Attorney General Jeff Sessions has announced what he called the largest health care fraud takedown in American history.
He says the federal government is charging 601 defendants, including 124 in South Florida, with more than $2 billion in health care fraud.
76 doctors, 23 pharmacists, 19 nurses and other medical personnel were among those charged.
"The South Florida based schemes involved hundreds of millions of dollars in fraud, and in some cases resulted in significant harm to patients in need of substance abuse treatment. When that treatment is withheld because of someone’s greed, the very people who are supposed to help the addicts end up enabling their addiction. Side by side with our great partners, we will continue to fight against all forms of healthcare fraud in South Florida," said U.S. Attorney Benjamin Greenberg in a statement.
The following are some of the recent health care fraud cases that have been charged in the Southern District of Florida:
I. SUBSTANCE ABUSE TREATMENT FRAUD AND ILLEGAL DISTRIBUTION OF OPIOIDS
The U.S. Attorney’s Office for the Southern District of Florida continues to partner with federal, state and local law enforcement agencies and the Greater Palm Beach Health Care Fraud Task Force (“Task Force”) to target fraud and other criminal practices in the substance abuse treatment/medical industry, including: money laundering; billing for treatment and laboratory testing that was not actually provided and not medically necessary; submission of claims that were solicited through the payment of kickbacks and bribes to patients, sober home owners, and treatment center owners; and the illegal distribution of opioids. To date, at least 34 individuals have been charged federally, 19 have been convicted, $20,292,916.37 in restitution has been ordered, and more than $4 million in restitution has been collected.
Health Care Fraud and Money Laundering
1. United States v. Kenneth Bailynson, et al., Case No. 18-80124-CR-Rosenberg
On June 22, 2018, Kenneth Bailynson, 45, of West Palm Beach, Florida, owner of GDSL, Inc., a/k/a Good Decisions Sober Living, Inc. (“GDSL”) in West Palm Beach, Stephanie Curran, 35, of Lake Worth, Florida, an employee of GDSL, Mark Agresti, 55, of Palm Beach, Florida, the Medical Director of GDSL, and Matthew Noel, 32, of Louisville, Kentucky, an employee of GDSL, were charged by indictment. The defendants were charged with conspiracy to commit health care and wire fraud, substantive counts of health care fraud, and substantive counts of money laundering for their involvement in a scheme at GDSL to illegally recruit patients, pay kickbacks, and defraud health care benefit programs by billing for widespread fraudulent urine testing that was not medically necessary. The indictment alleges that during the course of the fraudulent scheme, from September 2011 through December 2015, GDSL submitted claims for substance abuse treatment services in excess of approximately $106,576,358 to the insurance plans, and received insurance payments of approximately $31,356,527.
This case is being prosecuted by DOJ Trial Attorney James V. Hayes, formerly an Assistant U.S. Attorney in the Southern District of Florida.
2. United States v. Anthony Jackson, Case No. 18-80040-CR-Middlebrooks
On June 21, 2018, following his guilty plea to conspiracy to commit health care fraud, Anthony Jackson, 51, of Lantana, Florida, a Certified Addiction Counselor at Reflections Treatment Center in Margate, Florida and owner of Pantherview Sober Home in Boynton Beach, Florida was sentenced to 42 months in prison, to be followed by 3 years of supervised release. Jackson also was ordered to pay $5,122,886.86 in restitution.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
3. United States v. Eric Snyder, et al., Case No. 18-80111-CR-Rosenberg
On June 7, 2018, Eric Snyder, 31, of Delray Beach, Florida, an owner of Halfway There Florida, LLC/A Safe Place (“HWT”), a Delray Beach sober home, and Real Life Recovery Delray LLC (“RLR”), a substance abuse treatment facility, Paul R. Materia, 43, of Port St. Lucie, Florida, the CEO of RLR, and patient brokers Joseph Lubowitz, 29, of Pennsylvania and West Palm Beach, Florida, and Christopher Fuller, 33, of West Palm Beach, Florida, were charged by indictment. The defendants were charged with conspiracy to commit health care and wire fraud, substantive counts of health care fraud, substantive counts charging a violation of the Travel Act, conspiracy to commit money laundering, and substantive counts of money laundering for their involvement in a scheme to illegally recruit patients, pay kickbacks, and defraud health care benefit programs by billing for urine testing and substance abuse treatment that was medically unnecessary, and that was never provided. During the course of the alleged fraudulent scheme, from January 2011 through September 2015, HWT/RLR submitted claims for substance abuse treatment services in excess of approximately $58,209,385 to insurance plans, and received insurance payments of approximately $20,190,941. Eric Snyder and Christopher Fuller were previously charged with conspiracy to commit health care fraud in this case, in a criminal complaint filed in July 2017 (Case No. 17-MJ-08268-Brannon).
This case is being prosecuted by DOJ Trial Attorney James V. Hayes, formerly an Assistant U.S. Attorney in the Southern District of Florida.
4. United States v. Mark Jeffrey Hollander, Case No. 18-80102-CR-Rosenberg
On May 21, 2018, Mark Jeffrey Hollander, 44, of Miami, Florida, was charged by an information with laundering the proceeds of health care fraud, that is, monies he received from Smart Lab LLC, a clinical laboratory located in Palm Beach Gardens, Florida.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
5. United States v. Lawrence Weisberg, Case No. 18-80108-CR-Rosenberg
On May 29, 2018, Lawrence Weisberg, 51, of Boca Raton, Florida, was charged by an information with laundering the proceeds of health care fraud, that is, monies he received from Smart Lab LLC, a clinical laboratory located in Palm Beach Gardens, Florida.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
6. United States v. Lanny Fried, Case No. 18-80100-CR-Rosenberg
On May 21, 2018, Lanny Fried, 41 of Miami, Florida, was charged by an information with conspiracy to commit money laundering of proceeds from health care fraud, that is, monies he and others received from Smart Lab LLC, a clinical laboratory located in Palm Beach Gardens, Florida.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
7. United States v. Bosco Vega, Case No. 18-80101-CR-Middlebrooks
On May 22, 2018, Bosco Vega, 52, of Miami, Florida, was charged by an information with laundering the proceeds of health care fraud, that is, monies he received from Smart Lab LLC, a clinical laboratory located in Palm Beach Gardens, Florida.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
Illegal Distribution of Opioids
8. United States v. Arman Abovyan and Tina Marie Barbuto,
Case No. 18-80122-CR-Middlebrooks
On June 19, 2018, Arman Abovyan, 44, of Boca Raton, Florida, former Medical Director of Reflections Treatment Center in Margate and Journey to Recovery in Boca Raton, and Tina Marie Barbuto, 39 of Boca Raton, Florida, former Clinical Director of Reflections Treatment Center in Margate were charged by indictment with one count of conspiracy to distribute and dispense controlled substances outside the course of medical practice and two counts of distribution of controlled substances outside the course of medical practice.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
9. United States v. Kenneth Rivera-Kolb, Case No. 18-80121-CR-Cohn
On June 19, 2018, Kenneth Rivera-Kolb, 66, of Largo, Florida, was charged by indictment with one count of conspiracy to distribute controlled substances in relation to his employment with Angel’s Recovery, a substance abuse treatment facility located in Palm Beach County, Florida. Rivera-Kolb was a licensed physician in the State of Florida. In 2013, he was hired as the Medical Director for Angel’s Recovery. As the Medical Director of Angel’s Recovery, Rivera-Kolb prescribed controlled substances for patients. From approximately February 17, 2015 through September 2, 2015, after the suspension of his medical license, Rivera-Kolb allegedly continued to prescribe controlled substances to patients of Angel’s Recovery.
The case is being handled by Assistant U.S. Attorneys A. Marie Villafaña and Alexandra Chase.
10. United States v. Scott Novick, Case No. 18-20563-CR-Moore
On June 27, 2018, Scott Novick, 50, of Broward County, Florida, was charged by information with one count of conspiracy to dispense and distribute controlled substances. According to the information, Novick was the owner of American Pain Management, a pain management clinic located in Tamarac, Florida. He also owed Pacific Pharmacy, a Miami-area pharmacy. Between July 2016 and March 2018, Novick allegedly engaged in a conspiracy to dispense and distribute Schedule II substances, including oxycodone and morphine.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by DOJ Trial Attorney Timothy P. Loper.
Agencies involved with the Greater Palm Beach County Health Care Fraud Task Force include the FBI, IRS-CI, DIFS, Amtrak-OIG, DOL-EBSA, OPM-OIG, and NICB.II. CHECK CASHING FRAUD SCHEMES
11. United States v. Evelio Suarez, Case No. 18-MJ-2965-Torres
On June 21, 2018, Evelio Suarez, 53, of Miramar, Florida, was charged by criminal complaint with conspiracy to commit money laundering, bribery of a bank employee, and obstruction of justice.
According to allegations contained in the criminal complaint, Suarez controlled three check-cashing stores in Hialeah, Florida, in the name of nominee owners. From 2013 to 2014, Suarez’s check-cashing stores cashed nearly $500 million in checks, which were allegedly primarily funded by healthcare fraud, mortgage fraud, identity theft tax refund fraud, and other fraudulent activity. Suarez allegedly knowingly cashed checks made payable to individuals who were not present at the stores, including individuals whose identities had been stolen or individuals who had been paid to flee to Cuba. Suarez allegedly did not require real identification documents to cash the fraudulent checks and, if necessary, Suarez would make fake identification documents. Suarez allegedly charged a personal fee of approximately ten percent to cash healthcare fraud and mortgage fraud checks and thirty percent for identity theft tax refund fraud checks, on top of the fee charged by the check-cashing stores. On numerous occasions, Suarez allegedly cashed individual fraudulent Medicare checks exceeding $200,000 and individual U.S. Treasury tax refund checks exceeding $150,000.
Mr. Greenberg commends the investigative efforts of IRS-CI and FBI in this matter. The case is being handled by Assistant U.S. Attorney Michael Berger and DOJ Trial Attorney Yisel Valdes.
12. United States v. Enrique Indalecio Iglesias, Case No. 18-MJ-2973-Torres
On June 22, 2018, Enrique Iglesias, 44, of Homestead, Florida, was charged by criminal complaint with conspiracy to commit money laundering, money laundering, and structuring transactions to avoid reporting requirements justice.
According to allegations contained in the complaint, Iglesias controlled two check-cashing stores in Miami, in the name of nominee owners. From 2013 to 2015, Iglesias’ check-cashing stores cashed nearly $150 million in checks, which were allegedly funded primarily from health-care fraud, mortgage fraud, and other fraudulent activity. Iglesias allegedly did not require the payee on the check to be present and, on many occasions, the actual payee had been paid to flee to Cuba. Iglesias typically charged personal fees between eight to fifteen percent, for allegedly cashing health-care and mortgage-fraud checks. On numerous occasions, Iglesias allegedly cashed fraudulent individual health care fraud checks exceeding $50,000.
Mr. Greenberg commended the investigative efforts of the FBI, HHS-OIG and IRS-CI in this matter. The case is being handled by Assistant U.S. Attorney Michael Berger and DOJ Trial Attorney Yisel Valdes.III. DRUG AND PHARMACY FRAUD SCHEMES – Medicare Part D
A. TRICARE Fraud13. United States v. Alap Shah, Case No. 18-20526-CR-Ungaro
On June 19, 2018, Alap Shah, 44, of Columbus, Georgia, was charged by indictment with one count of conspiracy to defraud the United States and receive health care kickbacks and three counts of receiving health care kickbacks.
According to the indictment, Shah was a State of Georgia licensed podiatrist who allegedly received kickback payments from PGRX, a Weston, Florida based business that recruited and paid doctors to prescribe compounded medications for TRICARE and private commercial insurance beneficiaries. During the course of the conspiracy the defendant and his co-conspirators allegedly signed false Medical Director and Speaker agreements in order to conceal the fact that PGRX was paying the defendant for writing prescriptions. As a result of these prescriptions TRICARE made payments to Atlantic Pharmacy, a pharmacy located in the Southern District of Florida.
Mr. Greenberg commends the investigative efforts of DCIS, U.S. Army Criminal Investigation Command, FDA-Office of Criminal Investigations (FDA-OCI) and USPS-OIG. This case is being prosecuted by Assistant U.S. Attorney Daniel Bernstein.
14. United States v. Christopher Liva, et al., Case No. 18-60167-CR-Middlebrooks
On June 14, 2018, Christopher Liva, 39, of Boca Raton, Florida, Elaina Liva, 66, of Pompano Beach, Florida, and Stephen Chalker, 42, of Wellington, Florida, were charged by indictment with one count of conspiracy to commit health care fraud. Chalker was also charged with three counts of health care fraud.
According to the indictment, the Livas were the owners/operators of, and Chalker was the pharmacist in charge at Pop’s Pharmacy, LLC (“Pop’s Pharmacy”), a pharmacy located in Deerfield Beach, Florida. The indictment alleges that from approximately September 2014 to October 2016, the defendants and their co-conspirators caused Pop’s Pharmacy to submit false and fraudulent claims to Medicare, TRICARE, and Medicaid for compounded drugs and other prescription medications, including expensive pain and scar creams, that were not medically necessary and/or were never provided. As a result of these false and fraudulent claims, Medicare, TRICARE, and Medicaid made payments totaling nearly $5 million.
Mr. Greenberg commends the investigative efforts of the FBI, HHS-OIG, DCIS, and the State of Florida Medicaid Fraud Control Unit in this matter. This case is being prosecuted by DOJ Trial Attorney Leslie Wright.15. United States v. Ryan Long and Billy Burton,
Case. Nos. 18-60144-CR-Dimitrouleas; 18-60164-CR-Dimitrouleas
On May 24, 2018, Ryan Long, 47, of Dunnelon, Florida, was charged by indictment with conspiracy to receive healthcare kickbacks along with six counts of receiving healthcare kickbacks. Billy Burton, 28, of Louisville, Kentucky, was charged by information on June 12, 2018, with causing the misbranding of drugs while held for sale. These charges stem from Long and Burton’s alleged involvement in a $40 million compounding pharmacy fraud scheme, involving TRICARE, spearheaded by Monty Ray Grow, 47, of Tampa, Florida, who was convicted earlier this year in United States v. Monty Ray Grow, Case No. 16-20893-CR-Moreno(s), and recently sentenced to 22 years in prison.
Mr. Greenberg commends the investigative efforts of DCIS, FDA-OCI, and U.S. Army Criminal Investigation Command. This case is being prosecuted by Assistant U.S. Attorney Kevin Larsen.
16.United States v. Asif Uddin and Karl Voeller,
Case Nos. 18-20546-CR-Gayles and 18-20549-CR-Moreno
On June 25, 2018, Asif Uddin, 31, of Kansas City, Missouri, was charged by information with conspiracy to pay and receive healthcare kickbacks in connection with a multi-million dollar fraud scheme purportedly perpetrated on the TRICARE military health benefit program. Uddin, along with Karl Voeller, 33, of Boynton Beach, Florida, who was charged by a separate information on the same date, allegedly conspired with a company based in Miami, Florida to recruit and refer TRICARE beneficiaries to receive prescriptions from pharmacies in Florida and Oklahoma in exchange for kickbacks.
Attorney for the United States Randy A. Hummel commends the investigative efforts of DCIS. These cases are being prosecuted by Assistant U.S. Attorney Kevin J. Larsen.
B. Limited Income Newly Eligible Transition (“LINET”) Program Fraud
According to the criminal charges, filed in the following cases, the defendants allegedly defrauded the Limited Income Newly Eligible Transition (“LINET”) Program of Medicare Part D. The LINET Program exists to ensure that certain low-income individuals who are newly eligible for Medicare benefits receive immediate Part D coverage until they are enrolled in a traditional Medicare Part D prescription drug plan.17. United States v. Orelbis Gonzalez, Case No. 18-20477-CR-Gayles
On June 5, 2018, Orelbis Gonzalez, 32, of Miami, Florida, was charged by indictment with conspiracy to commit health care fraud, four counts of health care fraud, conspiracy to commit money laundering and four counts of money laundering.
According to the indictment, the defendant targeted the LINET program of Medicare Part D. Gonzalez was the president and registered agent of Universal Pharmacy Group Inc. (“Universal Pharmacy”), a Miami pharmacy that purportedly provided prescription drugs to Medicare beneficiaries. From June 2015 through September 2015, the defendant submitted and caused the submission of approximately $411,760 in claims for reimbursement to the Medicare Part D program, via interstate wires, that falsely and fraudulently represented that various health care benefits, primarily prescription drugs, were medically necessary, prescribed by a doctor, and had been provided by Universal Pharmacy. As a result of such false and fraudulent claims, Medicare prescription drug plan sponsors made payments funded by the Medicare Part D Program to the corporate bank accounts of Universal Pharmacy in the approximate amount of $354,979.
Mr. Greenberg commends the investigative efforts of the FBI and HHS-OIG. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.
Source: United States Attorney Benjamin G. Greenberg Southern District of Florida