Health Care Fraud

A Bala Cynwyd man told a federal judge yesterday that he stole almost $400,000 from Independence Blue Cross to prop up a financially struggling athletic club that he owned with his son-in-law. "It didn't do as well as I thought . . . and I guess I lost my mental control and tried to make up for it, and I did that by cheating," Mark Levin said, adding that he never took the money for himself but plowed it back into the gym. U.S. District Judge Gene E.K. Pratter sentenced Levin, 65, to a year and a day in prison and ordered him to make restitution of $399,883 to IBC. (Advisory sentencing guidelines called for 24 to 30 months behind bars.

The federal government is gaining ground in the battle against people who commit health-care fraud, recovering nearly $8 billion dollars over the past two years, Attorney General Eric Holder told a health-care forum yesterday in Philadelphia. He said that of that amount - recovered in judgments, settlements, fines, restitutions and forfeitures - about a quarter of it has been collected in the Philadelphia area. Holder and Health and Human Services Secretary Kathleen Sebelius addressed a summit on health-care fraud at the University of the Sciences as part of a series the government is holding nationwide.

Five nurses who worked for a Philadelphia hospice service were arrested by FBI agents today after being indicted for conspiring to defraud Medicare of millions of dollars. Between 2005 and 2008, Patricia McGill, professional services director at Home Care Hospice and a registered nurse, "allegedly authorized and supervised the admission of inappropriate and ineligible patients for hospice services, resulting in approximately $9.32 million in fraudulent claims," the U.S. Attorney's Office said.

The United States spends about $2.6 trillion per year on health care, or about 17.4 percent of our gross domestic product - more than most developed nations without correspondingly good results. The Justice Department has increased prosecution of health-care fraud, which can physically harm patients and fiscally injure taxpayers, against individuals or multinational companies. Philadelphia is a center for that fight because there are many health-care companies in the area.

A Philadelphia man pleaded guilty to submitting $1.5 million worth of claims for chiropractic treatments to Independence Blue Cross, Zane David Memeger. U.S. Attorney in Philadelphia, said. Prosecutors said that in 2009, Tahib Smith Ali, 35, posed as a chiropractor and physical therapist while operating a Philadelphia clinic known as Oasis Holistic Healing Village on South 17th Street in Center City and submitted claims under the name and medical provider number who no longer worked at the clinic.

In an era when pharmaceutical executives - like their brethren in banking - are under fire for paying fines too often instead of going to prison to settle allegations of wrongdoing, health care fraud investigations returned $4.2 billion to the nation's coffers last year, the U.S. government said Monday. For every $1 spent on investigations, the government got back $7.90 over the last three years, which is $2.50 higher than the rolling three-year average since the Health Care Fraud and Abuse Control Program began in 1997, according to a joint report released by the Department of Justice and Department of Health and Human Services.

A SUMMERDALE MAN who posed as a chiropractor and a physical therapist and treated patients as part of an elaborate health-care fraud scheme was sentenced to six years in federal prison Thursday. Tahib Smith Ali, 35, is to surrender to the Bureau of Prisons as soon as he gets a report date, U.S. District Judge Mitchell Goldberg said. The judge also ordered Ali to make restitution of $287,972, which includes co-pays that Ali allegedly charged to 86 patients. Ali, who was not licensed and had no medical training, purchased the Oasis Holistic Healing Village, on 17th Street near Spruce, in December 2008 from Dr. Paul Bodhise, a licensed chiropractor who was retiring and moving to California.

Zane David Memeger marked the end of his first year as U.S. attorney for Eastern Pennsylvania by gathering 67 people Friday to discuss how to combat health-care fraud. Attendees came from the federal government, but also from state and local agencies. Health-care companies and insurers had members on hand for the event in Philadelphia. "Health-care costs continue to rise as the public demands more health care," Memeger said. "While most health-care providers play by the rules, the reality is that more taxpayer dollars are lost each year to abuse.

Though he can explain it in calm, rational terms, James Sheehan said it still feels odd to be unemployed after 31 years of public service. In July, Sheehan, 59, arguably the nation's best known prosecutor of health-care fraud and the longtime former civil-division chief with the U.S. Attorney's Office in Philadelphia, was asked by New York Gov. Andrew Cuomo to resign his most recent position as New York Medicaid Inspector General. As he did in Philadelphia, Sheehan created headlines in New York with highly publicized probes and settlements, recovering more than $1.2 billion in improper Medicaid payments in his four years there and avoiding paying $2 billion more.

WASHINGTON - The Obama administration is upping the ante in the fight against health-care fraud, joining forces with private insurers and state investigators on a scale not previously seen in an attempt to stanch tens of billions of dollars in losses. Announcing the new public-private partnership Thursday, Health and Human Services Secretary Kathleen Sebelius said it "puts criminals on notice that we will find them and stop them. " Fraud is an endemic problem plaguing entitlement programs like Medicare and Medicaid as well as private insurance companies.

NEWARK, N.J. - A North Jersey cardiologist has admitted taking part in a scheme that subjected thousands of patients to unnecessary tests and treatment and resulted in $19 million in bogus bills, authorities said. Jose Katz, 68, of Closter, pleaded guilty Wednesday in federal court to conspiracy to commit health-care fraud and an unrelated count of Social Security fraud for giving his wife a years-long no-show job, making her eligible for Social Security. Katz, 68, was the founder and chief executive of Cardio-Med Services L.L.C., which had offices in Union City, Paterson, and West New York, and Comprehensive Healthcare & Medical Services, which had offices in Manhattan and Queens, N.Y. Katz, who is free on bail, is scheduled to be sentenced July 23. The health-care fraud charge carries a maximum penalty of 10 years in prison.

In the Region Guilty pleas in Medicare fraud   Two brothers who operated a Feasterville ambulance company, MedEx Ambulance Inc. , pleaded guilty to overcharging Medicare by $2.5 million for the transport of kidney patients to dialysis who could have gotten there safely by other means, United States Attorney Zane David Memeger announced. The brothers, Aleksandr N. Zagorodny and Sergey Zagorodny, pleaded guilty to all charges in a 41-count indictment charging them with health-care fraud, making false statements in connection with health-care matters, wire fraud, and conspiracy to commit health-care fraud and wire fraud, the prosecutor's office said.

A pair of brothers who operated a fleet of ambulances in Bucks Co. pleaded guilty today in defrauding taxpayers of more than $2.6 million. Aleksandr N. Zagorodny and Sergey Zagorodny operated the Feasterville-based MedEx Ambulance Inc. from 2007 through 2012. Federal prosecutors said the Zagorodny brothers ran their seven ambulances like a fleet of taxis, unnecessarily transporting patients who they knew were able to walk and then submitting false claims to Medicare and Medicaid.

Two brothers who operated a Feasterville ambulance company, MedEx Ambulance Inc., pleaded guilty to overcharging Medicare by $2.5 million for the transport of kidney patients to dialysis who could have gotten there safely by other means, United States Attorney Zane David Memeger announced Tuesday. The brothers, Aleksandr N. Zagorodny and Sergey Zagorodny, pleaded guilty to all charges in a 41-count indictment charging them with health care fraud, false statements in connection with health care matters, wire fraud, and conspiracy to commit health care fraud and wire fraud, the prosecutor's office said.

By Rebecca Nurick Perpetrators of Medicare and Medicaid fraud are clever and creative - and often quite successful: Every year, scams cost taxpayers about $65 billion. In recent years, the federal government has invested in programs to prevent Medicare fraud, and to make the criminals who commit it pay, both in fines and jail time. In particular, the Affordable Care Act will provide increased resources to fight these crimes. Beefed-up task forces have caught thieves around the country who have engaged in identity theft, billed for services not provided, or even performed unnecessary medical procedures.

If the automatic federal budget cuts kick in Friday, patients and pharmaceutical companies - and the authorities paid to protect the first group and watch over the second - could be affected both soon and over time. Evaluations of drugs and medical devices might take longer as the Food and Drug Administration curtails operations. Patients might not get some medicine. Philadelphia International Airport handles shipments of products and executives in the globalized drug business, so customs inspections, screening of passengers, and air traffic control might delay delivery of both.

In TV ads, the Scooter Store suggests to seniors and others needing motorized scooters and wheelchairs that they can be had for almost no cost because the company will handle all the messy paperwork with insurers, particularly Medicare. Wednesday and Thursday brought another example that nothing is free. Somebody - often taxpayers - has to pay. About 150 state and federal law enforcement officers raided the company's headquarters in a San Antonio suburb. The action was another phase in an ongoing health-care fraud investigation of the Scooter Store, which has an outlet in the Philadelphia region.

In an era when pharmaceutical executives - like their brethren in banking - are under fire for paying fines too often instead of going to prison to settle allegations of wrongdoing, health care fraud investigations returned $4.2 billion to the nation's coffers last year, the U.S. government said Monday. For every $1 spent on investigations, the government got back $7.90 over the last three years, which is $2.50 higher than the rolling three-year average since the Health Care Fraud and Abuse Control Program began in 1997, according to a joint report released by the Department of Justice and Department of Health and Human Services.

A SUMMERDALE MAN who posed as a chiropractor and a physical therapist and treated patients as part of an elaborate health-care fraud scheme was sentenced to six years in federal prison Thursday. Tahib Smith Ali, 35, is to surrender to the Bureau of Prisons as soon as he gets a report date, U.S. District Judge Mitchell Goldberg said. The judge also ordered Ali to make restitution of $287,972, which includes co-pays that Ali allegedly charged to 86 patients. Ali, who was not licensed and had no medical training, purchased the Oasis Holistic Healing Village, on 17th Street near Spruce, in December 2008 from Dr. Paul Bodhise, a licensed chiropractor who was retiring and moving to California.

Two brothers who owned a Bucks County ambulance company were indicted Wednesday on 41 counts of health-care fraud and other charges, officials said. The charges were the latest in a string of prosecutions targeting health-care fraud in the region. Aleksandr N. and Sergey Zagorodny operated MedEx Ambulance in Feasterville with four emergency vehicles. Beginning in 2004, MedEx falsified reports on its Medicare claims stating it transported patients who could not walk or travel by other means.