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Investigators Arrest Pharmacy Owner Indicted For Medicaid Fraud

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Tuesday, October 24, 2006
Attorney General Abbott’s Investigators Arrest Pharmacy Owner Indicted For Medicaid Fraud

Erasmo Cantu arrested in Brownsville; over $5 million in theft alleged

BROWNSVILLE - Texas Attorney General Greg Abbott today announced the arrest of a Cameron County pharmacy owner who was indicted by a grand jury on Oct. 18 for felony offenses involving more than $5 million in alleged fraudulent Medicaid reimbursements for excessive prescription refills.

STATE INVESTIGATION REVEALS WIDESPREAD MEDICAID FRAUD

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Department of Law
The State Capitol
Albany, NY 12224

For More Information:
518.473.5525

For Immediate Release
October 25, 2006

STATE INVESTIGATION REVEALS WIDESPREAD MEDICAID FRAUD

Doctor and pharmacists among those indicted for multi-million dollar fraud

Attorney General Eliot Spitzer and State Medicaid Inspector General Kimberly O’Connor today announced that, after a 4-month undercover investigation, prosecutors and investigators have dismantled a Medicaid fraud ring involving a doctor, pharmacists, several city pharmacies, millions in fraudulent Medicaid billings and large monetary transfers to individuals in Pakistan.

Review of Medicaid Eligibility in New York State, (A-02-05-01028)

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October 10, 2006

Complete Text of Report is available in PDF format (1.6 mb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.

EXECUTIVE SUMMARY:

Our objective was to determine the extent to which the State agency made Medicaid payments on behalf of beneficiaries who did not meet Federal and State eligibility requirements. The State agency (1) made some Medicaid payments on behalf of beneficiaries who did not meet Federal and State eligibility requirements and (2) did not always adequately document eligibility determinations. Of the 200 payments in our statistical sample, 16 payments totaling $874 (Federal share) were unallowable because the beneficiaries were ineligible for Medicaid. In addition, for 58 sampled payments totaling $10,699 (Federal share), the case files did not contain all documentation supporting eligibility determinations as required. As a result, for the 6-month audit period from January 1 through June 30, 2005, we estimated that the State agency made 4,217,888 payments totaling $230,375,748 (Federal share) on behalf of ineligible beneficiaries. We also estimated that case file documentation did not adequately support eligibility determinations for an additional 15,289,843 payments totaling $2,820,569,979 (Federal share). We did not recommend recovery primarily because, under Federal laws and regulations, a disallowance of Federal payments for Medicaid eligibility errors can occur only if the errors are detected through a State’s Medicaid eligibility quality control program. We recommended that the State agency use the results of this review to help ensure compliance with Federal and State Medicaid eligibility requirements. Specifically, the State agency should (1) reemphasize to beneficiaries the need to provide accurate and timely information and (2) require its district office employees to verify eligibility information and maintain appropriate documentation in its case files.

False Claims Act: Cabrini Medical Center (US Attorney Press Release)

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United States Attorney
Southern District of New York
FOR IMMEDIATE RELEASE
DECEMBER 6, 2005

UNITED STATES INTERVENES IN FALSE CLAIMS ACT LAWSUIT
AGAINST CABRINI MEDICAL CENTER ALLEGING ILLEGAL
MEDICAID PATIENT REFERRAL SCHEME

MICHAEL J. GARCIA, the United States Attorney for the Southern District of New York, announced today that on December 2, 2005, the Government filed a civil complaint against CABRINI MEDICAL CENTER (“CABRINI”). The complaint alleges that CABRINI entered into an illegal patient referral scheme with APPLIED CONSULTING, INC. (“CONSULTING”), and then falsely billed Medicaid for the care of these illegally-referred patients. CABRINI also allegedly billed Medicaid for alcohol and substance abuse detoxification treatment that it was not certified to provide.

Doctor Receiving TennCare Benefits?

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NASHVILLE – A Franklin County medical doctor has been charged with TennCare fraud. The Office of Inspector General (OIG) today arrested Dr. Floyd Brown, 54, an osteopathic specialist, of Estill Springs. He is charged with two counts of TennCare fraud for making false statements and concealing income information from TennCare. Read Press Release

Redding Cardiologists Agree to Pay Millions in Settlement

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Press Release from: McGregor W. Scott, United States Attorney, Eastern District of California

FOR IMMEDIATE RELEASE Contact: Patty Pontello, 916-554-2706
November 15, 2005

DOCTORS ACCUSED OF PERFORMING UNNECESSARY HEART SURGERIES AT REDDING MEDICAL CENTER AGREE TO PAY MILLIONS TO SETTLE FRAUD ALLEGATIONS AND ACCEPT RESTRICTIONS ON THEIR MEDICAL PRACTICE

  • The Agreement Preserves the Right to Revoke the Doctors’ Licenses and Exclude Them From the Medicare Program.

Flu Shot Fraud Indictment in Texas

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Press Release: US Dept of Justice, US Attorney, Southern District of Texas, Chuck Rosenberg

November 17, 2005

John Yembrick
Public Affairs Specialist
P. O. Box 61129 Houston, TX 77208
Phone: 713/567-9388 Fax: 713/718-3389
CONTACT US

GRAND JURY INDICTS TWO FOR FAKE FLU VACCINE

(HOUSTON, TX) – United States Attorney Chuck Rosenberg today announced the unsealing of a 14-count federal indictment charging Iyad Abu El Hawa, 35, of Houston, and Martha Denise Gonzales, 48, of Baytown, with conspiracy and tampering with a consumer product. These charges stem from an investigation into a scheme to administer fake flu vaccines at several Houston-area locations. The investigation began in October 2005 after the FBI received information that fake flu vaccines may have been given at a health fair sponsored by ExxonMobil for its Baytown refinery employees.

Texas Conviction of Physical Therapist

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Press Release: US Dept of Justice, US Attorney, Southern District of Texas, Chuck Rosenberg

November 17, 2005

John Yembrick
Public Affairs Specialist
P. O. Box 61129 Houston, TX 77208
Phone: 713/567-9388 Fax: 713/718-3389

(HOUSTON, TX) United States Attorney Chuck Rosenberg today announced the verdicts of a federal jury convicting Dr. Anant Mauskar, 72, of conspiracy to commit health care fraud and receiving kickbacks as a result of a scheme that cost Medicare and Medicaid health care benefit programs millions of dollars in losses due to fraudulent claims. Charged with a total of 24 counts of health care fraud in connection with Medicare and Medicaid claims for physical therapy services and durable medical equipment, Mauskar was convicted of 20 of those counts and acquitted of four.

Waging War on Prescription Drug Abuse: New Medco Analysis Reveals Prescription Drug Abusers Engage in Doctor Shopping and Script

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  • Half of all documented cases of prescription drug abuse and drug seeking (fraud) are aged 40-49 years old
  • Monthly drug costs nearly 7 times that of average patient
  • Medco deterrent program decreased abuse by 32 percent; costs by 20 percent

FRANKLIN LAKES, N.J., Sept. 29 /PRNewswire-FirstCall/ — A new data analysis released today by Medco Health Solutions, Inc. (NYSE: MHS) provides a striking profile of people who file excessive prescription claims for drugs of potential abuse and how their risky habits are bilking the healthcare system.

$2.5 Million Virginia Medicaid Fraud

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Press Release United States Attorney
Eastern District of Virginia

Paul J. McNulty, United States Attorney for the Eastern District of Virginia, announced that Darren Louis Stanford, age 32, of Richmond, Virginia, pled guilty today to one count of committing health care fraud and one count of possession with intent to distribute powder cocaine. Stanford faces a maximum sentence of ten years’ imprisonment, a $250,000 fine, and full restitution for the health care charge, and a maximum sentence of 20 years’ imprisonment and a $1 million fine for the drug charge when he is sentenced by United States District Court Judge Henry E. Hudson on October 28, 2005. The defendant was immediately remanded to the custody of the United States Marshals Service.

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