Owner of Medical Equipment Company Sentenced to 5 Years in Prison for Medicare Fraud

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Nnanta Felix Ngari, who is the owner of a medical equipment supply company in Louisiana, was sentenced to five years in prison for his part in a Medicare Fraud Scam yesterday, which was responsible for almost $5 million in Medicare fraud.

Ernest Payne, a patient recruiter for Ngari, was also sentenced to prison, receiving a slightly lower sentence of fifty-five months. Both men will also serve two years of probation and have been fined $2.5 million, although the fine will be split among others involved in the Medicare fraud.

Another man, a doctor named Sofjan Lamid who was paid kickbacks from Ngari, received three years probation, for his part in writing unnecessary prescriptions for medical equipment.

Ngari, and several of his co-defendents were convicted on August 16, 2011 and sentenced on January 12, 2012.

Ngari, is the owner of Unique Medical Solutions, LLC, which provided durable medical equipment for those on Medicare. Durable Medical Equipment includes things like wheelchairs, hospital beds, walkers, and other types of physical medical equipment that is typically covered by Medicare. For most types of home medical equipment, a doctor’s prescription is required to receive coverage and for some items, a more advanced certificate of medical necessity is needed.

Unique Medical Solutions focused on providing electric power wheelchairs to Medicare recipients, however, according to court documents, Ngari began to use his co-defendants, such as Payne, to get prescriptions for power chairs that were not required for medical reasons.

To help find Medicare recipients, Ngari began to hold regular health conferences at local churches and other public areas around Baton Rouge. Visitors to the health conferences that were on Medicare would often receive prescriptions for power chairs, written by doctors like Sofjan Lamid, who received kickbacks for their part in the scam.

According to the prosecuting attorney, this fraud scheme took place from between 2003 and 2009, resulting in over $4.5 million in fraudulent Medicare claims. Unique Medical Solutions received around half of this in payment from Medicare.

Broward County Florida Man Pleads Guilty in ATC Medicare Fraud Case

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Today, Barry Nash, who is the sixty-nine year old owner of a Halfway house in Broward County Florida, plead guilty to a single count of conspiracy to commit health care fraud for his part in a Medicare Fraud Kickback Scheme.

Nash’s guilty plea is related to the growing stack of guilty sentences associated with the American Therapeutic Corporation Medicare Fraud scam in Florida.

Nash is scheduled to be sentenced on March 8th, 2012, and faces up to ten years in prison, as well as a fine of up to a quarter of a million dollars.

Nash admitted to receiving kickbacks for funneling patients into a fraudulent mental health shell company operated by American Therapeutic Corporation(ATC) and American Sleep Institute(ASI,) who was related to American Therapeutic Corporation. According to the plea agreement, Nash was responsible for almost a million dollars in Medicare Fraud that was the direct result of patients from his halfway house being sent for treatment at ATC and ASI.

Nash is the most recent in a string of more than 9 individuals convicted of fraud related to ATC. The ATC and ASI fraud involved a large number of doctors, marketers, and even patients in Florida. These individuals received kickbacks for providing Medicare patients to American Therapeutic Corporation, which is related to Medlink Professional Management Group Inc.

Patients were supposed to receive mental health care and treatment, which included a partial hospitalization program(PHP,) but were typically ineligible or did not receive qualifying treatment. In all, the ATC and ASI fraud is believed to have been responsible for over $200 Million dollars in Medicare Fraud.

This prosecution is related to the Medicare Fraud Strike Force, which was formed five years ago to help fight Medicare Fraud. To date, the Health Care Fraud Prevention and Enforcement Action Team, also known as HEAT, and the Medicare Fraud Strike Force has helped prosecute over 1000 defendants, who are allegedly responsible for close to $3 Billion in Medicare Fraud.

AseraCare Hospice Accused of Enrolling Non-Terminal Patients into Hospice Care

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In a legal complaint published this week, the U.S. Department of Justice accused AseraCare, a national for-profit Hospice group, of making fraudulent Medicare Claims.

The Department of Justice contends that AseraCare defrauded the government of millions of dollars that was intended for patients who were terminally ill. Hospice care is covered by Medicare and is a type of Palliative, which is intended to address pain, stress, and other symptoms of those who are facing a terminal disease. Under Medicare, someone who has less than six months to live is eligible for this type of Medicare coverage, but it will prevent them from receiving other more standard treatments for their condition. This means that those receiving reimbursement for hospice care would not be eligible to also receive medications or treatments that are aimed at preventing death or other complications of their condition.

According to the complaint, AseraCare has, since 2007 at the earliest, claimed patients as terminally ill in order to receive payments from Medicare. These allegations were brought about by former employees of AseraCare, who created a whistle-blower lawsuit alleging that Medicare Fraud is prevalent nationwide. The original lawsuit was filed against Golden Gate National Senior Care LLC, who is related to Golden Living. AseraCare Hospice is owned by Golden Gate.

The Vice President of Golden Living, Blair Jackson, has denied these accusations, stating that they feel they have not violated any laws or regulations.

Owner of Brunswick Prosthesis Company Sentenced to 3 Years in Prison

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Samuel Curtis III, who is the owner of Preferred Prosthetics and Orthotics, was ordered to pay more than $250,000 in fines and sentenced to over three years in prison this week for his part in a Medicare Fraud scam that resulted in around a quarter of a million dollars in fraudulent Medicare Claims.

For his participation with the FBI, Curtis’s prison sentence is eight months lower than the standard minimum of 46 months. In his defense, Curtis stated that he would give the prosthetic legs that he billed Medicare for to other people who were in need, but could not afford them.

Curtis, who took over his fathers Prosthesis business in Houston Texas called Team Orthodics and Prosthetics, began defrauding Medicare in 2006. However, shortly after this, payments from Medicare were stopped after a Medicare Investigation into fraudulent claims.

He then packed up shop and moved to Brunswick Georgia, where he purchased a similar business called Team Orthodics and Prosthetics and started over again. This was in 2007, but was also short lived, as the staff at the new business notified the authorities of his actions.

Curtis would expand operations to Arkansas and Detroit, using Medicare account information from patients to submit electronic bills to Medicare. In addition to Curtis, his office manager Cecil Risher, who is 36, received a fine of around $70,000 and was sentenced to probation for his part in the fraud. Another acquaintance, Birdie Leroy Revis, pleaded guilty some months ago and faces five years in prison, but has not been sentenced yet.

Using Shell Companies to Preform Medicare Fraud

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Each year, billions of dollars is lost due to Medicare Fraud. There are many types of Medicare Fraud, however setting up Shell Companies and billing for services that are never preformed is one of the most common, especially in Florida.

A shell company is a fake company, typically setup in someone’s name who is not related to the fraudster or using falsified information, often everything about the company is fake, including addresses, although identity theft is another big threat. For cases of Medicare fraud in Florida, the majority involve shell companies.

After the company is setup, they begin to bill Medicare for services and procedures that are not preformed, using valid Medicare account information. Sometimes the company will pay kickbacks to patients and assisted care facilities, or others who have access to Medicare Recipients, although this information is also often stolen.

Most of the time, these individuals do not only setup a single company either, but instead create a group of companies that makes tracking and finding them all more difficult. For example, in the case of Jesus Huarte, who was recently sentenced to over twenty years in prison, his Medicare Fraud Ring extended up and down the east coast, with around thirty shell companies.

A big part of the issue is that Medicare will typically provide reimbursement to claims and follow up on them later. This is sometimes called a bill-and-chase situation, where they chase down the payment later, providing a very lucrative way for scammers to make money.

New legislation is being currently presented to make it a little more difficult for those who wish to preform this type of no-service Medicare scam and starting in 2012, states such as Florida where Medicare Fraud is so common will preform additional audits on those making claims. This also includes 10 other states, where Medicare Fraud is most common.