Illinois

May 25, 2010

Decatur Pediatrician Pleads Guilty to Theft Related to Health Care and Agrees to Surrender Medical License (U.S. Attorney for the Central District of Illinois)

Springfield, Illinois - A pediatrician who has practiced in Decatur, Illinois, Jamie S. Warnick, pled guilty today to theft in connection with health care and agreed to permanently surrender her license to practice medicine in the United States. Warnick, 54, previously was the sole physician practicing as Decatur Pediatric Clinic, at 1770 E. Lake Shore Drive, Suite 300, Decatur, Illinois. Sentencing has been scheduled on Oct. 4, 2010, before U.S. District Judge Richard Mills.

In November 2009, Warnick was charged by criminal complaint with health care fraud.  During court hearings today and on May 14, before U.S. Magistrate Judge Byron G. Cudmore, Warnick waived indictment and entered a plea of guilty to an information charging her with theft in connection with health care. Under terms of the plea agreement with the government, Warnick has agreed to permanently surrender her license to practice medicine in the U.S. within 10 days. Further, the parties have agreed to recommend to the court at sentencing that Warnick be ordered to serve three years probation, the first six months of which under home confinement.  Terms of the plea agreement also establish an agreed relevant loss amount of $63,561.89 to the Illinois Department of Public Health based on the value of the vaccine misapplied by Warnick.

During the hearing on May 25, 2010, and in court documents, Warnick admitted that she obtained vaccines, at no cost to her, from the U.S. Centers for Disease Control through the Illinois Department of Public Health. The vaccines were meant primarily for children without health insurance and for under-insured children, whose insurance did not pay for vaccines. 

On multiple occasions between 2005 and Oct. 1,2009, Warnick admitted she knowingly misapplied some vaccines and encouraged and directed parents of minor patients to falsely certify that they, and their child, qualified for the free vaccine, even though they had health insurance to cover the immunizations.  Insurance company records show that a large number of these vaccines were billed to the insurance companies by Warnick, and paid as if the vaccine had been purchased by Warnick. Many other insured individuals did not sign the form; yet the vaccines were administered to their children and their insurance company was billed as if Warnick had purchased the vaccine.

The federally-funded Vaccines for Children (VFC) program provides vaccines at no cost to children who might not otherwise be vaccinated because of an inability to pay.  Created in 1993, the VFC became a required part of each state’s Medicaid plan and was officially implemented in October 1994.  Federal funding is ultimately allocated to the Centers for Disease Control and Prevention (CDC). CDC buys vaccines and distributes them to grantees, such as state health departments and public health agencies, which distribute them at no charge to private physicians’ offices and public health clinics registered as VFC providers.

The Central Illinois Health Care Fraud Task Force, which includes agents of the U.S. Health and Human Services Office of Inspector General, Federal Bureau of Investigation, the Illinois State Police’s Medicaid Fraud Control Bureau, U.S. Postal Inspection Service, Illinois Attorney General’s Office and the Illinois Department of Public Health, conducted the investigation. Assistant U.S. Attorney Patrick D. Hansen is prosecuting the case.

May 24, 2010

Law Enforcement Successfully Targets Medical Professionals Illegally Dispensing Drugs (U.S. Attorney for the Southern District of Illinois)

Fairview Heights, Illinois - A. Courtney Cox, United States Attorney for the Southern District of Illinois, announced on May 20, 2010, the results of Project Dr. Feelgood, a three year initiative spearheaded by the United States Department of Health and Human Services, Office of Inspector General (HHS/OIG) and the Drug Enforcement Administration (DEA), designed to identify and eradicate the medically unnecessary dispensing of prescription medications to Medicaid recipients and Medicare beneficiaries in the Southern District of Illinois. In addition to identifying physicians who unlawfully prescribe controlled substances, Project Dr. Feelgood also sought to identify medical providers who divert controlled substances for their own personal use.

To date, Project Dr. Feelgood has resulted in eight federal convictions and thirteen state convictions. Also as a result of the project, twelve medical professionals have surrendered their DEA Registrations and twenty-one medical providers have had their licenses suspended or put on probation by the State of Illinois.

Project Dr. Feelgood cases were investigated and prosecuted as part of the Southern Illinois Healthcare Fraud Task Force, including agents, investigators and prosecutors from HHS/OIG, DEA, FBI, United States Attorney’s Office for the Southern District of Illinois Criminal and Civil Divisions, Illinois State Police, Illinois Department of Financial and Professional Regulation, Illinois Police Departments, Sheriffs’ Offices, and Drug Task Forces. Project Dr. Feelgood targets have been successfully prosecuted federally in the Southern District of Illinois and through State’s Attorneys’ Offices in Jackson County [State’s Attorney Mike Wepsiec], Massac County [State’s Attorney Patrick Windhorst], Saline County [State’s Attorney Michael Henshaw] Union County [ State’s Attorney Tyler Edmonds], and Williamson County [State’s Attorney Charles Garnati].

United States Attorney Courtney Cox stated: “Federal prosecutors in the Southern District of Illinois and the dedicated agents and prosecutors in the federal, state, and local law enforcement community with whom they work will continue their efforts to vigorously prosecute those who engage in fraudulent acts related to health care programs. The United States Attorney’s Office is committed to take all appropriate criminal or civil legal action to deter those whose conduct places the citizens of the Southern District of Illinois at risk. This project is an example of the many good things that can be accomplished through the cooperative efforts of law enforcement.”

“Prescription drug fraud diverts valuable resources from the Medicare and Medicaid programs and, in some cases, results in personal tragedy for program beneficiaries. HHS-OIG will continue to work with our law enforcement partners in pursuit of those who seek to defraud the Medicare and Medicaid prescription drug benefit,” said HHS-OIG Special Agent in Charge Mike Fields.

Harry S. Sommers, Special Agent in Charge of the DEA St. Louis Division said, “These arrests and DEA registration actions should send a clear message to the medical practitioners who are acting outside the scope of legitimate medical practice that the DEA, along with our state, local, and federal counterparts, are committed to disrupting their illegal activities in an effort to protect the public health and safety.”

According to White County Coroner Carl McVey, “The results of this project are ultimately saving lives in my county.” Complaints from Coroner McVey led to the federal conviction of a physician who practices in his county.

March 11, 2010

Chiropractor and Physician Among Three Defendants Indicted in Alleged $1 Million Health Care Fraud Scheme (U.S. Attorney for the Northern District of Illinois)

CHICAGO - A chiropractor, a medical doctor and a billing employee at a clinic owned by the chiropractor in Maywood were indicted on federal health care fraud charges, federal law enforcement officials announced on March 11, 2010.  The defendants allegedly illegally submitted false claims totaling more than $1 million to obtain payments from workers’ compensation and other insurers for services that were not provided and for inflated claims for services that were provided.  The physician signed false documents and the chiropractor forged doctors’ signatures on documents supporting the false claims, according to an 18-count indictment returned yesterday by a federal grand jury.  Most of the patients of the clinic, the Spine and Joint Rehabilitation Center, were U.S. Postal Service employees who were eligible for benefits from the U.S. Labor Department’s Office of Workers’ Compensation Program.

The chiropractor, Darwin Minnis, 54, of West Chicago, owned and operated the clinic from at least 1998 through 2009.  He was charged with 18 counts of health care fraud.  The physician, Dr. Jacob Salomon, 63, who worked at the clinic from approximately July 2004 to September 2007, and the clinic employee, Gary Strauss, 31, who worked as a biller and claims processor between 2003 and 2007, both of Chicago, were each charged with one count of healthcare fraud. All three defendants will be arraigned at a later date in U.S. District Court.

The indictment was announced by Patrick J. Fitzgerald, United States Attorney for the Northern District of Illinois; L. Scott Caspall, Special Agent-in-Charge of the Great Lakes Field Office of the U.S. Postal Service Office of Inspector General; James Vanderberg, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Labor Office of Inspector General; and Robert D. Grant, Special Agent-in-Charge of the Chicago Office of Federal Bureau of Investigation.

Mr. Caspall said: “Workers’ Compensation is a valuable healthcare program that provides a safety net to hardworking people injured on the job. This investigation is an effort to dismantle a group of medical providers and billers who the indictment alleges were abusing that program. In an age when individuals, businesses and the federal government are paying more for healthcare, this case is a prime example of the excellent results that come from combining the forces of federal law enforcement agencies.”

Mr. Vanderberg said: “This indictment is the result of collaboration by several federal agencies working together to root out federal workers’ compensation program fraud allegedly being perpetrated by medical providers. We will continue to detect and quickly respond to alleged fraud schemes committed against Department of Labor programs.”

According to the indictment, the defendants and others intentionally created and submitted false claims and information to the federal Workers’ Comp office and other health care insurers to obtain payment for the clinic and for patients. The false claims and information related to patients’ work-related injuries, including medical, diagnostic, and physical therapy services that were not provided or were inflated.

As part of the scheme, Minnis allegedly forged and caused others to forge physicians’ signatures on various documents falsely representing that services, treatment, physical therapy and/or testing had been provided, ordered or supervised by medical doctors.  Minnis allegedly forged the doctors’ signatures, and caused them to sign reports without having done patient exams, knowing that Workers’ Comp would not accept a chiropractor’s opinions or reports as medical evidence to support patients’ claims. Under the Federal Employees’ Compensation Act, chiropractors were not qualified physicians and their opinions did not constitute medical evidence except in very limited cases involving specific spine problems.

Minnis also falsely told patients that he was qualified to prepare impairment rating reports and to order and provide testing and treatment, and he failed to disclose that Workers Comp would not pay for services provided by a chiropractor except in very limited circumstances, the charges allege. Salomon and others allegedly signed false documents making it appear that Salomon or another licensed physician had examined or treated patients.  Minnis and Salomon and others allegedly prepared false progress notes and fee sheets showing that patient services were rendered when, in fact, they were not. 

Strauss allegedly forged physicians’ signatures on claim forms certifying that they were accurate, even though he knew that many were false, including whether the services were provided and by whom. He also prepared false itemized billing statements in personal injury cases to support payments to the clinic and patients. In addition, Minnis and Straus double-billed Workers Comp for disability exams that Minnis performed because he made every patient pay so the clinic was paid twice for the same service, the indictment alleges.

Each count of health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine.  If convicted, however, the Court would determine a reasonable sentence to be imposed under the advisory United States Sentencing Guidelines.

The government is being represented by Assistant U.S. Attorney Jacqueline Stern.

The public is reminded that an indictment contains only charges and is not evidence of guilt.  The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.

March 9, 2010

Chicago Hospital to Pay More Than $1.5 Million to Resolve Medicare False Claims Act Allegations (Civil Division)

WASHINGTON – Rush University Medical Center has agreed to pay $1,547,200 plus interest to resolve allegations that the facility violated the False Claims Act, the Justice Department announced on March 9, 2010. Rush is alleged to have submitted false claims to Medicare during the period 2000 through 2007 by entering into certain leasing arrangements for office space with two individual physicians and three physician practice groups that violated the Stark Law.

The Stark Law prohibits a hospital from profiting from patient referrals made by a physician with whom the hospital has an improper financial arrangement.  A leasing arrangement is improper under the Stark Law absent a written lease, signed by the parties, that specifies the premises covered by the lease.  Leasing arrangements must also be commercially reasonable and consistent with “fair market value” for the premises.  The Stark Law is intended to ensure that a physician’s medical judgment is not compromised by improper financial incentives and are based solely on the best interests of the patient.

“The Justice Department is committed to investigating cases that threaten the integrity of the Medicare program,” said Tony West, Assistant Attorney General for the Justice Department’s Civil Division.”  The department will continue to protect patients by pursuing hospitals that have improper financial relationships with physicians.”

Rush is one of several defendants in a suit brought in 2004 by two individuals under the whistleblower provisions of the False Claims Act, which permit private citizens with knowledge of fraud against the government to bring a lawsuit on behalf of the United States and to share in any recovery.  The lawsuit, in part, involves allegations that Rush entered into prohibited financial relationships with certain physicians. Under the civil settlement announced today, the whistleblowers, Dr. Robert Goldberg and June Beecham, will receive $270,760.

This settlement is part of the government’s emphasis on combating health care fraud.  One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover approximately $2.3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 have topped $3 billion.

The settlement announced today was the result of a coordinated effort among the Commercial Litigation Branch of the Justice Department’s Civil Division; the Department of Health and Human Services, Office of Inspector General; and the Illinois Attorney General’s Office.

December 7, 2009

Corporation Pleads Guilty to Various Fraud Schemes (United States Attorney for the Southern District Of Illinois)

A. Courtney Cox, United States Attorney for the Southern District of Illinois, announced that on December 10, 2009, CONVENIENT CARE CLINIC, LLC, also known as CONVENIENT HEALTH CARE CLINIC (CHC), of Perryville, Missouri, pled guilty to various fraud charges before the United States District Court in St. Louis, Missouri.

CHC pled to three fraud charges: (1) false statements to a federal healthcare program; (2) health care fraud; and (3) theft or embezzlement from an employee benefit plan. Each offense carries a maximum fine of $500,000 and five (5) years of probation. The plea agreement calls for restitution to be made to the employment benefit programs in the amount of $17,678.13. A separate civil agreement with the Government requires the restitution of $193,510.14 to be paid back to the Medicare and Medicaid programs. CHC improperly billed the federal and state government programs for physicians who were no longer employed by it and improperly billed labor union benefit funds.

Sentencing is currently scheduled for March 18, 2010. The case was investigated by the the U.S. Department of Health and Human Services, Office of Inspector General, and the U.S. Department of Labor, Office of Inspector General, Office of Labor Racketeering and Fraud Investigations. The U.S. Department of Justice recused the United States Attorney’s Office for the Eastern District of Missouri. Therefore, the United States Attorney’s Office for the Southern District of Illinois handled the cases. The criminal case is being handled by Assistant United States Attorneys Liam Coonan and Michael J. Quinley.

The civil case is being prosecuted by Assistant United States Attorney Nathan E. Wyatt.

If you suspect or know of an individual or company that is not complying with healthcare laws or public aid programs, you may report this activity to the local office of the U.S.Department of Health Human Services, Office of Inspector General or call 1.800.447.8477.

If you suspect or know of an individual or company involved in abuses or fraud relating to employee benefit plans, you may report this activity to the local office of theU.S. Department of Labor, Employee Benefit Security Administration at 1.866.444.3272.

For more information, visit the website of the United States Attorney's Office for the District of Minnesota at:  http://www.usdoj.gov/usao/mn/index.html

November 19, 2009

Decatur Pediatrician Charged with Health Care Fraud (U.S. Attorney for the Central District of Illinois)

Springfield, Ill. – A pediatrician who has practiced in Decatur, Illinois, Jamie S. Warnick, is scheduled to appear in federal court in Springfield on Dec. 17, after being charged in a criminal complaint with health care fraud. According to the affidavit filed in support of the complaint on Nov. 13, Warnick was the sole physician practicing as Decatur Pediatric Clinic, at 1770 E. Lake Shore Drive, Suite 300, Decatur, Illinois.

The affidavit alleges that Warnick, 53, defrauded a federally funded health care benefit program as well as private insurance companies. Warnick allegedly engaged in a pattern of making false statements and submitting fraudulent information and documents to obtain free vaccines under false pretenses from the U.S. Centers for Disease Control through the Illinois Department of Public Health. The affidavit alleges Warnick obtained vaccines, at no cost to her, meant primarily for children without health insurance and for under-insured children, whose insurance did not pay for vaccines. On multiple occasions, from 2005 until October 2008, Warnick allegedly administered the vaccines to patients who did not qualify and often billed insurance companies for it.

The federally-funded Vaccines for Children (VFC) program provides vaccines at no cost to children who might not otherwise be vaccinated because of an inability to pay. Created in 1993, the VFC became a required part of each state’s Medicaid plan and was officially implemented in October 1994. Federal funding is ultimately allocated to the Centers for Disease Control and Prevention (CDC). CDC buys vaccines and distributes them to grantees, such as state health departments and public health agencies, which distribute them at no charge to private physicians’ offices and public health clinics registered as VFC providers.

The affidavit alleges that Warnick submitted an application in 2005 to the Illinois Department of Public Health to become a provider for the VFC program. Before vaccines are administered, the child’s parent or guardian must complete a form to certify the child’s eligibility. The affidavit alleges that parents of numerous patients were asked to sign the form on Warnick’s recommendation even though they had health insurance to cover the vaccines. Further, a number of vaccines were allegedly billed to the insurance companies by Warnick as if the vaccine had been purchased by Warnick. The affidavit does not allege a specific amount of loss to Medicaid or private insurers.

Warnick’s court appearance is scheduled at 11:30 a.m. on Dec. 17, 2009, before U.S. Magistrate Judge Byron G. Cudmore in Springfield.

If convicted, each count of health care fraud carries a statutory penalty of up to 10 years in prison and a fine of $250,000 or twice the defendant’s gain or loss to the victim.

The investigation is being conducted by the Central Illinois Health Care Fraud Task Force which includes agents of the U.S. Health and Human Services Office of Inspector General, Federal Bureau of Investigation, the Illinois State Police’s Medicaid Fraud Control Bureau, U.S. Postal Inspection Service, Illinois Attorney General’s Office and the Illinois Department of Public Health. Assistant U.S. Attorney Patrick D. Hansen is prosecuting the case.

For more information, visit the website of the United States Attorney's Office for the Central District of Illinois at: http://www.justice.gov/usao/ilc/

November 5, 2009

Doctor from Energy, Illinois, Pleads Guilty to Charges of Obstruction of Justice, Tampering with a Witness, and Illegal Dispensation of a Controlled Substance – Methadone and Doctor’s Three Corporations Plead to Charges of Conspiracy and Health Care Fraud (U.S. Attorney for the Southern District of Illinois)

The United States Attorney’s Office for the Southern District of Illinois announced today that on November 4, 2009, Dr. SUKHDARSHAN S. BEDI, 56, of Energy, Illinois, and his three health care clinics pled to various charges in the United States District Court in Benton, Illinois. Dr. BEDI pled to the following: (a) obstruction of justice in Counts 1 and 2, which carries penalties of up to 20 years’ imprisonment, a fine of up to $250,000, or both; (b) tampering with a witness in Count 3, which carries penalties of up to 20 years’ imprisonment, a fine of up to $250,000, or both; and (c) illegal dispensation of controlled substances, Methadone, in Count 6, which carries penalties of up to 20 years’ imprisonment, a fine of up to $1,000,000, or both.

Dr. BEDI’s corporations, ILLINOIS HEALTHCARE CLINIC, P.C. d/b/a MARION FAMILY HEALTH CARE; M-CFHC, INC. d/b/a HARRISBURG FAMILY HEALTHCARE; and GALATIA MEDICAL CENTER CORP., pled to the following: (a) conspiracy to illegally dispense a controlled substance in Count 7, which carries penalties of up to 5 years’ probation, a fine of up to $5,000,000, or both; and (b) health care fraud in Count 12, which carries penalties of up to 5 years’ probation, a fine of up to $500,000, or both.

Dr. BEDI agreed to voluntarily surrender his medical license and to withdraw his application for reinstatement of his DEA Registration. He also agreed to pay criminal restitution in the amount of $47,784.31 to the Medical program administered by the Illinois Department of Healthcare and Family Services. Upon sentencing, the Government agrees to dismiss remaining counts. The three corporations agreed to be jointly and severally responsible with Dr. BEDI for paying the criminal restitution.

The case was investigated by the U.S. Department of Health and Human Services, Office of Inspector General; the Drug Enforcement Administration; the Federal Bureau of Investigation; the Illinois State Police; the Southern Illinois Enforcement Group; and the Williamson County Sheriff’s Office. The case is being handled by Assistant United States Attorneys Michael Quinley and Liam Coonan.

If you suspect or know of an individual or company that is not complying with healthcare laws

or public aid programs, you may report this activity to the local office of the U.S. Department of Health and Human Services, Office of Inspector General or call 1-800-447-8477.

More information on the U.S. Attorney's Office for the Southern District of Illinois: http://www.justice.gov/usao/ils/

June 30, 2009

Fairfield Woman Sentenced for Making False Statements to A Federal Health Care Program (U.S. Attorney for the Southern District of Illinois)

Courtney Cox, United States Attorney for the Southern District of Illinois, announced today that on June 25, 2009, April L. Santiago, 30, of Fairfield, Illinois was sentenced in federal district court in Benton for making False Statements to a Federal Health Care Program. The district court sentenced SANTIAGO to two years’ probation. The court also ordered Santiago to pay restitution.

As part of her plea on March 24, 2009, defendant Santiago admitted that she worked from July 2005 to April 2006 as a Certified Nurse Assistant (CNA) with the Norris City Health Care Clinic in Norris City, Illinois. Santiago admitted that she instructed individuals to come to the clinic and complain of ailments that they did not have in order to obtain controlled substance prescriptions to which they were not entitled. As a result, Medicaid, a Federal Health Care Program, reimbursed the clinic for visits that were not medically necessary and the pharmacy for prescriptions to which the patients were not entitled.

On or about December 14, 2005, Santiago instructed a Medicaid patient to falsely claim to have a toothache in order to obtain a prescription for the controlled substance, Hydrocodone, a Schedule III Controlled Substance. SANTIAGO then purchased the Hydrocodone from the patient. SANTIAGO admitted that while she was working for the clinic, she would change and alter prescriptions for individuals on Medicaid who received a prescription for regular cough syrup. She would add “HC” which would change the prescription to a cough syrup containing Hydrocodone, which can be a Scheduled Controlled Substance. She then faxed the prescriptions to the pharmacy or give the altered prescription to the individual patient. SANTIAGO then purchased back the controlled substance from the individual patient.