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2023 National Health Care Fraud Enforcement Action

Case Summaries

DOJ Announces Nationwide Coordinated Law Enforcement Action to Combat Health Care Fraud and Opioid Abuse

June 28, 2023

Summary of Criminal Charges

Central District of California

  • Neda Mehrabani, 47, of Tarzana, California, was charged by information with health care fraud in connection with an alleged scheme to fraudulently obtain over $3.3 million in Medicare funds.  According to the information, Mehrabani, a licensed chiropractor and acupuncturist and owner of Health Clinic of Southern California, caused the submission of false and fraudulent claims to Medicare for chiropractic services that were medically unnecessary, not provided as represented, or not rendered.  The case is being prosecuted by Trial Attorney Alexandra Michael of the Los Angeles Strike Force.
     

Middle District of Florida

  • Joelson Viveros, 43, of Boca Raton, Florida, was charged by information with conspiracy to defraud the United States and to pay and receive health care kickbacks in connection with an alleged $3 million kickback scheme involving pharmacies in multiple states.  As alleged in the information, Viveros invested in South Bend Specialty Pharmacy (“SBSP”), which was part of a network of pharmacies controlled by co-conspirators, and operated a call center where telemarketers persuaded Medicare beneficiaries to accept prescriptions for expensive medications, primarily topical pain creams, which the beneficiaries neither needed nor wanted.  Viveros allegedly obtained signed prescriptions by paying kickbacks to two telemedicine companies.  Through two companies he controlled, Viveros was allegedly paid kickbacks from SBSP and other pharmacies in the network in exchange for supplying signed prescriptions for the medications.  The case is being prosecuted by Trial Attorney Gary Winters of the National Rapid Response Strike Force and Assistant U.S. Attorney David Mesrobian of the U.S. Attorney’s Office for the Middle District of Florida.
     
  • Tommy Louisville, 70, of Pembroke Pines, Florida was charged by indictment with wire fraud in connection with $33,034 he obtained from a COVID-19 relief program.  As alleged in the indictment, Louisville, the owner of First Help Urgent Care Clinic, a shuttered opioid addiction treatment center, misappropriated funds from the Paycheck Protection Program and submitted a false loan application to the Small Business Administration, rather than use the funds for COVID-19 patient care and to support small businesses experiencing disruption due to the COVID-19 pandemic, as required.  The case is being prosecuted by Assistant U.S. Attorney Greg Pizzo of the U.S. Attorney’s Office for the Middle District of Florida.
     
  • Steven Parker, 69, of Prosper, Texas, was charged by information with conspiracy to solicit and receive kickbacks and bribes in connection with an alleged multi-million dollar kickback scheme involving DME front companies in Pinellas County, Florida.  As alleged in the information, Parker owned and operated Unique Media Connections (“UMC”) and often operated UMC under the fictitious name Media Lead Kings (“MLK”).  Parker allegedly utilized MLK to purchase completed and signed doctors’ orders for DME for federal health care program beneficiaries.  Parker then utilized UMC to solicit and receive kickbacks and bribes from DME front companies in Pinellas County, Florida, in exchange for selling the completed and signed doctors’ orders to them.  Parker allegedly received $14,355,000 in kickbacks and bribes for reselling the completed and signed doctors’ orders.  The DME front companies allegedly used the completed doctors’ orders purchased from Parker to submit false and fraudulent claims for payment to federal health care programs, including Medicare.  As a result, Medicare paid the DME front companies in Pinellas County over $37 million.  The case is being prosecuted by Assistant U.S. Attorney Tiffany E. Fields of the U.S. Attorney’s Office for the Middle District of Florida.
     

Southern District of Florida

  • Brett Blackman, 39, of Johnson County, Kansas, Gary Cox, 77, of Maricopa County, Arizona, and Gregory Schreck, 49, of Johnson County, Kansas, were charged by indictment with conspiracy to commit health care fraud and wire fraud, conspiracy to pay and receive kickbacks, and conspiracy to defraud the United States and make false statements, in connection with the submission of $1.9 billion in false and fraudulent claims to Medicare and other government insurers for orthotic braces, prescription skin creams, and other items that were medically unnecessary and ineligible for Medicare reimbursement.  As alleged in the indictment, Blackman, Cox, and Schreck owned, controlled, or operated DMERx, which was an internet-based platform that the defendants programmed to generate false and fraudulent doctors’ orders in exchange for illegal kickbacks and bribes.  Cox was the CEO of the company that operated DMERx prior to a corporate acquisition, and Blackman was the CEO and Schreck a Vice President of the company that operated it after the acquisition.  The defendants are alleged to have offered to connect pharmacies, durable medical equipment (“DME”) suppliers, and marketers to telemedicine companies who would accept illegal kickbacks and bribes in exchange for orders that were transmitted using the DMERx platform.  The defendants allegedly received payments for coordinating these illegal kickback transactions and referring the completed doctors’ orders to the DME suppliers, pharmacies, and telemarketers that paid for them.  The fraudulent orders and prescriptions generated by DMERx falsely represented that doctors had examined and treated the Medicare beneficiaries when in reality, purported telemedicine companies paid doctors to sign these orders and prescriptions without regard to medical necessity and based on a brief telephone call with the beneficiary or sometimes no interaction with the beneficiary at all.  In order to conceal and disguise the scheme, and obstruct investigations by Medicare and its contractors, the defendants allegedly removed references to telemedicine in the orders. The DME supply companies and pharmacies that paid illegal kickbacks in exchange for these orders and prescriptions generated through DMERx billed Medicare more than $1,963,000,000 in false and fraudulent claims.  The case is being prosecuted by Trial Attorneys Darren C. Halverson of the National Rapid Response Strike Force and Andrea Savdie of the Miami Strike Force.
     
  • Lazaro Hernandez, 52, of Miami, Florida, was sentenced on June 15, 2023, to 15 years in prison after pleading guilty to conspiracy to defraud the United States and to introduce into interstate commerce adulterated and misbranded drugs and conspiracy to commit money laundering, in connection with a nationwide scheme to unlawfully distribute more than $230 million in diverted, adulterated, and misbranded medications, including HIV drugs.  According to court documents, Hernandez and his co-conspirators illegally acquired large quantities of prescription drugs from patients for whom the drugs had been prescribed but intentionally not consumed.  Hernandez and his co-conspirators then sold the diverted drugs to pharmacies across the country.  The diverted drugs were accompanied by false pedigrees to conceal their true origin.  In at least several instances, the diverted HIV medication that Hernandez sold consisted of bottles containing the wrong medication, broken pills, and even pebbles, leading to complaints by pharmacies.  Hernandez and his co-conspirators then laundered the proceeds of these illegal sales.  Hernandez also used his share of the proceeds to purchase luxury goods, including a $280,000 Lamborghini, a $220,000 Mercedes, and three boats.  The case is being prosecuted by Trial Attorney Alexander Thor Pogozelski of the Miami Strike Force and Assistant U.S. Attorney Timothy J. Abraham of the U.S. Attorney’s Office for the Southern District of Florida.
     
  • Armando Herrera, 42, of Miami, Florida, was charged by information with one count of conspiracy to introduce adulterated and misbranded drugs into interstate commerce in connection with a nationwide scheme to unlawfully distribute adulterated and misbranded prescription medications, including HIV medications, valued at more than $16.7 million.  As alleged in the information, Herrera and his co-conspirators illegally acquired these prescription medications through fraud or from individual patients for whom the prescription medications had been prescribed.  The information alleges that these medications were then repackaged and resold with false labeling and documentation to conceal their true origin.  It further alleges that, in some instances, the prescription medications Herrera distributed contained the wrong medication.  The case is being prosecuted by Trial Attorney Alexander Thor Pogozelski of the Miami Strike Force.
     
  • Reginal N. Vines, 47, of Tuscaloosa, Alabama, was charged by indictment with conspiracy to commit health care fraud and wire fraud, health care fraud, conspiracy to defraud the United States and to pay and receive health care kickbacks, and receiving health care kickbacks, in connection with his role in selling doctors’ orders for medically unnecessary genetic tests to several laboratories. Vines obtained the orders by paying kickbacks and bribes to a doctor in exchange for the doctor signing prescriptions for genetic tests, without ever meeting or treating the Medicare beneficiaries for whom the tests were orders.  In some instances, Vines allegedly forged the doctor’s signature on the prescriptions.  The indictment alleges that the laboratories billed Medicare approximately $10 million for medically unnecessary genetic tests, of which Medicare paid $2.9 million.  The case is being prosecuted by Trial Attorney Reginald Cuyler Jr. of the Miami Strike Force.
     
  • Yosbel Roque Rubier, 43, of Miami, Florida, was charged by indictment with health care fraud and aggravated identity theft in connection with an alleged scheme to defraud Medicare of approximately $900,000 for durable medical equipment that was never supplied to Medicare beneficiaries.  As alleged in the indictment, Rubier was the owner and operator of FCM Supply LLC (“FCM”), a clinic in Greenacres, Florida, that purported to provide DME to eligible Medicare beneficiaries.  In a four-month period, FCM submitted approximately $900,000 in allegedly fraudulent health care claims to Medicare for DME that FCM never provided, and that Medicare beneficiaries never requested or needed.  To support these fraudulent claims, Rubier used stolen means of identification of medical providers.  As a result, Medicare paid approximately $443,000 to FCM.  The case is being prosecuted by Assistant U.S. Attorney Shannon Shaw of the U.S. Attorney’s Office for the Southern District of Florida. 
     
  • Jesus Enrique Moreno, 48, of Miami, Florida, was charged by information with unlicensed money transmitting for transmitting health care fraud proceeds between December 2020 and February 2021.  The case is being prosecuted by Assistant U.S. Attorney Timothy J. Abraham of the U.S. Attorney’s Office for the Southern District of Florida. 
     
  • Tania Cesar, 55, of Hialeah, Florida, was charged by indictment with conspiracy to commit health care fraud in connection with an alleged scheme to defraud health care plans managed by Blue Cross Blue Shield (“BCBS”).  As alleged in the indictment, Cesar was a licensed physical therapist assistant at Elite Therapy Group, Inc (“Elite Therapy”), a physical therapy clinic in Miami, Florida.  Cesar signed patient therapy records misrepresenting that she had provided physical therapy to insurance beneficiaries when, in fact, she had not.  Cesar’s co-conspirators at Elite Therapy, who were previously convicted for the Elite Therapy conspiracy in United States v. Wated et al., No. 21-cr-20110-MGC, submitted millions of dollars in claims to BCBS for physical therapy that Cesar purported to provide, but never did.  The case is being prosecuted by Assistant U.S. Attorney Joseph Egozi of the U.S. Attorney’s Office for the Southern District of Florida.  Assistant U.S. Attorney Joshua Paster of the U.S. Attorney’s Office for the Southern District of Florida is handling the asset forfeiture.
     
  • Arian Bernal, 43, of Hialeah, Florida, was charged by information with conspiracy to commit health care fraud in connection with an alleged scheme to defraud health care plans managed by BCBS.  As alleged in the information, Bernal paid kickbacks to beneficiaries to recruit them to visit several Miami clinics so that his co-conspirators could submit claims to those beneficiaries’ insurance plans managed by BCBS.  Those claims fraudulently represented that various health care benefits and services were medically necessary and provided to patients.  As a result of Bernal’s conduct, BCBS paid the Clinics nearly $250,000.  The case is being prosecuted by Assistant U.S. Attorney Joseph Egozi of the U.S. Attorney’s Office for the Southern District of Florida.  Assistant U.S. Attorney Joshua Paster of the U.S. Attorney’s Office for the Southern District of Florida is handling the asset forfeiture.
     
  • Silvana Perez, 44, of Miami, Florida, was charged by information with conspiracy to commit health care fraud in connection with an alleged scheme to defraud health care plans managed by BCBS.  As alleged in the information, Perez paid kickbacks to beneficiaries to recruit them to visit a sleep study clinic so that her co-conspirators could submit claims to those beneficiaries’ ASO insurance plans managed by BCBS.  Those claims fraudulently represented that various health care benefits and services were medically necessary and provided to patients.  As a result of Perez’s conduct, BCBS paid the Clinics over $550,000.  The case is being prosecuted by Assistant U.S. Attorney Joseph Egozi of the U.S. Attorney’s Office for the Southern District of Florida.  Assistant U.S. Attorney Joshua Paster of the U.S. Attorney’s Office for the Southern District of Florida is handling the asset forfeiture.
     
  • Ariel Gonzalez, 54, of Naples, Florida, and Linda Taylor, 55, of Miami, Florida, were charged by indictment for their roles in an alleged health care fraudulent billing scheme, along with several others who were previously charged in a separate indictment and have since pleaded guilty. According to the indictment, Gonzalez was one of the owners of Phoenix Rehab Center Corp., a physical therapy clinic based in Miami that offered and paid kickbacks to patient recruiters, including Taylor, in exchange for referring beneficiaries of Administrative Services Only corporate insurance plans held by employers JetBlue Airways and AT&T Inc. and administered by BCBS to Phoenix Rehab for various forms of physical therapy treatments that they did not need and in many cases never received.  The indictment further alleges that Gonzalez provided funding to Phoenix Rehab to further the fraud, including by taking out a loan to obtain sufficient cash to pay kickbacks to patient recruiters and beneficiaries.  The cases are being prosecuted by Assistant U.S. Attorney Will J. Rosenzweig of the U.S. Attorney’s Office for the Southern District of Florida.
     
  • Carlos Jose Martin Gomez, 36, of Miami, Florida, was charged by indictment for his role in an alleged health care fraudulent billing conspiracy in conjunction with Arisleidys Fernandez Delmas, 32, of Miami, Florida, and several others who were previously charged in separate indictments.  The scheme involved several fraudulent physical therapy clinics that targeted Administrative Services Only corporate insurance plans held by employers JetBlue Airways, AT&T Inc., and TJX Companies Inc. and administered by BCBS.  Martin Gomez was also charged with five counts of health care fraud related to five clinics involved in the larger conspiracy.  According to the indictment, Martin Gomez offered and paid kickbacks and bribes to patient recruiters for referring beneficiaries to the clinics and directly to beneficiaries of these insurance plans in exchange for allowing the clinics to bill these plans for various forms of physical therapy treatments purportedly provided to these beneficiaries that they did not need and in many cases never received.  The cases are being prosecuted by Assistant U.S. Attorney Will J. Rosenzweig of the U.S. Attorney’s Office for the Southern District of Florida.
     
  • Adrian Lazo, 45, of Miami, Florida, was charged by indictment with laundering health care fraud proceeds by depositing a $3,303,974 check from the Centers for Medicare and Medicaid Services to YG Medical Supplies Inc. in October 2021.  The Indictment alleges that Lazo conspired with others to deposit the check for the purpose of concealing, among other things, the nature, source, and ownership of those funds.  The case is being prosecuted by Assistant U.S. Attorney Will J. Rosenzweig of the U.S. Attorney’s Office for the Southern District of Florida.

Southern District of Georgia

  • Christopher Ciani, 40, of Land O’Lakes, Florida, was charged by information with conspiracy to defraud the United States and pay and receive kickbacks in connection with the purchase and sale of doctors’ orders for cancer genomic and pharmacogenetic testing in exchange for illegal kickbacks and bribes.  As alleged in the information, Ciani brokered relationships between laboratories and various marketing groups that recruited Medicare beneficiaries and sent doctors’ orders and specimens for genetic testing to the laboratories in exchange for approximately $1.4 million in illegal kickbacks and bribes.  The case is being prosecuted by Acting Assistant Chief Brynn Schiess of the Dallas Strike Force and Assistant U.S. Attorney Ryan Grover of the Southern District of Georgia.

District of Idaho

  • Angela Kathryn Hughes, 49, and Sydney L. Neal, 37, both of Boise, Idaho, were charged by indictment with conspiracy to distribute controlled substances and distribution of controlled substances.  As alleged in the indictment, Hughes, a nurse practitioner, routinely prescribed various Schedule II controlled substances to her patients and other individuals knowing and intending that the distribution was outside the scope of professional practice and not for a legitimate medical purpose.  Hughes and Neal, Hughes’ patient and medical assistant, allegedly conspired to distribute oxycodone, oxycodone/acetaminophen, and hydrocodone/acetaminophen.  In addition, Hughes allegedly distributed hydrocodone acetaminophen to Neal on two occasions and oxycodone to another person on a third occasion.  The case is being prosecuted by Assistant U.S. Attorneys Darci Crane and Erin Blackadar of the U.S. Attorney’s Office for the District of Idaho.
     

Western District of Kentucky

  • Stephen Troy Wilmoth, 45, and Ashley Ramsey-Wilmoth, 41, of Hodgenville, Kentucky, were charged by information with conspiracy to commit theft of medical products and conspiracy to unlawfully distribute controlled substances.  As charged in the information, Wilmoth and Ramsey-Wilmoth conspired to take, carry away, and conceal, and knowingly possess, transport, and traffic oxycodone and hydrocodone; and conspired to sell and trade the oxycodone and hydrocodone.  Ramsey-Wilmoth, a pharmacy technician at Century Medicines, a retail pharmacy, took, carried away, and concealed unopened bottles of oxycodone and hydrocodone from Century Medicines prior to the controlled substances being made available for retail purchase by a consumer and provided them to her husband, Wilmoth, to sell and distribute.  The case is being prosecuted by Assistant U.S. Attorney Joe Ansari of the U.S. Attorney’s Office for the Western District of Kentucky.
     

Eastern District of Louisiana

  • Craig Lovelace, 53, of Destrehan, Louisiana, was charged by information with health care fraud in connection with an alleged scheme to defraud Medicare and Medicaid by Advanced Medical Equipment, Inc. (“AME”), a DME supply company in Kenner, Louisiana, that he owned and operated.  As alleged in the information, Lovelace, through AME, billed Medicare and Medicaid approximately $11.4 million for respiratory support and nutritional support DME, including ventilators, tracheostomy supplies, and feeding tubes, that were not medically necessary or not provided as represented, and for which AME was paid approximately $7.96 million.  In response to audits and record requests, Lovelace allegedly directed the forgery of medical records, order forms, and provider signatures to cover up the scheme.  The case is being prosecuted by Trial Attorney Kelly Z. Walters of the Gulf Coast Strike Force and Assistant U.S. Attorney Nicholas Moses of the U.S. Attorney’s Office for the Eastern District of Louisiana.
     

Eastern District of Michigan

  • Melanie Davis, 44, of Sterling Heights, Michigan, was charged by information with health care fraud in connection with an approximately $660,000 scheme to defraud Medicare.  As alleged in the information, Davis, the owner and operator of Michigan Adult Services 1 LLC, an adult day care center in Detroit, fraudulently billed Medicare for psychotherapy services that were medically unnecessary or not rendered.  The case is being prosecuted by Trial Attorneys Andres Almendarez and Shankar Ramamurthy of the Detroit Strike Force.
     

District of New Jersey

  • Steven Diamantstein, 36, of Brooklyn, New York, was charged by indictment with conspiracy to introduce misbranded drugs into interstate commerce and to defraud the United States, conspiracy to commit wire fraud, and conspiracy to traffic in pre-retail medical products with false documentation.  Diamantstein was an owner and corporate officer of Scripts Wholesale, Inc., a wholesale distributor of pharmaceutical products.  According to the indictment, Diamantstein and others purchased at least $150 million worth of diverted prescription medications, including HIV medications, from various suppliers that were obtained primarily through unlawful “buyback” schemes in which previously dispensed bottles of prescription drugs were purchased in cash from patient, many of whom were HIV patients.  The indictment further alleges that Diamantstein and others falsified, and caused to be falsified, pedigrees and other labeling to make it appear as though the diverted prescription medications had been properly acquired through legitimate and regulated channels of distribution and from authorized distributors.  The case is being prosecuted by Trial Attorneys Chris Wenger of the National Rapid Response Strike Force and Nicholas Peone of the Newark Strike Force.
     
  • Devon Burt, 50, of Blue Bell, Pennsylvania, and Hallum Gelzer, 44, of Enola, Pennsylvania, were each charged by separate informations with conspiracy to commit health care fraud and conspiracy to commit extortion in connection with a scheme to pay cash to Amtrak employees in exchange for their insurance information.  As alleged in the informations, Burt, a former Amtrak employee, and Gelzer recruited Amtrak employees to participate in a health care fraud scheme through the offer of cash payments, in exchange for the employees allowing health care providers to use their patient and insurance information to submit false and fraudulent claims.  Burt and Gelzer allegedly received cash payments from health care providers in return for recruiting others to participate in the scheme.  Burt also allegedly received cash payments from providers in exchange for allowing the providers to use his personal and insurance information, and that of his dependents, to submit false and fraudulent claims.  The informations also allege that Burt and Gelzer threatened a health care provider who participated in the scheme by interstate telephone calls and text messages, indicating that the provider would be injured if the provider did not pay Gelzer several thousand dollars.  The cases are being prosecuted by Assistant U.S. Attorney Katherine Romano of the U.S. Attorney’s Office for the District of New Jersey.
     

Eastern District of New York

  • Jian Ai Chen, a/k/a Maggie, 48, of Syosset, New York, was charged by indictment with conspiracy to commit health care fraud and conspiracy to pay health care kickbacks in connection with an alleged scheme to pay over $5 million in kickbacks to Medicare and Medicaid beneficiaries in exchange for bringing their prescriptions to AC Pharmacy Corp. and A Star Pharmacy Inc., both in Brooklyn, New York.  As alleged in the indictment, Chen, an owner of the pharmacies, agreed with others to submit false and fraudulent claims to Medicare and Medicaid plans for dispensing prescription medications that were induced by the payment of kickbacks and not actually dispensed.  Chen’s pharmacies received approximately $101 million as a result of the scheme.  The case is being prosecuted by Trial Attorney Andrew Estes of the Brooklyn Strike Force. 
     
  • Manling Shen, a/k/a Mary Shen, 64, and Ruibing Zhu, a/k/a Bing Bing, 53, both of Flushing, New York, were charged by superseding indictment in connection with an alleged scheme to defraud Medicaid of over $8.3 million by submitting false and fraudulent claims for social adult day care services that were not provided and were induced by the payment of kickbacks and bribes.  Shen was charged with paying kickbacks and bribes and health care fraud, in addition to previously being charged with conspiracy to commit health care fraud and conspiracy to pay health care kickbacks; and Zhu was charged with conspiracy to pay kickbacks, paying kickbacks, and tampering with evidence.  As alleged in the indictment, Shen and Zhu, employees of Blue Sky Adult Day Care Inc. (“Blue Sky”), located in Flushing, New York, paid cash kickbacks to individuals who were enrolled, but often did not attend, social adult day care services at Blue Sky, and Shen submitted or caused the submission of claims for those services that were not provided.  During the execution of a search warrant at Blue Sky, Zhu fled the scene with cash used to pay kickbacks and bribes.  The case is being prosecuted by Trial Attorney Patrick J. Campbell of the Brooklyn Strike Force.
     
  • Carlo Elomina Garcia, 51, of Astoria, New York, was charged by criminal complaint with health care fraud in connection with over $1.6 million he obtained for purported occupational therapy services.  Garcia, the owner and operator of Carlo E. Garcia Occupational Therapy, P.C., allegedly billed Medicare and Medicaid for services that were not eligible for reimbursement, were not provided as billed, or were never provided, including repeatedly billing for over 24 hours of one-on-one occupational therapy services in a single day.  The case is being prosecuted by Assistant U.S. Attorney John Vagelatos of the U.S. Attorney’s Office for the Eastern District of New York.
     

Middle District of Louisiana

  • Billy Baker, 41, of Louisville, Kentucky, was charged by information with conspiracy to pay and receive kickbacks in connection with an alleged scheme to pay and receive kickbacks for the referral of diagnostic testing services, including cancer genetic testing, that resulted in the submission of over $20 million in fraudulent claims to Medicare.  As alleged in the information, Baker conspired with the owners of Acadian Diagnostic Laboratories, LLC, and Specialty Drug Testing, LLC, to refer specimens for medically unnecessary testing in exchange for a percentage of the reimbursements that Medicare and other insurers paid.  Baker allegedly received over $2.4 million in kickbacks from the scheme.  The case is being prosecuted by Trial Attorney Samantha Stagias of the Gulf Coast Strike Force and Assistant U.S. Attorney Kristen Craig of the U.S. Attorney’s Office for the Middle District of Louisiana.
     

Southern District of Ohio

  • Gulam Mukhdomi, 69, and Abida Mukhdomi, 71, both of Phoenix, Arizona, were charged by indictment with conspiracy to unlawfully distribute and dispense controlled substances, unlawful distribution of controlled substances, conspiracy to commit health care fraud, health care fraud, and false statements relating to health care matters, in connection with the unlawful distribution of controlled substances.  Abida Mukhdomi is also charged with unlawful distribution and dispensing of a controlled substance resulting in death.  As alleged in the indictment, the Mukhdomis were physicians who owned and operated Chronic Pain Resources, LLC, a pain management practice in Columbus, Ohio.  The Mukhdomis ignored several red flags that their patients were diverting or abusing their prescribed pain medications.  The indictment further alleges that the Mukhdomis ignored urine drug screens and ordered both qualitative and quantitative urine drug screens simultaneously, rendering the qualitative drug screen useless and medically unnecessary.  The total amount of fraud resulting from the drug screen fraud exceeded $150,000.  The case is being prosecuted by Assistant U.S. Attorneys Nicole Pakiz and Ken Affeldt Metzler of the U.S. Attorney’s Office for the Southern District of Ohio.
     
  • Sally Njume-Tatsing, 45, of Pickerington, Ohio, was charged by indictment with health care fraud and false statements relating to health care matters in connection with a $2 million scheme to defraud Medicaid.  As alleged in the indictment, Njume-Tatsing, the owner of Labelle Home Health Care, LLC (“Labelle”), a home health agency with three offices located in Ohio, inflated the number of nursing services provided by Labelle nurses to Medicaid beneficiaries, as well as billing for services purported provided by registered nurses that were actually provided by licensed practical nurses.  The case is being prosecuted by Assistant U.S. Attorney Ken Affeldt and Special Assistant U.S. Attorney Jonathan Metzler of the U.S. Attorney’s Office for the Southern District of Ohio.
     

Southern District of Texas

  • Lily Tran Daniels (“Tran”), 49, of Orange County, California, and Kenneth Reynolds, 62, of New Castle County, Delaware, were charged by superseding indictment in connection with an alleged $142 million health care kickback scheme, along with Emylee Thai, 38, who was previously charged by indictment.  Tran was charged with conspiracy to commit health care fraud, conspiracy to defraud the United States and to pay and receive health care kickbacks, and receipt of health care kickbacks; and Reynolds was charged with conspiracy to defraud the United States and to pay and receive health care kickbacks, and receipt of health care kickbacks.  As alleged in the superseding indictment, Thai, the owner of ApolloMDx, LLC (“ApolloMDx”) (later renamed Artemis DNA TX, LLC), a clinical laboratory in Houston, Texas, offered and paid kickbacks to marketers, including Tran and Reynolds, in exchange for referring to ApolloMDx Medicare beneficiary DNA samples and signed doctors’ orders authorizing medically unnecessary genetic testing.  Many of these referrals included paperwork with false dates of service and false beneficiary diagnoses designed to increase Medicare reimbursement on genetic testing claims, which ApolloMDx used to submit false and fraudulent claims to Medicare.  The case is being prosecuted by Trial Attorneys Andrew Tamayo and Courtney Chester of the Houston Strike Force.  Assistant U.S. Attorney Brandon Fyffe of the U.S. Attorney’s Office for the Southern District of Texas is assisting with forfeiture.
     
  • Rene Gaviola, 67, Ifeanyi Ndubisi Ozoh, 51, both of Houston, Texas, and Christian Agno Aquino, 42, of Humble, Texas, were charged by superseding indictment for their roles in a $6 million Medicaid fraud and kickback scheme.  Gaviola was charged with paying kickbacks, in addition to previously being charged with conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive kickbacks, and money laundering; Ozoh was charged with paying kickbacks, in addition to previously being charged with conspiracy to pay and receive kickbacks; and Aquino was charged with conspiracy to commit health care fraud, health care fraud, conspiracy to pay and receive kickbacks, and paying kickbacks.  As alleged in the superseding indictment, Gaviola, as operator of Floss Family Dental Care (“Floss”), submitted fraudulent claims to Medicaid for pediatric dental services, including numerous cavity fillings, that were not provided or were provided by an unlicensed individual.  At Gaviola’s direction and with Aquino’s assistance, Floss allegedly employed one unlicensed individual to practice dentistry on children and billed Medicaid for these dental services as if they were provided by a licensed dentist.  Gaviola, Ozoh, and Aquino also allegedly paid kickbacks to marketers and caregivers of Medicaid-insured children to bring them to Floss for dental services.  The case is being prosecuted by Special Assistant U.S. Attorney Kathryn Olson and Assistant U.S. Attorney Grace Murphy of the U.S. Attorney’s Office for the Southern District of Texas.
     

Eastern District of Washington

  • David Antonio Becerril, 67, formerly of Selah, Washington, was charged by indictment with conspiracy to commit health care fraud, conspiracy to commit wire fraud, health care fraud, wire fraud, and false statements relating to health care matters, in connection with a scheme to defraud Medicare by ordering millions of dollars in medically unnecessary genetic tests and DME.  As alleged in the indictment, Becerril, a medical doctor, signed more than 2800 fraudulent orders for genetic tests and DME for patients he was not treating and had never spoken to.  According to the indictment, telemarketers obtained beneficiary information and prepared fraudulent physician orders and other false documentation that Becerril signed.  The Indictment alleges that Becerril took an average of less than 40 seconds to sign each order and denied few or no orders for a lack of medical necessity – even approving orders for braces for nonexistent limbs for patients whose limbs previously had been amputated.  The telemarketers sold the signed orders to a DME or genetic testing company, which billed Medicare.  The indictment alleges Becerril was paid a kickback for each fraudulent order he electronically signed, he never denied a single order out of thousands, and he reviewed orders for as few as 11 seconds before electronically signing them.  The case is being prosecuted by Assistant U.S. Attorneys Dan Fruchter, Tyler H.L. Tornabene, and Allie Jensen of the U.S. Attorney’s Office for the Eastern District of Washington.
     
  • Geoffrey Wayne Reynolds, 51, formerly of East Wenatchee, Washington, was charged by information with false statements relating to health care matters, in connection with a scheme to falsify COVID-19 vaccination information for Washington State firefighters.  Reynolds, a licensed Washington pharmacist formerly employed at a Walgreens pharmacy in East Wenatchee, falsified COVID-19 vaccination cards for at least two firefighters to assist them with evading Washington’s vaccine mandate for state employees.  Reynolds destroyed vaccine doses for both firefighters, then completed fraudulent vaccine cards to make it appear as though Reynolds had provided the vaccines.  Reynolds also completed fraudulent health insurance documentation falsely reflecting that the vaccine doses had been administered for purposes of billing health insurance providers for both firefighters.  The case is being prosecuted by Assistant U.S. Attorneys Dan Fruchter and Tyler H.L. Tornabene of the U.S. Attorney’s Office for the Eastern District of Washington.
     

Eastern District of Wisconsin

  • Markita Barnes, 30, of Milwaukee, Wisconsin, was charged by indictment with health care fraud, aggravated identity theft, false statements relating to health care matters, offering and paying kickbacks, obstruction of a health care fraud investigation, and engaging in unlawful monetary transactions in connection with an alleged $2.5 million health care fraud and kickback scheme involving a health care benefit program intended to help low-income and high-risk pregnant women and their babies achieve better birth outcomes.  As alleged in the indictment, Barnes, the owner of Here For You Prenatal Care Coordination Services LLC, offered and provided kickbacks to induce women to sign up for prenatal care coordination services with her company, and then submitted millions of dollars of fraudulent claims for services never actually provided to those women.  The services Barnes claimed to have been providing were part of a health care benefit that was created in Wisconsin to address the state’s historically high infant mortality rate for African Americans.  The case is being prosecuted by Assistant U.S. Attorneys Julie Stewart and Kate Biebel of the U.S. Attorney’s Office for the Eastern District of Wisconsin.
     

Indiana Office of Attorney General

  • Melissa Lou Fannin, 43, of Hartford City, Indiana, was charged by criminal complaint with obtaining a controlled substance by fraud, furnishing false or fraudulent information, and possession of a narcotic drug.  As alleged in the complaint, Fannin, a registered nurse, worked at a hospital and dispensed hydromorphone at a rate 155% higher than the next registered nurse in the same unit and was documenting waste at a rate 116% higher than the next registered nurse in the same unit.   The complaint alleges that Fannin admitted to investigators that she took controlled substances for her own use and dispensed hydromorphone for herself when she falsely documented that it had been administered to a patient or wasted.  The case is being prosecuted by Deputy Attorney General Grainne Kao of the Indiana Office of the Attorney General.
     
  • Erin McMillan, 44, of Columbus, Indiana, was charged by criminal complaint with obtaining a controlled substance by fraud, furnishing false or fraudulent information, and failure to make, keep, or furnish a record.  As alleged in the complaint, McMillan, a licensed practical nurse, documented dispensing a medication on dates that she did not work and without the medication actually being administered to a patient.  The complaint further alleges that video footage from the facility where she worked showed McMillan remove medications from the narcotic box without leaving the area to go administer the medications and walk back behind the nurses’ station and put items into her personal bag.  The case is being prosecuted by Deputy Attorney General Grainne Kao of the Indiana Office of the Attorney General.
     
  • Heather Heugel, 37, of Plainfield, Indiana, was charged by criminal complaint with obtaining a controlled substance by fraud, furnishing false or fraudulent information, and failure to make, keep, or furnish a record.  As alleged in the complaint, Heugel, a licensed practical nurse, worked for Avon Health and Rehabilitation Center where she dispensed controlled substances to residents without documenting administration, documented administration of controlled substances to residents who did not typically ask for their as-needed medications and who denied receiving controlled substances, and documented the dispensing of controlled substances on dates when timesheets show she was not working.  The case is being prosecuted by Deputy Attorney General Grainne Kao of the Indiana Office of the Attorney General.
     
  • Victoria Bell, 57, of Michigan City, Indiana, was charged by criminal complaint with obtaining a controlled substance by fraud and failure to make, keep, or furnish a record, in connection with stealing oxycodone.  As alleged in the complaint, after Bell’s assignment to the locked narcotic cart at the facility where she worked as a registered nurse, oxycodone was determined to be missing.  The complaint further alleges that Bell admitted to stealing the medication.  The case is being prosecuted by Deputy Attorney General Grainne Kao of the Indiana Office of the Attorney General.
     
  • Traci Lindfors, 50, of Michigan City, Indiana, was charged by criminal complaint with obtaining a controlled substance by fraud, furnishing false or fraudulent information, and failure to make, keep, or furnish a record.  As alleged in the complaint, Lindfors, a licensed practical nurse, documented dispensing controlled substances with no subsequent documentation of administration to the patient.  The complaint further alleges that Lindfors documented dispensing as-needed medications to patients who did not request medications from any other nurse for the entire month, and on dates that Lindfors was not in the building.  The complaint further alleges that one resident indicated he had not received his medication from Lindfors, and a drug screen yielded negative results for medication.  The case is being prosecuted by Deputy Attorney General Grainne Kao of the Indiana Office of the Attorney General.
     
  • Wendy Hahn, 52, of Indianapolis, Indiana, was charged by criminal complaint with obtaining a controlled substance by fraud, furnishing false or fraudulent information, and theft.  As alleged in the complaint, Hahn, a registered nurse, was arrested in Rush County, Indiana, on unrelated charges and had controlled substances packaged for patients within her vehicle.  The complaint further alleges that due to a unique coding on the packaging, the investigator was able to link this specific medication to the exact dispensing and administration and determine that Hahn had documented this medication as administered to a patient.  The case is being prosecuted by Deputy Attorney General Grainne Kao of the Indiana Office of the Attorney General.
     
  • David Tanner, 55, and Daniel Tanner, 52, both of Marshall County, Indiana, were charged by complaint in connection with their operation of Concierge Medicine of Marshall County (“Concierge Medicine”).  David Tanner was charged with practicing medicine without a license and practicing nursing with a suspended or revoked license.  Daniel Tanner was charged with aiding, inducing, or causing each of the offenses with which David Tanner was charged, as well as issuing invalid prescriptions.  As alleged in the complaint, Daniel Tanner, a nurse practitioner, owned and operated Concierge Medicine and employed his brother David Tanner as a nurse, despite David’s nursing license having been indefinitely suspended since 2005.  The complaint further alleges that during the times that Daniel Tanner was out of the office, David Tanner practiced as a nurse at Concierge Medicine by examining patients, taking vital signs, recommending medications, providing medical opinions, evaluating and diagnosing patients, and prescribing medication using Daniel Tanner’s DEA number.  The case is being prosecuted by Deputy Attorney General Jennifer Anwarzai of the Indiana Office of the Attorney General.
     

New York Office of Attorney General

  • Juan Poveda, 32, of Mineola, New York, the owner of Santiago Pharmacy, and Javier Burbano, 32, of Queens, New York, the manager of Santiago Pharmacy, were charged by felony complaint with grand larceny in the first degree, health care fraud in the second degree, and unlawfully paying kickbacks to Medicaid recipients, in connection with an alleged scheme to defraud the New York Medical Assistance Program.  Poveda was also charged with money laundering in the first degree.  As alleged in the felony complaint, Poveda and Burbano, through Santiago Pharmacy, submitted claims to Amida Care, a Medicaid-funded managed care organization, for more than 25,000 pills of the expensive HIV retroviral medication Biktarvy that Santiago Pharmacy either never dispensed or dispensed with medication allegedly purchased from black-market suppliers that were not licensed or registered to sell prescription medication in New York, placing those recipients who received the diverted medication at serious health risk.  As a result of the fraudulent claims submitted to Amida Care, Medicaid paid Santiago Pharmacy more than $2.9 million.  The felony complaint further alleges that Poveda and Burbano paid Medicaid recipients monthly kickbacks to fill their HIV prescriptions at Santiago Pharmacy, and those prescriptions provided the foundation for more than $600,000 in fraudulent claims in 2022 alone.  Poveda then allegedly attempted to hide the fraudulently obtained funds by funneling the money from Santiago Pharmacy accounts to accounts in the name of shell companies controlled by Poveda and his associates.  The case is being prosecuted by Special Assistant Attorneys General Chase Ruddy and Amy Delfyett of the New York State Office of the Attorney General.
     

Pennsylvania Office of Attorney General

  • Anna Colon, 34, of Allentown, Pennsylvania, was charged by complaint with Medicaid fraud and theft by deception for allegedly submitting false timekeeping records for services not rendered causing a loss to the Pennsylvania Medical Assistance Program greater than $300,000.  As alleged in the complaint, Colon was employed as a personal care attendant to aid with activities of daily living.  Colon allegedly submitted false timekeeping records indicating she worked greater than 24 hours in a single day on at least 675 occasions which totaled more than 16,000 fraudulent hours.  The case is being prosecuted by Senior Deputy Attorney General Susann B. Morrison of the Pennsylvania Office of Attorney General.
     
  • Jennifer Ann Batrus, 50, of Altoona, Pennsylvania, was charged by complaint with Medicaid fraud and theft by deception for entering progress notes and issuing prescriptions for patients with whom she had no contact or communication.  As alleged in the complaint, Batrus was employed as a physician’s assistant for American Family Psychiatry at the State College, Pennsylvania and Huntingdon, Pennsylvania locations, where she allegedly issued prescriptions, entered progress notes, and caused $40,000 in fraudulent billings to a Pennsylvania Medical Assistance managed care organization for over 500 office visits that did not occur.  The case is being prosecuted by Senior Deputy Attorney General Susann B. Morrison of the Pennsylvania Office of the Attorney General.

 
Updated September 26, 2023