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Detroit-area resident Emma King pleaded guilty today to engaging in a fraudulent medical testing scheme, announced the Departments of Justice and Health and Human Services (HHS).

King, 61, pleaded guilty today to one count of conspiracy to commit health care fraud before U.S. District Court Judge Patrick J. Duggan in the Eastern District of Michigan.  King faces a maximum penalty of 10 years in prison and a $250,000 fine.  A sentencing date has not yet been scheduled.

According to the plea documents, beginning in approximately September 2007, King began recruiting and transporting patients to a clinic called Ritecare LLC.  Ritecare, was owned and operated by co-conspirators and had locations in Detroit and Livonia, Mich.  King admitted that she and a co-conspirator paid kickbacks to Medicare beneficiaries that she recruited and transported to Ritecare.  According to the plea documents, the owners and operators of Ritecare were the source of the funds used by King to pay the Medicare beneficiaries she recruited.  King admitted that she would keep part of the funds she received from the owners and operators of Ritecare to secure patients as a kickback for referring the Medicare beneficiaries she recruited.  Typically, the owners of Ritecare would provide $100-$150 per patient King recruited, with King retaining $50-$75 of that amount for the referral.  

According to the plea documents, the patients King recruited had to subject themselves to medically unnecessary tests to receive the money.  Per instructions from the owners and operators of Ritecare, King admitted that she instructed the patients to claim they had certain symptoms to trigger medically unnecessary tests.  Consequently, the patients' medical records contained false symptoms allowing Ritecare to deceive Medicare as to the legitimacy and medical necessity of the tests it performed.  

King admitted that she was responsible for recruiting at least 269 patients to Ritecare.  Through her recruitment efforts, King caused the submission of approximately $940,760 in false or fraudulent billings by Ritecare.  Medicare paid approximately $533,643 on those claims.

Today's guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI's Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General's (OIG) Chicago Regional Office.

The case was prosecuted by Senior Trial Attorney John K. Neal and Trial Attorney Gejaa T. Gobena of the Criminal Division's Fraud Section.  The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division's Fraud Section and the U.S. Attorney's Office for the Eastern District of Michigan.  

Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 500 individuals who collectively have falsely billed the Medicare program for approximately $1.1 billion.  In addition, HHS's Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

SOURCE U.S. Department of Justice

Atricure Inc., a medical device manufacturer, has agreed to pay the United States $3.76 million to resolve civil claims in connection with the alleged promotion of its surgical ablation devices, the Justice Department announced today. Surgical ablation devices use focused energy to create controlled lesions or scar tissue on a patient's heart or other organs.

The settlement resolves allegations that the West Chester, Ohio-based company marketed its medical devices to treat atrial fibrillation (the most common cardiac arrhythmia or abnormal heart rhythm), a use that is not approved by the U.S. Food and Drug Administration (FDA). Atricure also allegedly promoted expensive heart surgery using the company's devices when less invasive alternatives were appropriate, advised hospitals to up-code surgical procedures using the company's devices to inflate Medicare reimbursement, and paid kickbacks to health care providers to use its devices. The United States asserted that by engaging in this conduct, Atricure knowingly violated the Food, Drug, and Cosmetic Act and caused the submission of false and fraudulent claims in violation of the False Claims Act.

"This settlement reflects our commitment to enforce the Food, Drug, and Cosmetic Act and protect Medicare from the improper marketing practices of Atricure and other medical device manufacturers," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "We will continue to work with our partners at the Department of Health and Human Services Inspector General's Office and the FDA Office of Chief Counsel to preserve the integrity of our public health programs."

The allegations were made against Atricure in a lawsuit filed under the qui tam or whistleblower provisions of the False Claims Act, which permit private citizens, called "relators," to bring lawsuits on behalf of the United States and receive a portion of the proceeds of any settlement or judgment. The relator will receive a total of $625,000 as the statutory share of the current settlement.

"The misuse of medical devices has the potential of exposing patients to dangerous procedures and taxpayers to payment of unwarranted claims against Medicare," said Tim Johnson, United States Attorney for the Southern District of Texas. "This settlement demonstrates the government's commitment to maintaining safe and affordable health care for its citizens."

Assistant Attorney General West noted that the settlement with Atricure resulted from a coordinated effort by the Justice Department's Civil Division, the U.S. Attorney's Office for the Southern District of Texas, the Department of Health and Human Services' Office of Inspector General, and the FDA Office of Chief Counsel.

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 $2.2 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.

SOURCE U.S. Department of Justice

Wheaton Community Hospital, the City of Wheaton, Minn. and Dr. Stanley Gallagher (collectively WCH) have agreed to pay $846,461 to settle allegations that their hospital admission practices violated the False Claims Act, the Justice Department announced today.

This settlement resolves allegations that WCH knowingly made false claims to Medicare for unreasonable and unnecessary hospital admissions. Specifically, the government contended that, from 1998 to 2004, WCH admitted some patients and kept others admitted to acute care when doing so was not medically necessary. The defendants then billed Medicare for the cost of these hospital admissions.

"Hospitals and doctors have a responsibility to provide patients with reasonable and necessary care. When they neglect those obligations, patients and taxpayers suffer," said Tony West, Assistant Attorney General for the Justice Department's Civil Division.

The allegations against WCH arose from a lawsuit filed in federal court in Minnesota under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private individuals to file civil actions on behalf of the United States and share in any recovery. Dr. Steven Radjenovich, the whisteblower in this case, formerly practiced at Wheaton Community Hospital with Dr. Gallagher. Dr. Radjenovich will receive $203,150 as his share of the settlement with WCH.

Assistant Attorney General West thanked the Justice Department's Civil Division, the U.S. Attorney's Office for the District of Minnesota and the Department of Health and Human Services' Office of the Inspector General for their efforts in handling this investigation and settlement.

Orthopedic surgeon fails to diagnose and treat hip dysplasia in a newborn baby

A Fort Worth family has been awarded $210,530.73 by a Dallas County jury in a medical negligence case resulting from improper treatment to a newborn child by an orthopedic surgeon.

The lawsuit was filed in Dallas County by the child's mother, Tiffany Martinez, and alleged that Dr. Monica Omey and DFW Orthopedic Associates, P.A. failed to diagnose the hip dysplasia [dislocation] and failed to provide appropriate care for the child. Trial began in Dallas County before Judge King Fifer on October 26. On October 30 the jury reached a verdict in favor of the family and awarded $210,530.73.

Tiffany's daughter was born on April 7, 2005. Her pediatrician referred her to an orthopedic surgeon, Dr. Monica Omey at DFW Orthopedic Associates, P.A., for evaluation and treatment of possible hip dislocation. The jury found that Dr. Omey was negligent in the care provided to the child.

As a result of Dr. Omey's failure to diagnose and treat the hip dislocation, the child required surgery to repair her hip. She spent three months in a cast, several more months in a brace, and may require future surgery. The evidence showed that the child has had a positive recovery with no current limitations in her activities.

"Children should receive the quality of care that they deserve from healthcare providers," said attorney John David Hart of the Law Offices of John David Hart in Fort Worth, who represented the family. "We are pleased that the jury found the physician responsible for failing to provide the appropriate care to the baby."

The Law Offices of John David Hart is a group of experienced and dedicated legal professionals working to protect the rights of people wronged by the acts of others. Across the country, the firm represents individuals in cases of medical malpractice, catastrophic personal injury, wrongful death, dangerous drugs, automobile and truck accidents, oil and gas and commercial litigation.

SOURCE The Law Offices of John David Hart

Sixteen new lawsuits allege that KBR, Inc. (NYSE: KBR) jeopardized the health and safety of tens of thousands of American soldiers and private contractors in Iraq and Afghanistan by burning vast quantities of unsorted waste in enormous open-air burn pits with no safety controls.

The lawsuits were filed during the past week in federal courts throughout the nation by Burke O'Neil LLC and co-counsel on behalf of military veterans and private contractors. The suits allege that round-the-clock hazardous emissions from the burn pits caused illnesses such as multiple cancers, respiratory disease, pulmonary complications, chronic coughing, debilitating headaches, and neurological and skin disorders.

KBR is accused of allowing thick, noxious smoke, coming off of flames sometimes colored blue or green by burning chemicals, to hang over U.S. bases and camps across Iraq and Afghanistan since 2004.

According to the complaints, the burn pits are so large that tractors are used to push waste onto them and the flames shoot hundreds of feet into the sky. KBR allegedly burned waste such as biohazard materials including human corpses, medical supplies, paints, solvents, asbestos, items containing pesticides, animal carcasses, tires, lithium batteries, Styrofoam, wood, rubber, medical waste, large amounts of plastics, and even entire trucks.

Susan L. Burke, Elizabeth M. Burke, and Susan M. Sajadi, of Burke O'Neil LLC, in Washington, D.C., and co-counsel represent the more than 200 veterans, KBR employee-contractors and families in the cases which are pending in 37 states.

Elizabeth M. Burke, of Burke O'Neil LLC, stated, "KBR utterly disregarded the safety of the troops when they chose to use open air burn pits and failed to use incinerators and other safer methods of waste disposal. The hazards of operating large open-air burn pits were well known, and KBR promised to minimize the environmental effects of the burn sites they operated in Iraq and Afghanistan. KBR willfully endangered these men and women who honorably served their country in military service or in support of the military."

The legal team for the plaintiffs intends to seek class certification of the lawsuits to cover costs of medical monitoring, future medical expenses, and other damages for other individuals exposed to KBR burn pit emissions.

The new cases were filed in federal courts in Arkansas, Colorado, Connecticut, Idaho, Indiana, Kentucky, Maine, Massachusetts, Mississippi, Nevada, New Jersey, New Mexico, North Dakota, Tennessee, Virginia, and Washington. Earlier this year, dozens of other current and former military personnel, private contractors and families of men who allegedly died as a result of exposure to toxic emissions from KBR burn pits brought similar claims.

Troy, Mich., resident Syed Aziz pleaded guilty today in U.S. District Court in Detroit to participating in a conspiracy to defraud the Medicare program, Assistant Attorney General Lanny A. Breuer of the Criminal Division, U.S. Attorney Terrence Berg of the Eastern District of Michigan and Daniel R. Levinson, Inspector General of the Department of Health & Human Services (HHS) announced.

In his plea today, Aziz, a licensed physical therapist, admitted that he began working in approximately May 2005 as a contract therapist for a co-conspirator, Suresh Chand. Chand owned and controlled several companies operating in the Detroit area that purported to provide physical and occupational therapy services to Medicare beneficiaries. Aziz admitted that he, Chand, and others created fictitious therapy files appearing to document physical and occupational therapy services provided to Medicare beneficiaries, when in fact no such services were provided. According to court documents, the fictitious services reflected in the files were billed to Medicare through sham Medicare providers controlled by co-conspirators.

Chand admitted to paying cash kickbacks and other inducements to Medicare beneficiaries in exchange for the beneficiaries' Medicare numbers and signatures on documents falsely indicating that they had received physical or occupational therapy. Chand pleaded guilty on Sept. 28, 2009, in U.S. District Court in Detroit to one count of conspiracy to commit health care fraud and one count of conspiracy to launder money. Aziz admitted that he was one of the licensed physical or occupational therapists from whom Chand obtained signatures on fictitious "progress notes" and other documents falsely indicating that the therapists had provided services to the Medicare beneficiaries.

Aziz also admitted that during the course of the scheme, he signed approximately 400 fictitious physical therapy files, indicating that he had provided physical therapy services to Medicare beneficiaries, when in fact he had not. Aziz admitted that he was paid between $70 and $90 for each file he falsified. Aziz also admitted that between approximately May 2005 and December 2006, he falsified physical therapy files that supported claims to the Medicare program totaling approximately $1,895,000. According to court documents, Medicare paid approximately $817,000 on those claims. Aziz admitted that throughout the conspiracy he was fully aware that Medicare was being billed for physical therapy services that he falsely indicated he had performed.

At sentencing, scheduled for Feb. 3, 2010, Aziz faces a maximum prison sentence of 10 years and a $250,000 fine.

The case is being prosecuted by Trial Attorneys John K. Neal, Gejaa T. Gobena and Benjamin Singer of the Criminal Division's Fraud Section and by Special Assistant U.S. Attorney Thomas W. Beimers of the Eastern District of Michigan. The FBI and the HHS Office of Inspector General (HHS-OIG) conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division's Fraud Section and the U.S. Attorney's Office for the Eastern District of Michigan.

Since the inception of Strike Force operations in March 2007 -- Miami (Phase One), Los Angeles (Phase Two), Detroit (Phase Three) and Houston (Phase Four) -- the Strike Force has obtained indictments of more than 331 individuals and organizations that collectively have billed the Medicare program for more than $720 million. In addition, HHS's Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Each of the Strike Force teams across the separate phases is led by a federal prosecutor from the Criminal Division's Fraud Section or the U.S. Attorney's Office. Each team has an agent from the FBI and HHS-OIG.

Thirty-two people have been indicted for schemes to submit more than $16 million in false Medicare claims in the continuing operation of the Medicare Fraud Strike Force in Houston, Deputy Attorney General David W. Ogden and Deputy Secretary Bill Corr of the Department of Health and Human Services (HHS) announced today. The Strike Force in Houston is the fourth phase of a targeted criminal, civil and administrative effort against individuals and health care companies that fraudulently bill the Medicare program.

While the indictments were returned by a grand jury in Houston, individuals were arrested today in Houston, New York, Boston and Louisiana. In addition, Strike Force agents executed 12 search warrants at health care businesses and homes across the Houston area.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. The fourth phase was announced in May 2009, with agents from FBI, HHS Office of the Inspector General (HHS-OIG), the Texas Attorney General's Medicaid Fraud Control Unit (MFCU), the Drug Enforcement Administration (DEA), Office of Personnel Management, Office of the Inspector General (OPM-OIG) and the Office of the Inspector General at the Railroad Retirement Board (RRB-OIG).

"Our Medicare Strike Force is striking back against health care fraud in all its forms and wherever it occurs. We will stop fraud as its happening, using real-time data analysis of Medicare billing records," said Deputy Attorney General David W. Ogden. "Those who commit health care fraud will not be allowed to steal money from American taxpayers. Anyone operating or considering operating a health care fraud scheme around the country should take notice that they will be held accountable."

"When criminals rip off Medicare beneficiaries, we all pay the price. These false Medicare schemes and scams are costing the taxpayers millions of dollars, harming Medicare beneficiaries and driving up the cost of health care, but thanks to this new innovative partnership and the hard work of our staff on the ground, we are starting to fight back against fraud in a big way. The Administration's HEAT initiative and our Strike Forces are making a big difference in a very short amount of time, returning millions back to the Medicare Trust in just a few months," said Bill Corr, Deputy Secretary of Health and Human Services and the top HHS official on the HEAT Team. "We are also working together across the federal government on important new innovations in the way we do business on the front end, to try and prevent crime like this from happening in the first place."

The Strike Force operations in Houston are another important step of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their joint efforts to reduce and prevent Medicare and Medicaid fraud through enhanced cooperation. The HEAT taskforce, co-chaired by Deputy Attorney Ogden and Deputy Secretary Corr, is made up of top-level law enforcement agents, prosecutors and staff from both Departments and their operating divisions. In the May 2009 announcement, Attorney General Eric Holder and Secretary Kathleen Sebelius announced the expansion of the Strike Force into Detroit and Houston to build upon existing partnerships between the agencies in a heightened effort to reduce fraud and recover taxpayer dollars.

Charges were unsealed today against 32 individuals who are accused of various Medicare fraud offenses, including conspiracy to defraud the Medicare program, and criminal false claims. The Strike Force operations in Houston have identified the primary fraud schemes as those related to false billing for "arthritis kits," power wheelchairs and enteral feeding supplies.

According to the indictments, the defendants charged today participated in schemes to submit claims to Medicare for products that were in fact medically unnecessary and oftentimes, never provided. In some cases, indictments allege that beneficiaries were deceased at the time they allegedly received the items. Collectively, the physicians, company owners and executives charged in the indictments are accused of conspiring to submit more than $16 million in false claims to the Medicare program.

"Americans deserve quality healthcare and have the right to expect that money expended on Medicare is not wasted," said U.S. Attorney Tim Johnson. "We will prosecute anyone who fraudulently obtains Medicare benefits at the expense of the truly needy."

"We will protect the Medicare program and its beneficiaries by stopping those who falsely bill for power wheelchairs, orthotic devices and other supplies that are not needed," said Daniel R. Levinson, Inspector General of the Department of Health & Human Services. "Today's arrests demonstrate the significant impact of the new HEAT strike force on combating fraud and abuse in the Houston area."

"We will continue to work together to combat those who corrupt the system and wish to line their pockets with taxpayer dollars," said Special Agent in Charge Richard C. Powers, FBI Houston Field Office. "Healthcare fraud strikes at the heart of our health care system and our economy."

Texas Attorney General Greg Abbott added: "Today's arrests reflect a concerted effort to crack down on those who defraud Texas taxpayers. We will continue working with our federal partners to uncover waste, fraud, and abuse in the Medicare and Medicaid systems."

Since the inception of Strike Force operations in March 2007 with phase one in South Florida, phase two in Los Angeles in May 2008, and phase three in Detroit in March 2009, the Strike Force has obtained indictments of more than 293 individuals and organizations that collectively have billed the Medicare program for more than $674 million. In addition, HHS's Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Each of the three Houston Strike Force teams is led by a federal prosecutor from the U.S. Attorney's Office in Houston or the Criminal Division's Fraud Section. Each team has an agent from the FBI, HHS-OIG and the Texas Attorney General's MFCU. DEA, OPM-OIG and RRB-OIG also have agents on the teams.

The cases are being prosecuted by attorneys from the U.S. Attorney's Office, including Assistant U.S. Attorney Jennifer Lowery and Special Assistant U.S. Attorney Justin Blan, on detail from HHS-OIG, as well as from the Criminal Division's Fraud Section, including Assistant Chief John S. (Jay) Darden and Trial Attorneys Charles Reed, Katherine Houston, Anthony Burba and John Cunningham.

An indictment is merely an allegation, and defendants are presumed innocent until and unless proven guilty.

Source: U.S. Dept. of Justice