News and Commentary

Another Lupron Guilty Plea

News and Commentary | Fraud Cases | Kickbacks | Prescription Drug Fraud

November 15, 2004, Boston. Dr. John Romano, a urologist in Massachusetts pleaded guilty to fraud for charging Medicare and Medicaid for free samples of Lupron. Sentencing is scheduled for February 2005.

According to the US Attorney’s Office in Massachusetts, four other urologists have been sentenced in connection with this investigation. Dr. Joseph Olstein (Maine), Dr. Rodney Mannion (Indiana), Dr. Jacob Zamstein (Connecticut), and Dr. Joseph Spinella (Connecticut) pleaded guilty healthcare fraud. These doctors were sentenced to probation, in exchange for their help with the Lupron investigation, which resulted in a $1.2 million settlement from TAP Pharmaceutical.

Houston Couple Receive Huge Sentences

News and Commentary - Medicaid Fraud Costs Taxpayers Millions of Dollars

According to KPRC News, a Houston woman received a 67 year sentence for Medicaid fraud, while her husband received a 35 year sentence. See the news about a couple who used vans to recruit kids for free pizza parties and counseling. They did not provide the counseling, but they billed Medicaid at least $600,000 last year.

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The woman claims that she is in jail because of racism. “They know and I know it was a railroad deal, and I should not be (in a state women’s prison in Gatesville),” Dranetta Williams said.

Doctors Behind Bars: Treating Pain Is Now Risky Business

News and Commentary
Doctors Behind Bars: Treating Pain Is Now Risky Business - Dr. Frank Fisher’s ordeal lingers as a cautionary tale of what can happen to doctors who treat pain aggressively. [New York Times Healthcare News] This article is worth reading. Just because the data looks weird, it doesn’t mean that the doctor is a criminal. But interviewing patients, pharmacists and other

HIPAA and Employers

News and Commentary

Here’s a question I saw at the ACFE forums:

We’re a self-insured entity, so when it comes to insurance fraud, we’re ultimately the victim. Here’s an example: I get a tip regarding an employee who is allegedly committing fraud. Since we don’t directly administer the plan, I don’t have any records regarding the transactions. What could the plan administrator legally share with me in terms of documentation of the situation?

I thought non-ACFE people would be interested in my response:

One of HIPAAs purposes is to keep employers from having health information that could be used to discriminate against their employees. Here’s what you need to do to protect yourselves from healthcare fraud without running into problems with HIPAA:

Google Helps Solve Cases

News and Commentary
Google IDs 1993 hit-and-run victim - MOXEE, Washington (AP) — Google, the Internet search engine, has done something that law enforcement officials and their computer tools could not: Identify a man who died in an apparent hit-and-run accident 11 years ago in this small town outside Yakima. [CNN Technology]

While this is not about healthcare fraud, it shows that creative use of resources can help solve cases. One way of using Google to find fraud is to search for keywords related to illegal marketing practices. For example, you could search for “free chiropractic exams.” The first article I found was My Visit to a Straight Chiropractor, which is an excellent article about a visit to the chiropractor in response to a telemarketing call. It gives a great explanation of the kinds of scams we’re looking for.

Pittsburgh Dentist Gets 4 Years

News and Commentary | Dental Fraud Cases | Fraud Cases

Dr. Alan I. Aronowitz was sentenced this week to four years in jail and ordered to pay $200,000 in restitution to United Concordia insurance after pleading guilty to using unlicensed assistants to perform root canals.

Aronowitz’s lawyer had argued that white-collar criminals should not get jail time.

There’s an attitude that poor people should go to jail, but wealthy educated people should do community service.

“The lawyer is implying that fraud isn’t so bad,” says Robin Mathias, a healthcare fraud control specialist. “There’s an attitude in this country that if a mother steals to feed her kids and pay the rent, she should go to jail, but if a wealthy person steals to get a vacation home, that person should just do community service. This attitude increases healthcare fraud not only because perpetrators think they are unlikely to go to jail if caught, but also because they often convince themselves that what they’re doing isn’t wrong.”

Maine Urologist Receives Light Sentence for Lupron Scam

News and Commentary | Fraud Cases | Kickbacks | Medicare Fraud Cases | Physician Fraud Cases | Prescription Drug Fraud

Dr. Joseph Olstein helped the government get a $1.2 billion settlement from TAP Pharmaceutical and AstraZeneca. In return he received only a light sentence for his part in the scam. The US Attorney announced that Olstein was sentenced this week to one year probation and a $20,000 fine (in addition to a previous $50,000 restitution payment).

Dr. Olstein pleaded guilty in 2001 to billing insurance companies for free samples of Lupron, which he received from TAP sales people. Lupron is an injectible drug used for treating prostate cancer. Physicians can bill Medicare and other insurers for injectible drugs. Because the free samples were given as a way for physicians to enhance their income, the samples are considered a kick-back. Without the kickbacks that TAP offered to urologists, an equivalent drug that is cheaper than Lupron would probably have been prescribed.

$4.7 Million Injectable Drug Fraud in Florida

News and Commentary | Fraud Cases | Medicaid Fraud Cases | Prescription Drug Fraud

Two owners of a South Florida treatment center for infectious diseases, a physician at the center and a nurse who served as its administrator, were arrested for their roles in a costly Medicaid fraud scheme, according to an October 1, 2004 press release from the Florida Attorney General. The scheme involved billing for prescriptions for medications that were never dispensed and the creation of false medical records to conceal the doctor’s absence from patient treatment and office supervision. Medicaid investigators seized over $1.6 million in illegally purchased assets, including a 40-foot boat, an ocean-view condominium, and a Cadillac SUV.

Texas Celebrates Losing Battle

News and Commentary | Healthcare Policy and Technology
September 2004 Texas announced that they had increased Medicaid Fraud Control Unit (MFCU) staff from 36 to 110, and expect to increase to at least 200 by the end of fiscal year 2005. In FY 2004 the MFCU doubled the number of cases it opened, the number of cases presented for prosecution and the number of cases in which criminal charges were filed. Identification of illegal overpayments made to fraudulent operators has increased by 85 percent to over $27 million. Last month the U.S. Department of Health and Human Services recognized Texas by awarding them the annual Inspector General’s State Fraud Award.

Greedy Dentists Busted in California

News and Commentary | Dental Fraud Cases | Fraud Cases | Kickbacks | Medicaid Fraud Cases

“It’s all about the money,” was the operating creed of Hatch Dental, as described in a 42-count felony complaint filed by California Attorney General Bill Lockyer on September 22, 2004. The complaint describes how 20 defendants affiliated with three Hatch Dental clinics let greed rule their practice at the expense of patient health and safety.

In spring of 2002, when Brian Kanarek, DDS asked defendant Kyon Maung Teo (the alleged ringleader) why he over-diagnosed treatment, Teo told him, “Something has to pay for this practice.” After Kanarek diagnosed only 2 fillings for a patient whom Teo diagnosed 26, Teo told him to leave Hatch Dental “and don’t come back.”

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