Louisiana

June 24, 2010

Ex-Pharmacist is Sentenced for Prescription Fraud (U.S. Attorney for the Western District of Louisiana)

New Orleans, LA – Paul Williams, Jr., 56, of Grand Coteau, La., was sentenced by United States District Judge Rebecca F. Doherty to 15 months for filling fraudulent prescriptions for an illegal internet drug company, United States Attorney Stephanie A. Finley announced on June 24, 2010.  William also was ordered to serve 3 years of supervised release at the conclusion of his prison sentence. In addition, a preliminary order of forfeiture was signed by the Judge ordering that the Grand Coteau Prescription Shoppe and Grocery be forfeited to the United States.

According to court documents, Williams was the owner and pharmacist at the Grand Couteau Prescription Shoppe (GCPS) in Grand Couteau, Louisiana. In September 2006, GCPS  entered into a contract with Ardopole International Inc., a Panamanian Company, which paid GCPS $8 per prescription ordered by the company.  GCPS had no costs associated with filling the prescriptions because the Panamanian company also paid for all the drugs that were being filled. They had no financial dealing with the customers. The customers dealt with the Panamanian Company and the company then e-mailed the prescriptions to the Pharmacy.

CGPS would not receive an original signed prescription from Ardopole International, but would receive a scanned document over the internet. The document had a signature on it claiming to be a doctor’s signature, but in fact was false. Sometimes the signature appeared to be written by a child. Other times there was simply an X in the place of the signature. Between 2006 and 2007 Williams filled fraudulent prescriptions and profited $881,970. The prescriptions were primarily for narcotic  medications, including Lorazepan, Didrex and Ambien.

The case was investigated by the Drug Enforcement Administration, New Orleans, Division and prosecuted by Assistant United States Attorney J. Luke Walker.

June 3, 2010

Indictment in Baton Rouge, Louisiana, on Charges of Health Care Fraud (U.S. Attorney for the Middle District of Louisiana)

Baton Rouge, LA – United States Attorney Stan Lemelle announced that a federal grand jury returned an indictment on June 3, 2010, charging Ray A. Kirt, age 44, a resident of Franklin, Louisiana, with ten counts of health care fraud, and Peggy Mingo, age 57, a resident of Morgan City, Louisiana, with six counts of health care fraud.

The ten-count indictment alleges that Kirt formed, owned, and was a member of Above and Beyond, LLC (“Above & Beyond”), a business located in both Baton Rouge, Louisiana, and New Iberia, Louisiana. Kirt managed the location in New Iberia. Among other things, Above & Beyond purported to engage in the business of providing psychotherapy services to Medicare beneficiaries. The indictment alleges that beginning at least as early of March 2003 and continuing through at least in or about August of 2005, within the Middle District of Louisiana and elsewhere, Kirt employed and instructed unlicensed and unqualified individuals to visit Medicare beneficiaries and caused false claims to be submitted to Medicare. Kirt employed Mingo to prepare claims for submission to Medicare and together they caused others to submit false and fraudulent information to Medicare. The indictment alleges that Kirt and Mingo caused Above & Beyond to collect payments of approximately $1,063,873 from Medicare as a result of the submission of false claims. Kirt was paid approximately $270,215 for his participation in the scheme to defraud Medicare.

Mike Fields, Special Agent in Charge of the Dallas region of the Office of Inspector General for the U.S. Department of Health and Human Services, said, “This indictment further demonstrates that Medicare fraud will not be tolerated. The Medicare program is a valuable resource that must be protected.”

If convicted, Kirt and Mingo could receive a maximum sentence of ten years imprisonment and a fine of up to $250,000 on each count. The court may also order restitution. The case was investigated by the Office of Inspector General for the United States Department of Health and Human Services and the Federal Bureau of Investigation. The case is being prosecuted by Assistant United States Attorneys René Salomon and Catherine Maraist of the United States Attorney’s Office for the Middle District of Louisiana.

An indictment is a determination by a grand jury that there is probable cause to believe that offenses have been committed by the defendants. The defendants, of course, are presumed innocent until and unless they are proven guilty at trial.

June 2, 2010

Physician Sentenced to Health Care Fraud Offense (U.S. Attorney for the Eastern District of Louisiana)

New Orleans, Louisiana - Dr. Windsor Dennis, age 78, and a resident of New Orleans, Louisiana, was sentenced on June 2, 1010, in federal court by Judge Ivan L.R. Lemelle to two (2) years of probation in a health care fraud, announced U. S. Attorney Jim Letten.  As a condition of his probation, the defendant was ordered to spend twelve (12) months in home confinement and to be subject to electronic monitoring.  In addition to the term of probation, Judge Lemelle ordered that DR. DENNIS pay restitution in the amount of $750,000.00, a special assessment of $100.00 and to pay a $5,000.00 fine to the United States.

Dr. Dennis, an orthopaedic surgeon who operated a medical practice in New Orleans, Louisiana, pleaded guilty before U.S. District Judge Ivan L. R. Lemelle to one count of health care fraud on March 3, 2010.  According to court documents, DR. DENNIS billed the United State Department of Labor, Office of Worker’s Compensation, for health care services he claimed he performed after Hurricane Katrina, when his office was not open.

The case was investigated by the Offices of Inspector General for the United States Postal Service and the United States Department of Labor.

The case was being prosecuted by Assistant U. S. Attorney Patrice Harris Sullivan.

May 27, 2010

Former Medical Billing Services Employee Sentenced for Embezzling from Medical Providers (U.S. Attorney for the Western District of Louisiana)

Lake Charles, Louisiana - A former account manager for Medical Provider Services (MPS), a Lake Charles company that provides billing services for physicians and other medical providers, was sentenced to 37 months in federal prison for embezzling hundreds of thousands of dollars from medical providers’ accounts, Acting United States Attorney William J. Flanagan announced on May 27, 2010.  Nikkie A. LaFleur, 46, of Lake Charles, La., was also ordered to pay $621,737.00 in restitution. The sentence was imposed today by United States District Judge Patricia Minaldi. 

LaFleur pleaded guilty in March 2010  to three counts of health care fraud.  According to court documents, LaFleur’s duties at MPS included billing insurance companies for services provided by physicians and other health care providers, and posting reimbursement payments received from the insurance companies to the medical providers’ accounts.  Beginning in June 2005 and continuing through September 2007, LaFleur altered MPS records to reflect that certain treatments and medications were ordered by the physicians when in fact such treatments and medications were neither ordered nor performed.  After altering the records, the defendant then fraudulently billed the patients’ insurance companies to obtain payments, which LaFleur then deposited into her personal checking account after forging their endorsements.LaFleur personally received $646,685 from these fraudulent checks. 

LaFleur also fraudulently billed both Medicare and Blue Cross Blue Shield (BCBS) as part of her scheme, but those entities typically provide reimbursement directly to providers via electronic payments. LaFleur was unable to obtain these funds for her personal use, and the doctors did not even realize this was occurring until her criminal activities were discovered.

As part of the criminal prosecution, the United States is seeking to forfeit certain assets belonging to LaFleur which were purchased with proceeds for the fraud, including two jet skis, a motorboat, a tandem trailer, boat trailer, and 31 foot travel trailer, as well as cash.

This case was investigated by the Federal Bureau of Investigation, Lake Charles Resident Agency, and was prosecuted by Assistant United States Attorney Kelly P. Uebinger.

March 4, 2010

Physician Pleads Guilty to Health Care Fraud Offense (U.S. Attorney for the Eastern District of Louisiana)

NEW ORLEANS - Dr. Windsor Dennis, age 78, and a resident of New Orleans, Louisiana, pled guilty in federal court on March 4, 2010, before U. S. District Judge Ivan L. R. Lemelle to one count of health care fraud, announced U. S. Attorney Jim Letten.

According to court documents, Dr. Dennis, an orthopaedic surgeon who operated a medical practice in New Orleans, billed the U. S. Department of Labor, Office of Worker’s Compensation, for health care services he claimed to have performed after Hurricane Katrina when his office was not open.  He has agreed to pay $750,000.00 in restitution to the U. S. Department of Labor.

Dr. Dennis faces a possible maximum sentence of ten (10) years, a fine of $250,000 and three (3) years of supervised release following any term of imprisonment.  Sentencing has been scheduled for May 26, 2010.

Daniel R. Petrole, Acting Inspector General, United States Department of Labor, stated:

“This plea is the result of collaboration by several Federal agencies working together to root out workers’ compensation fraud and bring those responsible to justice. We will continue to detect and quickly respond to fraud schemes perpetrated against the Department of Labor programs.”

David C. Williams, Inspector General for the U.S. Postal Service, added, “Today’s plea and restitution agreement by Dr. Windsor Dennis is a significant victory in the on-going battle against fraudulent workers’ compensation claims.  The workers’ compensation program benefits thousands of postal employees who have received legitimate on-the-job injuries.  But false claims, particularly by health care providers, undermine the system.

The case was investigated by the Offices of Inspector General for the United States Postal Service and the United States Department of Labor.  The case is being prosecuted by Assistant U. S. Attorney Patrice Harris Sullivan.

February 11, 2010

New Orleans Man Arrested For Health Care Fraud (U. S. Attorney for the Eastern District of Louisiana)

New Orleans, Louisiana -Lionel Perkins, Jr., age 58, a resident of New Orleans, Louisiana was arrested on February 10, 2010 pursuant to a criminal complaint charging him with committing health care fraud, announced U. S. Attorney Jim Letten.

According to the complaint, Perkins used the identity of his deceased brother to obtain a new Social Security number.  He then used his brother’s identity, along with the Social Security Number to obtain Medicaid benefits.  The complaint states that on multiple occasions since December 2009, Perkins caused a bill of service to be submitted to Medicaid for goods, services, and care he received while using his brother’s identity and the new Social Security Number, including at pharmacies in Baton Rouge, Louisiana and Jefferson, Louisiana.  The complaint further alleges that Perkins contacted a Medicaid analyst by telephone and requested to be recertified for Medicaid benefits, in the name of his deceased brother, within the past several days.

Currently, Perkins has other charges pending against him in Case Number 09-178 in the Eastern District of Louisiana for defrauding the federal government out of more than $300,000 in Hurricane Katrina-related funds as well as Social Security fraud.

If convicted of the new charge, Perkins faces a possible maximum term of imprisonment of ten (10) years, a fine of $250,000.00 and three (3) years of supervised release following any term of imprisonment.

U. S. Attorney Letten reiterated that the complaint is merely a charge and that the guilt of the defendant must be proven beyond a reasonable doubt.

This case was investigated by Special Agents of the U. S. Department of Housing and Urban Development, Office of Inspector General, Special Agents of the U. S. Small Business Administration, Office of Inspector General, Department of Homeland Security, Office of Inspector General, and the Federal Bureau of Investigation.  The case is being prosecuted by Assistant U. S. Attorneys Jordan Ginsberg and Matthew Chester.

January 21, 2010

Physician Indicted for Health Care Fraud (U.S. Attorney for the Eastern District of Louisiana)

NEW ORLEANS - Windsor Dennis, M. D., age 77, a resident of New Orleans, Louisiana, was charged in a one-count indictment by a Federal Grand Jury for health care fraud, announced U. S. Attorney Jim Letten.

According to the indictment, Dr. Dennis was an orthopedic surgeon and operated a medical practice in New Orleans, Louisiana.  The indictment charges that Dr. Dennis submitted claims in the amount of $102,053 to the U. S. Department of Labor’s Office of Workers’ Compensation Programs for services he claimed he provided after Hurricane Katrina that Dr. Dennis did not render.  

If convicted, Dr. Dennis faces a possible maximum term of ten (10) years imprisonment, a fine of $250,000, and three (3) years of supervised release following any term of imprisonment. 

Daniel R. Petrole, Acting Inspector General, United States Department of Labor, stated:

“This indictment is the result of collaboration by several federal agencies working together to root out workers’ compensation fraud and bring those responsible to justice. We will continue to detect and quickly respond to fraud schemes perpetrated against the Department of Labor programs.”

David C. Williams, Inspector General for the U.S. Postal Service, added:

“Today’s indictment of Dr. Windsor Dennis is a significant step forward in the on-going effort to reduce fraudulent workers’ compensation claims.  The workers’ compensation program benefits thousands of postal employees who have received legitimate on-the-job injuries.  But false claims, particularly by health care providers, undermine the system.”

U. S. Attorney Letten reiterated that the indictment is merely a charge and that the guilt of the defendant must be proven beyond a reasonable doubt.  

The case was investigated by the Offices of Inspector General for the U. S. Postal Service and the U. S. Department of Labor.  The case is being prosecuted by Assistant U. S. Attorney Patrice Harris Sullivan.

November 24, 2009

United States Intervenes in Civil Case Against Mehmood Patel, M.D.: The Civil Lawsuit Seeks Treble Damages and Penalties for False Claims to the U.S. Government (U.S. Attorney for the Western District of Louisiana)

LAFAYETTE, La. - The United States has intervened in a civil lawsuit seeking treble damages and penalties from Dr. Mehmood Patel, a Lafayette, Louisiana interventional cardiologist, United States Attorney Donald W. Washington announced on Nov. 24, 2009. The lawsuit accuses Dr. Patel of performing and billing Medicare for medically unnecessary cardiovascular procedures.

The suit was originally filed in the U. S. District Court for the Western District of Louisiana by cardiologist Christopher Mallavarapu under the qui tam provisions of the False Claims Act. Under the federal statute, a private party, known as a “relator,” can file an action on behalf of the United States and receive a portion of the recovery ranging from 15-25% of the monetary damages recovered through the lawsuit. Under the False Claims Act, the United States may recover three times the amount of its losses plus civil penalties. Civil penalties range from $5,500 to $11,000 for each false claim submitted to the government agency for payment.

The Government’s intervention follows Dr. Patel’s criminal conviction of 51 counts of healthcare fraud in connection with claims that he performed medically unnecessary procedures such as cardiac angiograms, angioplasties, and stents. Patel was sentenced to 10 years in prison, and has filed an appeal.

The Government’s civil complaint also alleges that Patel performed unnecessary right and left heart catheterizations. Medicare does not pay for procedures that are medically unnecessary. Another defendant in the lawsuit is Acadiana Cardiovascular Center, LLC, a cardiac catheterization lab owned and operated by Dr. Patel.

This and other press releases issued by the United States Attorney's Office for the Western District of Louisiana can be found at our website at http://www.justice.gov/usao/law/.

November 17, 2009

Owner of Local Medicaid Agency Sentenced to Five Years in Federal Prison for Health Care Offense (U.S. Attorney for the Eastern District of Louisiana)

NEW ORLEANS, LOUISIANA - AKASIA LEE, age 36, a resident of New Orleans, was sentenced today in federal court by U. S. District Judge Mary Ann Vial Lemmon to five (5) years (60 months) in prison for her role in the conspiracy to commit health care fraud, announced U.S. Attorney Jim Letten. In addition to the term of imprisonment, Judge Lemmon ordered that LEE pay $3,977,288 in restitution, a $1 million fine and be placed on three (3) years of supervised release following the term of imprisonment, during which time the defendant will be under federal supervision and risks an additional term of imprisonment should she violate any terms of her supervised release.

According to court documents, on March 19, 2009, LEE pled guilty to one count of a superseding indictment admitting that she and workers of A New Beginning of New Orleans, Inc. (ANBNO) conspired to commit health care fraud. According to the factual basis, LEE, the owner/operator of ANBNO, a Medicaid provider that made claims for Personal Care Services (PCS) it claimed to have provided to Medicaid recipients, solicited mothers with children who had Medicaid benefits to apply for PCS. LEE admitted that after Medicaid approved the PCS applications, false documentation containing employees’ time sheets and daily schedules which detailed the services rendered to Medicaid child recipients was created by employees of ANBNO and parents of the Medicaid recipient children. LEE further admitted that Medicaid paid approximately $3,977,288 as a result of the fraudulent claims made by ANBNO and its employees.

The case was investigated by agents of the Federal Bureau of Investigation, the U. S. Department of Health and Human Services, Office of Inspector General, and the Louisiana Medicaid Fraud Control Unit. The case was prosecuted by Assistant United States Attorneys Patrice Harris Sullivan, Jordan Ginsberg and G. Dall Kammer.

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

November 12, 2009

Oklahoma Doctor Indicted for Health Care Fraud Committed While Practicing in New Orleans Area (U.S. Attorney for the Eastern District of Louisiana)

NEW ORLEANS - DR. GREGORY KHOURY, age 55, a resident of Oklahoma City, Oklahoma, was indictment by a federal grand jury in a 48 count indictment with over $1 million in health care fraud, announced U.S. Attorney Jim Letten. 

According to today’s indictment, between 1999, until about June of 2006,  DR. GREGORY KHOURY, defrauded Medicare, the Federal Employee Health Benefit Plan (FEHBP) and its associated health care benefit providers, Blue Cross and Blue Shield (BCBS), Tricare, the health care provided for  active and retired men and women in our armed services and their families, and Travelers Insurance Company, who processed worker’s compensation claims.

Specifically, the indictment alleges KHOURY fraudulently submitted claims to Medicare,  FEHBP, BCBS, Tricare and Travelers for patients who were not physically present in his office.  Part of the scheme was that KHOURY’S billing often represented that he was spending well over 8 hours with one patient at a time. Instead, the indictment alleges that KHOURY discussed the absent patient’s condition with a family member or other related or interested person.  

Additionally, according to the indictment, KHOURY also met with an interested person or family member instead of the patient and falsely billed Medicare, FEHBP, BCBS, Tricare and Travelers for services he claimed to have performed for the absent patient.  At the same time, he falsely billed the insurers for services he claimed he performed for the person while he was speaking about the absent patient.  It is charged that KHOURY then submitted fraudulent claims as if those services had been rendered to the absent patient. 

As a result of the alleged fraud, KHOURY was paid approximately $1,357,618.14 he was not entitled to receive.U. S. Attorney Letten reiterated that the indictment is merely a charge and that the guilt of the defendant must be proven beyond a reasonable doubt.  

The case was investigated by the U. S. Department of Health and Human Services, Office of Inspector General, the Federal Bureau of Investigation, U. S. Office of Personnel Management, Office of Inspector General, and Defense Criminal Investigative Service, with the cooperation of Blue Cross/Blue Shield of Louisiana.  The case is being prosecuted by Assistant United States Attorneys Patrice Harris Sullivan and Jordan Ginsberg.

More information on the U.S. Attorney for the Eastern District of Louisiana: http://www.justice.gov/usao/lae/

October 3, 2009

Bossier City Doctor, His Wife and Former Employee Convicted at Trial for Prescription Fraud Scheme (U.S. Attorney for the Western District of Louisiana)

SHREVEPORT, La.: TANDY McELWEE, JR., age 61, of Natchitoches, Louisiana, formerly of Bossier City, Louisiana, was convicted along with his wife AVA CATES McELWEE, age 50, and a former employee, CATHERINE COCKRELL, age 36, of Keithville, Louisiana, by a federal jury for participating in a wide-ranging scheme to obtain controlled substances by fraud, United States Attorney Donald W. Washington announced on Oct. 3, 2009. The jury returned its verdict after 10 p.m. Friday evening after a two week trial, including a day and a half of deliberation.

All three defendants were convicted of conspiracy to obtain hydrocodone, a Schedule III controlled substance, by fraud over a three and a half year period from January 2004 through August 2007. Hydrocodone is also known as Lorcet, Lortab, Histussin HC and Histinex HC. They carried out the conspiracy by submitting improper prescriptions to pharmacies in the Shreveport-Bossier area in one another’s names as well as the names of family members and fictitious names. One prescription was written for an individual named Brandi McElwee, who in fact is one of the McElwee’s dogs.

In addition to the conspiracy, Tandy McElwee was convicted of 19 counts of obtaining or acquiring a controlled substance by fraud, 9 counts of possession of hydrocodone with intent to distribute, one count of conspiracy to possess hydrocodone with intent to distribute, one count of providing false information in records of dispensed controlled substances, and one count of health care fraud related to fraudulently billing Blue Cross Blue Shield of Louisiana. The jury acquitted Tandy McElewee of 48 counts of obtaining or acquiring hydrocodone by fraud and three counts of health care fraud.

Ava McElwee was convicted of one additional count of obtaining or acquiring hydrocodone by fraud. The jury acquitted Ava McElwee of 66 counts of the same offense and one additional count of health care fraud.

Catherine Cockrell was convicted of an additional six counts of obtaining or acquiring hydrocodone by fraud. The jury acquitted Catherine Cockrell of 60 counts of the same offense and one count of health care fraud.

U. S. Attorney Donald Washington stated: “Reducing the supply of illegal drugs to this community remains a major law enforcement priority. Dispensing drugs illegally under cover of a professional practice and not for a legitimate medical purpose is a serious violation of public trust.”

United States District Judge S. Maurice Hicks set sentencing for January 10, 2010. The conspiracy charge and each count of obtaining or acquiring hydrocodone by fraud, as well as the charge of providing false record information, carries a maximum penalty of four years in prison, a $250,000 fine, or both. Health care fraud carries a maximum penalty of 20 years in prison, a $250,000 fine, or both. Conspiracy to possess hydrocodone with intent to distribute carries a maximum penalty of 5 years in prison, a $250,000 fine, or both.

Sentencing in federal court is determined by the discretion of federal judges and the governing statute. Parole has been abolished in the federal system.

The case was investigated by the Shreveport Offices of the Drug Enforcement Administration and the Federal Bureau of Investigation, and is being prosecuted by Assistant United States Attorneys Allison D. Bushnell and C. Mignonne Griffing.

A copy of this press release may be found on the website of the Western District of Louisiana at: http://www.usdoj.gov/usao/law/pressrel.html

October 1, 2009

Harvey Woman Sentenced for Role in Health Care Fraud (U.S. Attorney for the Eastern District of Louisiana)

NEW ORLEANS, La. - CRYSTAL BLACK, age 36, a resident of Harvey, Louisiana, was sentenced on Sept. 30, 2009 by U. S. District Judge Helen G. Berrigan to five (5) months imprisonment for one count of health care fraud and pay restitution to the Louisiana Department of Health and Hospitals in the amount of $71,712, announced U. S. Attorney Jim Letten. In addition, following the term of imprisonment, the defendant was ordered to serve five (5) months of home incarceration and three (3) years of supervised release, during which time the defendant will be under federal supervision and risk additional imprisonment should she violate any terms of the supervision.

According to court records, on November 4, 2008, BLACK pled guilty to one count of health care fraud which took place while she was an employee of A New Beginning of New Orleans, Inc., a Medicaid provider formally located in Harvey, Louisiana, that made claims for Personal Care Services it claimed to have provided to Medicaid recipients.

The case was investigated by the Federal Bureau of Investigation, the U. S. Department of Health and Human Services, Office of Inspector General, and the Louisiana Medicaid Fraud Control Unit. The prosecution was handled by Assistant United States Attorneys Patrice Harris Sullivan, Jordan Ginsberg and G. Dall Kammer.

More information may be found on the website of the Eastern District of Louisiana http://www.usdoj.gov/usao/law/

September 9, 2009

Employees of Local Medicaid Agency Found Guilty of Federal Conspiracy, Health Care Offenses and False Statements to Federal Agents (U.S. Attorney for the Eastern District of Louisiana)  

NEW ORLEANS - UNA FAVORITE BROWN, age 53, a resident of New Orleans, MELINDA LANGLEY, age 48 , a resident of New Orleans, and ERNESTINE GIROD, age 44, a resident of Marrero, were found guilty on Sept. 9 by a New Orleans jury of conspiracy and multiple counts of health care fraud, announced U. S. Attorney Jim Letten.

Specifically, BROWN was convicted as charged of one count of conspiracy and twenty-four (24) counts of health care fraud and three (3) counts of false statements to federal law enforcement agents; GIROD was convicted as charged of one count of conspiracy, twenty-five (25) counts of health care fraud and three (3) counts of false statements to federal law enforcement agents; and LANGLEY was convicted of one count of conspiracy and ten (10) counts of health care fraud.  LANGLEY was found not guilty of three (3) counts of health care fraud.

According to evidence introduced at trial, AKASIA LEE was the owner and operator of A New Beginning of New Orleans, Inc.(ANBNO), a Medicaid Provider located in Harvey, Louisiana that made claims for Personal Care Services it claimed to have provided to Medicaid recipients.  UNA FAVORITE BROWN and MELINDA LANGLEY were employees of ANBNO, and ERNESTINE GIROD was the mother of Medicaid recipients.  

Personal Care Services (PCS) are Medicaid services provided by attendants to eligible recipients meeting the medical necessity criteria who are unable to care for themselves.  ANBNO solicited mothers with children who had Medicaid benefits to apply for PCS.   Medicaid approved the PCS applications, false documentation containing employees’ time sheets and daily schedules which detailed the services rendered to Medicaid child recipients was created by employees of ANBNO and parents of the Medicaid recipient children.  From the time of the inception of ANBNO through May 4, 2005, Medicaid paid approximately $3,977,288 as a result of the fraudulent claims made by ANBNO and its employees.

MELINDA LANGLEY faces up to one hundred five (105) years in prison and fines of up to $2.75 million. UNA FAVORITE BROWN faces up to one-hundred twenty (120)  years in prison and fines of up to $3.5 million.  ERNESTINE GIROD  faces up to two hundred seventy (270) years in prison and fines of up to $7,250,000.  The U. S. Attorney reminds citizens that the statutory maximum penalties notwithstanding, the U. S. Sentencing Guidelines, although not mandatory, still remain advisory in the fashioning of sentences by the Court.

Speaking to these developments, U. S. Attorney Jim Letten stated, “Today’s convictions send a clear and unambiguous signal that we in federal law enforcement will aggressively pursue those who enrich themselves at the expense of taxpayers and those among us (including our children) who desperately need publicly funded health care.  My thanks to the prosecution team, FBI, HHS Inspector General and Louisiana Attorney General’s Medicare Fraud Control Unit.”

Special Agent in Charge Mike Fields of the U. S. Department of Health and Human Services, Office of Inspector General, Office of Investigators, stated, “Today’s action sends a message to those who take advantage of the Louisiana Medicaid Program.  The Office of Inspector General, Dallas Regional Office will continue to work aggressively with our federal and state law enforcement partners to eliminate this type of fraudulent conduct in our health care systems.”

Louisiana Attorney General Buddy Caldwell added, “I applaud the efforts of not only my Medicaid Fraud unit but every agency involved. To each individual who worked tirelessly to bring these people to justice, I thank you. I pledge that my office will continue to work with all local, state and federal entities to stop the abuse of our Medicaid system.”

This investigation, which is continuing, is being conducted by the U. S. Department of Health and Human Services, Office of Inspector General, the Federal Bureau of Investigation, and the Louisiana Medicaid Fraud Control Unit.  The prosecution is being handled by Assistant United States Attorney Patrice Harris Sullivan, Jordan Ginsberg and G. Dall Kammer.

More information may be found on the website of the Eastern District of Louisiana http://www.usdoj.gov/usao/law/

September 3, 2009

Doctor Sentenced in Drug Trafficking Conspiracy (U.S. Attorney for the Eastern District of Louisiana)

NEW ORLEANS - DR. JOSEPH BRAUD, age 82, a resident of New Orleans, Louisiana, was sentenced in federal court on Sept. 3, by U. S. District Judge Mary Ann Vial Lemmon to a 30 month term of imprisonment, announced U.S. Attorney Jim Letten.  In addition,  BRAUD was required to forfeit $500,000.00 to the Government and be placed on three years of supervised release following the term of imprisonment, during which time the defendant will be under federal supervision and risks an additional term of imprisonment should he violate any terms of his supervised release.  

According to court documents, on May 27, 2009, BRAUD pled guilty to conspiracy to illegally distribute and dispense controlled substances.  BRAUD was charged in a 17-count indictment along with co-defendants Candace Wilson, Monica Jones, Thadrian Johnson, Ples Dobbins, Deshawn Whatley, Jimmie Lee Winters, and Joshua Williams, with conspiracy to illegally distribute and dispense controlled substances, illegal distribution and dispensation of controlled substances, conspiracy to commit health care fraud, and conspiracy to commit money laundering.  Candace Wilson and her sister, Monica Jones, established Stanton Trinity Medical Group, Inc., Maximum Pain Management, LLC, and Reddi Care Ambulatory Clinic, LLC, pain management clinics in New Orleans, Lafayette, and Baton Rouge, Louisiana.  Wilson, Jones, Dobbins, and Johnson (a pharmacist) also opened a pharmacy, Southern Discount Drugs, to service the customers of Stanton Trinity Medical Group.  The clinics offered patients “pain management” by writing prescriptions that were not for legitimate medical purposes and not within the bounds of professional medical practice.  In some instances, controlled substances and/or prescriptions for controlled substances were distributed without the recipient seeing a physician.  In essence, the clinics and pharmacy were “pill mills.” 

During the conspiracy, BRAUD was employed as a physician at Stanton Trinity Medical Group in New Orleans and following Hurricane Katrina at Maximum Pain Management in Lafayette, Louisiana.  The clinics only accepted cash for medical services. The cost of a doctor visit was determined by the type of controlled substances the patient wanted.  The cost of the visit was higher for patients who obtained prescriptions for Schedule II drugs than for patients who obtained Schedule III drugs.  Patients regularly requested and paid for the type of drugs they wanted before being seen by a doctor.

BRAUD illegally prescribed controlled substances such as Oxycontin, Methadone and Hydrocodone without determining a sufficient medical necessity for the controlled substances.  Patients were not required to provide adequate histories nor were diagnostic tests ordered or performed.  He did not communicate or maintain records of communication with prior physicians.  No alternative therapies were ever attempted beyond a very limited combination of highly addictive medications, including opiates, muscle relaxants and sedatives.  BRAUD prescribed quantities and combinations of controlled substances and other drugs to patients that would cause patients to abuse, misuse and become addicted to controlled substances.

The case was investigated by the Drug Enforcement Administration, Internal Revenue Service/Criminal Investigations, and Gulf Coast High Intensity Drug Trafficking Area Task Force and prosecuted by Assistant United States Attorneys Tracey Knight and Bill McSherry.

More information may be found on the website of the Eastern District of Louisiana http://www.usdoj.gov/usao/law/

June 15, 2009

Owner of Aging Care Home Health Care Sentenced In Federal Court for Falsifying Health Care Records (U.S. Attorney for the Western District of Louisiana)

MONROE, LOUISIANA -- United States Attorney Donald W. Washington announced today that JANICE DAVIS, age 62, of West Monroe, was sentenced in United States District Court for healthcare fraud.  U.S. Chief Judge Robert G. James sentenced DAVIS to spend 15 months in federal prison and a term of three years of supervised release following confinement.

DAVIS was charged in July 2008 in a one-count indictment and later plead guilty to  concealment or falsification of records in a federal investigation.  After being served with a subpoena for documents from the Department of Health and Human Services (HSS), Office of Inspector General (OIG), on July 23, 2003, the defendant personally destroyed, concealed, covered up, and falsified records and documents, including physician service logs, with the intent to impede, obstruct, and influence an investigation into Medicare fraud by ACHH.  The investigation revealed that DAVIS produced documents that she created after receipt of the OIG subpoena and that many of ACHH’s doctors did not perform the services indicated in the records. 

JANICE DAVIS has owned and operated ACHH, a Monroe-based company, since 1991 until its closure in 2005.  ACHH provided nursing and therapy services to patients in their homes.  Clinic-based doctors monitored the patients’ home health services by updating treatment plans and prescribing medications.  Normally, a physician would bill Care Plan Oversight services directly to Medicare.   Payment is made by Medicare directly to the physician for services rendered to home health and hospice patients.

The subpoena issued by HSS-OIG to Aging Care Home Health was a result of an October 2002 False Claims Act suit which alleged that ACHH tracked physicians “Care Plan Oversight” services and billed Medicare as a means to induce patient referrals from physicians.  In November of 2004, the United States intervened in that suit alleging that Janice Davis, her husband Otis Davis and her company violated federal Stark and Anti-Kickback statutes by creating a sham physician advisory board and paying its members not for legitimate duties actually performed, but instead for Medicare referrals, which is illegal.  The False Claims Act lawsuit ended in 2008 when U.S. District Judge Robert James granted several motions for summary judgment against Janice Davis, Otis Davis and Aging Care and awarded almost $5,000,000 in damages and penalties to the United States.  In that suit, Judge James also found that Janice Davis had destroyed company records which were responsive to the federal subpoena and attempted to replace them with false records she fabricated in an attempt to mislead federal regulators and law enforcement.

United States Attorney Donald W. Washington stated: “Healthcare and Medicare fraud should be a concern to every citizen.  The costs associated with this type of fraud compromises the integrity of the Medicare program and negatively impacts the healthcare burden for all of us.”

Sentencing in federal court is determined by the discretion of federal judges and the governing statute.  United States Sentencing Guidelines established by the United States Congress and the United States Sentencing Commission are only used as guidelines by the judge in determining the appropriate sentence. Parole has been abolished in the federal system.

This case was investigated by Special Agent Jeff Richards of Health & Human Services.  The case was prosecuted by Assistant United States Attorney Cytheria D. Jernigan.  The related False Claims Act matter was handled by Assistant United States Attorney Alec Alexander and Sara McLean, United States Department of Justice, Washington, D.C.