After string of successful fraud prosecutions, Sullivan takes on medical device makers

BY JEREMY OLSON

Pioneer Press

A watchdog of the pharmaceutical industry is turning his attention to the marketing practices of the medical device industry.

Michael Sullivan, the U.S. attorney for the Massachusetts district, has earned more than $3.3 billion for the federal government through health care fraud lawsuits. His biggest cases challenged whether drug makers used kickbacks or other improper methods to sell their products.

SAN ANTONIO - A medical supply company owner was sentenced to a year and a half in jail and ordered to pay $1.3 million in restitution. In December he pleaded guilty to falsifying Certificates of Need for medical supplies.

United Healthcare Insurance Company paid $3.5 million to settle a case that alleged that they defrauded Medicare by falsifying reports of how they handled phone inquiries. United Healthcare was acting as a Durable Medical Equipment Regional Carrier, responsible for processing DME claims submitted by Medicare providers and beneficiaries. United Healthcare did not admit any of the allegations. The case was the result of a qui tam lawsuit brought by a former United Healthcare employee. The whistleblower will receive $647,500 of the settlement. “This settlement demonstrates our continuing commitment to pursue vigorously allegations of fraud and abuse in Medicare,” said Peter Keisler, Assistant Attorney General for the Department’s Civil Division.

Gambro US to pay $355 mln in fraud case - Gambro Healthcare US, Lakewood, Colo., said it will pay $355 mln to settle civil and criminal charges stemming from illegal relationships with doctors and pharmaceutical companies in an alleged decade-long fraud scheme that began in 1991. [Healthcare Fraud News]

The settlement resolves civil liabilities from alleged kickbacks paid to physicians, false statements made to obtain payment for unnecessary services, and payments made to Gambro Supply, a sham DME company.

In Washington last week, deputies arrested Sally Hansen after they caught her selling medical supplies on eBay. The supplies were allegedly paid for by Washington state for Hansen’s disabled child. The Seattle Post-Intelligencer reported thta the state Department of Social and Health Services paid $15,100 for diapers, fruit drinks, PediaSure and a state employee health insurance program paid about $23,000 for medical supplies for Hansen’s daughter.

The investigation reportedly started after Wanda DeGolier bought PediaSure from Hansen on eBay. Ms. DeGolier contacted the medical supply company after she noticed that a label on the box that said the supplies were intended for Hansen’s daughter. Read the Seattle Post-Intelligencer article

On June 22, 2004 Dr. Romulo Valdez, a San Diego physician, pleaded guilty to conspiracy to defraud Medicare and Medi-Cal of more than $725,000. He admitted that he signed Certificates of Medical Necessity for motorized wheelchairs for patients who did not need them. In doing so, he helped Benison Medical Supply defraud Medicare and Medi-Cal. Dr. Valdez faces a maximum penalty of five years in prison and a $250,000 fine.

Motorized wheelchair fraud is a problem across the US. Expect to see more about this type of fraud. See also: 2 Brothers Plead Guilty

A 79-count Indictment charged Lazaro Betancourt, Carlos Marx Mesa, Kenia Mesa, Osvaldo Piedra, Viridiana Negrin, Gilberto Herrera, and Guillermo Carnet with healthcare fraud against Medicare, as well as money laundering and check cashing schemes. According to an August 5, 2004 press release by the United States Attorney for the Southern District of Florida, the people indicted created durable medical equipment (DME) companies that billed Medicare for services which were not delivered to Medicare beneficiaries. The defendents allegedly laundered the money they received from Medicare. A money laudering conviction could result in a maximum sentence of 20 years in prison. Financial penalties could amount to $21 million (treble the $7 million identified as Medicare fraud.).

Two brothers plead guilty to defrauding Medicare - Anietie H. Edoho-Ukwa, 46, and Ukwa H. Edoho-Ukwa, 48, each pleaded guilty to one count of health care fraud before U.S. District Judge Paul Brown, federal prosecutors said in a news … [Healthcare Fraud News]

Wheelchair fraud is in the news again, as two men in Texas pleaded guilty to submitting fraudulent claims to Medicare for power wheelchairs. In the past year, the Federal government has taken many steps to crack-down on power wheelchair fraud. In February 2004, the Deptartment of Justice announced 11 arrests in Texas as the result of Operation Roll Over. In September 2003, the Centers for Medicare and Medicaid Services (CMS) announced Operation Wheeler Dealer, a ten point plan to curb wheelchair fraud in the Medicare program. At the end of April 2004, CMS announced new payment guidelines to make sure that people who need wheelchairs get them and people who don’t, don’t.