients, while Tedesco received a percentage of the money the pharmacy received for the prescriptions, sources indicate.

Sokalsky and Tornari had a similar arrangement with the Pennsylvania pharmacy, officials allege. The indictment claims Tornari received 50 percent of the insurance payments the pharmacy got for prescriptions Sokalsky wrote. He hired an individual identified as Mark Bruno to find patients who would agree to receiving medication from the pharmacy in exchange for cash payments. Bruno sent the patients to Sokalsky, who gave them prescriptions for drugs they didn’t need, sometimes without even seeing them. The prescriptions cost insurers over $500,000, according to officials.

The third scheme involved Tornari and Lyon-Valenti. Tornari allegedly hired Lyon-Valenti’s boyfriend to find him patients and paid him commissions for each prescription Lyon-Valenti wrote for the Pennsylvania pharmacy. Lyons-Valenti allegedly received half of the commission payments her boyfriend received from Tornari.

Lyon-Valenti is also accused of persuading individuals who work at her medical office to receive prescription medications from the Pennsylvania pharmacy that they did not need, often without performing a medical examination or recording the prescriptions in their medical records, officials said. The scheme cost insurance companies over $1.25 million. Lyons-Valenti received over $90,000 in kickbacks.

Lyons-Valenti was additionally charged with witness tampering for allegedly making false and misleading statements to a co-worker who was a witness in the investigation. She called and texted the witness before and after they spoke to the FBI, and before the witness was scheduled to testify in court, sources indicate.

In total, the three defendants allegedly defrauded the state health benefits program and other insurers out of more than $6 million by prescribing compound drugs.

Anyone under investigation for health care fraud should immediately consult an attorney. A good attorney can quickly come up with a defense strategy that will resolve the matter with minimal penalties.

South Florida Fraud Attorney

Are you accused of committing health care fraud in South Florida? Contact Brian Silber, P.A. for a free initial consultation with one of South Florida’s most experienced fraud defense attorneys.

Source: 6.25.20 three individuals charged in $6 million health care fraud conspiracy.pdf

Nine Pharmacists Charged for Role in $12.1 Million Health Care Fraud Scheme in Michigan and Ohio

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freestocks-nss2eRzQwgw-unsplash-300x200The U.S. Department of Justice (DOJ) has unsealed the indictments of nine pharmacists who were charged last week for their alleged participation in a $12.1 million health care fraud scheme executed in Michigan and Ohio.

The nine pharmacists named in the DOJ’s press release are:

  • Auday Maki, 66, of Northville, Michigan, charged with health care fraud.
  • Hassan Abdallah, 49, of Sterling Heights, Michigan, charged with health care fraud.
  • Ali Abedrazzaq, 44, of Sterling Heights, Michigan, charged with health care fraud.
  • Hassan Khreizat, 40, of Dearborn Heights, Michigan, charged with health care fraud and conspiracy to commit health care fraud.
  • Nofal Cholag, 41, of Macomb Michigan, charged with health care fraud and conspiracy to commit health care fraud.
  • Raef Hamaed, 50, of Scottsdale, Arizona, charged with conspiracy to commit health care fraud and wire fraud.
  • Kindy Ghussin, 45, of Greene County, Ohio, charged with conspiracy to commit health care fraud and wire fraud.
  • Balhar Singh, 57, of Butler County, Ohio, charged with conspiracy to commit health care fraud and wire fraud.
  • Tarek Fakhuri, 47, of Windsor, Canada, charged with conspiracy to commit health care fraud, health care fraud, and wire fraud.

The indictments filed in the Eastern District of Michigan allege that the nine defendants—who are all licensed pharmacists and/or owners of the pharmacies in Michigan and Ohio—billed Medicare, Medicaid and Blue Cross Blue Shield (BCBS) for prescription drugs that were never dispensed.

According to court documents, Abdallah, Hamaed, Fakhuri, Ghussin, Singh, and Abdelrazzaq received $6.9 million for drug sales from Medicare and Medicaid even though their pharmacies didn’t have sufficient inventory to dispense medication of that volume. The Michigan and Ohio pharmacies they used for the alleged fraud scheme are: Harper Drugs Inc., Heartland Pharmacy LLC, Heartland Pharmacy 2 LLC, and Wayne Campus Pharmacy LLC.

From January 2013 to January 2016, Cholag and Khreizat reportedly received $1.5 million from Medicare, Medicaid, and BCBS for drugs their pharmacy, Universal Pharmacy LLC, couldn’t have dispensed. Maki received approximately $3.7 million through City Drugs Pharmacy Inc. In total, the named defendants allegedly received more than $12.1 million from fraudulent claims filed between 2010 and 2019.

Medical billing fraud is the most common healthcare fraud scheme. Most cases of this kind are based on the theory that a healthcare business or medical provider deliberately submitted fraudulent billing to Medicare, Medicaid, or a private insurance provider. However, billing mistakes can happen, and the alleged fraud must be widespread and financially significant for the government to become involved.

If your business is under investigation for health care fraud, you should immediately consult an experienced fraud attorney. The sooner you contact an attorney, the easier it will be to resolve the matter. A good lawyer will understand the nuances of different medical fraud scenarios and tailor a specific defense strategy for your case.

South Florida Fraud Attorney

Are you accused of committing health care fraud in South Florida? Contact Brian Silber, P.A. for a free initial consultation with one of South Florida’s most experienced fraud defense attorneys.

Source: 6.17.20 nine pharmacists charged for role in $12.1 million health care fraud scheme.pdf