Fugitive for 13 Years Pleads Guilty

Dr. Juan Rios Admits Engaging in Frauds

Stephen R. Wigginton, United States Attorney for the Southern District of Illinois, announced today that on September 18, 2012, Dr. Juan Rios, 65, who was extradited from Peru, pled guilty in federal district court to one count of health care fraud, three counts of mail fraud, and one count of failure to appear. Rios was first indicted in December 1999. Additional charges were brought after Rios fled to Peru shortly after his indictment, forfeiting a $350,000 in cash that he had posted as bond on the original charges. At his sentencing, Rios faces up to 35 years of imprisonment and fines of up to $1.5 million, three years of mandatory supervised release, and a special assessment of $500. Sentencing has been set for January 4, 2013, at 10:30 a.m. in United States District Court in East St. Louis, Illinois.

In court today, Rios admitted fleeing the United States after he was indicted. He acknowledged that, as a Southern Illinois physician in the mid to late 1990s, he defrauded several insurance companies of over $400,000. Rios, who had medical offices in Collinsville and Bethalto, also admitted that he had submitted false bills for medical treatment and services that were not provided to his patients, while at the same time fraudulently receiving over $250,000 in personal disability payments.

The investigation was conducted by the Southern Illinois Health Care Fraud Task Force, with the U.S. Postal Inspection Service, the Federal Bureau of Investigation, the National Insurance Crime Bureau, the U.S. Department of Human Services-Office of Inspector General, and the Illinois State Police. The case is being prosecuted by Assistant United States Attorneys Ranley R. Killian and Michael J. Quinley.

Detroit-Area Clinic Owner Pleads Guilty to $16 Million Psychotherapy Fraud Scheme

WASHINGTON – Detroit-area resident Louisa Thompson pleaded guilty today for her role in a $16 million fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

 Thompson, 63, pleaded guilty today before U.S. District Judge Nancy D. Edmunds in the Eastern District of Michigan to one count of conspiracy to commit health care fraud.  At sentencing, scheduled for Oct. 18, 2012, Thompson faces a maximum penalty of 10 years in prison and a $250,000 fine.

 According to the plea documents, in approximately January 2006, Thompson began billing Medicare for psychotherapy services through two companies, TGW Medical Inc. and Caldwell Thompson Manor Inc.  The services billed by Thompson at TGW and Caldwell Thompson were never performed or were performed by unlicensed staff who were not authorized to perform services reimbursed by Medicare.  The unlicensed staff members also fabricated therapy notes for patients that were never seen and billed Medicare using document templates created by Thompson.

 According to court documents, Thompson also received payments from the owner of P&C Adult Day Care Inc., a psychotherapy clinic.  Those payments to Thompson were, in part, for the use of Thompson’s provider number by P&C.  Thompson also admitted signing therapy documents for P&C patients she never saw or treated.  P&C, like TGW and Caldwell Thompson, billed for psychotherapy services that were either not performed or performed by unlicensed staff.  Caldwell Thompson and P&C shared Medicare beneficiaries and/or beneficiary information.

 Thompson admitted to submitting or causing to be submitted approximately $15.9 million in fraudulent psychotherapy claims on behalf of TGW, Caldwell Thompson and P&C.  Medicare paid approximately $4.9 million of those claims.

 The guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Acting Special Agent in Charge of the FBI’s Detroit Field Office Edward J. Hanko; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (HHS-OIG), Chicago Regional Office.

The case is being prosecuted by Trial Attorney Gejaa T. Gobena of the Criminal Division’s Fraud Section and Assistant U.S. Attorney for the Eastern District of Michigan Philip A. Ross.  The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan. 

 Since its inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,330 individuals and organizations that collectively have billed the Medicare program for more than $4 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

 To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

Tampa-Area Resident Charged in Nationwide Medicare Fraud Strike Force Takedown

WASHINGTON—The Departments of Justice and Health and Human Services and the Florida Department of Law Enforcement announce today that a Tampa-area pharmacist was charged for illegal diversion of controlled substances. In an indictment unsealed today, Emmanuel Mekowulu (56, Tampa) was charged with conspiring to distribute controlled substances, primarily Oxycodone, not for a legitimate medical purpose, and outside the usual course of professional practice. Mekowulu was arrested earlier today by members of the Tampa Bay Medicare Fraud Strike Force. He faces a maximum penalty of 20 years in federal prison. The indictment also notifies Mekowulu that the United States intends to forfeit his Florida Department of Health Pharmacist License; the DEA Registration and Florida Department of Health Pharmacy License for Felky Rx, LLC, which are alleged to be property used to commit or to facilitate the commission of the offense. The United States is also seeking a money judgment in the amount of $121,350, representing the amount of proceeds that Mekowulu obtained as a result of the conduct charged in the indictment. Assistant United States Attorney Kathy J.M. Peluso is prosecuting the case.

In addition to the arrest of Mekowulu, agents of the Tampa Bay Strike Force also executed search warrants at four businesses in the Tampa Bay area today. These law enforcement efforts in Tampa are part of a nationwide takedown by Medicare Fraud Strike Force operations in seven cities. The national effort is linked to charges against 107 individuals for their alleged participation in schemes to collectively submit more than $452 million in fraudulent claims to Medicare.

“Any time false claims are submitted for payment, our nation’s health insurance programs and beneficiaries suffer,” said Christopher Dennis, Special Agent in Charge of the federal Health and Human Services Department, Office of Inspector General’s region covering Florida. Today’s arrest brings a successful conclusion to a lengthy health care fraud/prescription drug diversion investigation involving exceptional partnerships between federal, state, and local law enforcement.”

“Individuals involved in health care fraud activities steal vital resources from those citizens who truly need them. The FBI and our local law enforcement partners continue to increase our investigative efforts and rely on the public’s support in combating this crime problem,” said Special Agent in Charge Steven E. Ibison, FBI Tampa Field Office.

“FDLE is committed to ending the illegal distribution of prescription drugs,” said Commissioner Gerald Bailey. “We will continue to work with our law enforcement partners to investigate and arrest those who represent a danger to Florida.”

Last week two arrests were made as a result of investigations generated by the Tampa Bay Strike Force. Luis Duluc (51, formerly of Weston, Florida), and Margarita Grishkoff (57, Charlotte, North Carolina) were charged with health care fraud-related violations. According to the 30-count indictment, Duluc and Grishkoff utilized multiple physical therapy clinics to fraudulently bill Medicare for services not rendered to any Medicare beneficiaries. During the time frame of the conspiracy, through their holding company, Duluc and Grishkoff allegedly purchased three physical therapy clinics in the Middle District of Florida. These clinics were used by Duluc and Grishkoff to fraudulently bill Medicare. The indictment alleges that, as a result of the health care fraud scheme, Medicare paid out approximately $8,152,262.14 for services not rendered. Assistant United States Attorney Simon Gaugush is prosecuting the case.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

The results of today’s nationwide takedown were announced earlier today by Attorney General Eric Holder, HHS Secretary Kathleen Sebelius, Assistant Attorney General Lanny A. Breuer, FBI Deputy Director Sean Joyce, HHS Deputy Inspector General Gary Cantrell, and Deputy Administrator for Program Integrity of the Centers for Medicare and Medicaid Services (CMS) Dr. Peter Budetti.

An indictment is merely a charge and defendants are presumed innocent until proven guilty.

To learn more about HEAT, go to: www.stopmedicarefraud.gov.

Owner of Med-Quick Diagnostics Convicted in Illegal Kickback Conspiracy

MCALLEN, TX—The owner of an area medical supply and diagnostic testing company has pleaded guilty to one count of conspiracy to violate the federal anti-kickback statute, United States Attorney Kenneth Magidson announced today.

Jose “Joe” Trevino, 44, of Weslaco, Texas, pleaded guilty this morning before U.S. District Judge Micaela Alvarez to a one-count criminal information charging conspiracy to violate the anti-kickback statute. The federal anti-kickback statute prohibits individuals and entities from knowingly and willfully paying or offering to pay, as well as soliciting or receiving, remuneration (money or other things of value) in return for the referral of patients for medical services or items which are benefits under a federal health care program, such as Medicare or Medicaid. A violation of the statute is a felony offense.

According to information presented by the United States at today’s hearing, Trevino is the owner of Med-Quick Diagnostics, a medical supply and diagnostic testing facility located in Weslaco, Texas. From approximately September 2009 through April 2011, Trevino authorized thousands of dollars in illegal kickback payments to an area marketer, Alicia Vasquez, in exchange for Vasquez’s referrals of numerous Medicare and Medicaid patients to Med-Quick. Trevino paid the kickbacks to Vasquez through a third-party—referred to in the criminal information as “Person A.” The kickbacks were deposited into Person A’s bank account, from where the money was later diverted to Vasquez. Med-Quick subsequently billed Medicare and Medicaid hundreds of thousands of dollars for patients that were illegally referred by Vasquez.

Vasquez previously pleaded guilty to conspiracy and is awaiting sentencing.

Judge Alvarez has scheduled Trevino’s sentencing for July 25, 2012 at which time he faces up to five years in federal prison, without parole, and a $250,000 fine.

The ongoing investigation is being conducted by FBI and the U.S. Department of Health and Human Services-Office of Inspector General. Assistant United States Attorney Gregory S. Saikin is prosecuting the case.

Six Doctors and Owner of Three Ohio Pain Clinics Indicted for Illegal Distribution of Prescription Drugs

CINCINNATI—A federal grand jury has indicted the owner of three pain clinics in Ohio and six of the doctors he hired from around the United States to satisfy the demand for the illegal diversion of prescription drugs in central and southern Ohio, Kentucky, West Virginia, and Tennessee. The indictment alleges that the defendants conspired to write prescriptions for powerful pain medications outside the scope of legitimate medical practice and that their conspiracy resulted in the death of at least one customer.

Carter M. Stewart, U.S. Attorney for the Southern District of Ohio; Ohio Attorney General Mike DeWine; Robert L. Corso, Special Agent in Charge, Drug Enforcement Administration, Detroit Field Division; Edward J. Hanko, Special Agent in Charge, FBI; Lamont Pugh, Special Agent in Charge, U.S. Department of Health and Human Services-Office of Inspector General; Kyle W. Parker, Executive Director of the Ohio Board of Pharmacy; and Richard A. Whitehouse, Executive Director, State Medical Board of Ohio, announced the indictment, which was returned on April 18, 2012.

The 12-count indictment alleges that between January 2009 and June 2011, Tracy Bias, 47, of West Portsmouth, Ohio, owned and operated Southern Ohio Complete Pain Management and Portsmouth Medical Solutions in Portsmouth and Trinity Medical Care in Columbus, Ohio, even though he has no known medical education. He allegedly secured doctors for brief periods of time ranging from one day to several years through what are known as locum tenens, or temporary service contracts, to prescribe pain medication for customers at his clinics.

Customers allegedly traveled hundreds of miles to the clinics in central and southern Ohio where, for a cash payment of approximately $200 per office visit and with little or no physical examination, clinic customers would receive excessive amounts of “cocktails” of controlled substances including diazepam, hydrocodone, oxycodone, and alprazalam.

Doctors charged in the indictment are:

■Joon H. Chong, 69, Coldwater, Michigan;

■John Dalhsten, 55, Burlington, Iowa;

■Mark R. Fantauzzi, 49, unknown;

■Marcellus Jajuan Gilreath, 49, Cleveland;

■Stephen L. Pierce, 62, Gallup, New Mexico; and

■James E. Lassiter, 58, Findlay, Ohio.

All seven are charged with conspiracy to distribute drugs outside the scope of legitimate medical practice, a crime that is punishable by up to 20 years in prison and a fine of up to $1 million.

Bias and Chong are charged with distribution of controlled substances that resulted in death, a crime punishable by at least 20 years and up to life in prison. Bias is charged with operating a continuing criminal enterprise, a crime punishable by at least 20 years and up to life in prison.

FBI agents and task force officers from the Scioto County Sheriff’s Office and the Portsmouth Police Department, serving as members of the Southern Ohio Drug Task Force, arrested Bias in Portsmouth on April 18, 2012. He appeared before visiting U.S. Magistrate Judge Candace Smith, who ordered him held without bond and scheduled a detention hearing for 3:30 p.m. on Tuesday, April 24, 2012 in federal court in Cincinnati. The other defendants will be summoned to appear for their initial appearances and arraignment.

The indictment also seeks forfeiture of $6,725,000, representing the proceeds from illegal activities involved at the clinics.

Stewart commended the cooperative investigation by agents and officers of the agencies named above, as well as Assistant U.S. Attorneys Timothy Oakley and Adam Wright, who are prosecuting the case.

An indictment is only a charge and is not evidence of guilt. The defendants are entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.