Medical Fraud

Published on: October 25, 2012

Did You Accidentally Violate Los Angeles Medicare Fraud Laws? (And What To Do If You Did…)

Many people believe that most Los Angeles Medicare and medical fraud defendants “knew what they were doing.”

In other words, when you crack open the Los Angeles Times and read about some executive or ambulance administrator who allegedly “bilked” the federal benefits program out of millions of dollars, you might assume that the suspect had organized an intricate operation – had behaved, in sense, like a criminal mastermind.

Indeed, there are individuals who fit this description, more or less. However, they are in the minority. In fact, a lot of Southern California white collar crime, insurance fraud and healthcare fraud cases are far more ambiguous. Indeed, perfectly innocent mistakes can get you into serious legal hot water.

Published on: September 20, 2012

Los Angeles Medicare Fraud Conviction Nets L.A. Physician’s Assistant 6 Years in Jail

by Michael Kraut

50-year-old David James Garrison was sentenced to 72 months behind bars last week for his involvement in a Los Angeles Medicare scam that bilked the federal government out of nearly $19 million. On top of his lengthy jail term, Garrison was ordered by a U.S. District Judge to pay nearly $25,000 in restitution to several defendants.

The charges concerned Garrison’s involvement in a Los Angeles Medicare fraud scam that ran from early 2007 through the fall of 2008. Garrison and other co-conspirators, including Edward Aslanyan, operated a sophisticated shell game. The scam had many “threads.” One of the biggest money makers involved a scheme to recruit Medicare beneficiaries to write and collect prescriptions for power wheelchairs. Garrison and his conspirators resold these ill begotten wheelchairs to wholesalers at an enormous markup. For instance, they might have paid $900 for a wheelchair and billed Medicare for $5,000 for it. Garrison was also involved in writing illegal prescriptions and ordering fraudulent diagnostic tests for at least six different L.A. doctors.

A federal jury convicted Garrison in June on six counts of Los Angeles healthcare fraud, one count of aggregated identity theft, and one count of conspiracy to commit medical fraud in Southern California.

Published on: September 13, 2012

Sophisticated Computers May Prove the Bane of Los Angeles Medicare Fraud Defendants

by Michael Kraut

If you’ve recently been investigated or arrested for Medicare or MediCal fraud in Southern California, prepare for serious challenges.

According to a recent NPR report, the Affordable Care Act (a.k.a. “Obamacare”) has empowered federal investigators to identify and prosecute fraud like never before. Peter Budetti, an anti-fraud manager at the Centers for Medicare & Medicaid Services, said the federal government is now “able to verify whether a person was being treated by two different physicians in two different states on the same day or a variety of other possibilities,” thanks to powerful anti-fraud computer software. These systems are roughly analogous to systems that credit card companies use to suss out suspicious buying patterns.

The anti-fraud computer systems may spark a paradigm shift in terms of how the government suppresses fraud. The old/current paradigm is often known as the “pay and chase” model. Here’s how it works:

Published on: September 10, 2012

Big, Garish Los Angeles Medicare Fraud News: Ting Huan Tai Allegedly Defrauded Benefits Programs of $30 million to Buy Lamborghini (Among Other Things)

by Michael Kraut

If you have come under investigation for a serious Los Angeles Medicare fraud or Medi-Cal fraud crime, be thankful your situation is probably not as bad as 34-year-old Ting Huan Tai’s.

Tai allegedly ran a massive scam out of his New York City apartment (designed by the architect Frank Gehry). Federal prosecutors say that Tai stole the identify of a doctor and then used that identity to procure millions and millions of dollars of Medicare and Medi-Cal funds by billing for radiological services that no one ever provided to patients. Tai worked with this doctor before nabbing his identity.

Authorities seized Tai’s blue Lamborghini, among other possessions, and his parents had to put up their Great Neck home and other assets to pay his $2 million bond. So far there hasn’t been a grand jury indictment; rumor are swirling that the defendant is maneuvering to get a plea deal. If convicted of all the charges against him, Tai could face a decade behind bars.

Published on: August 19, 2012

Los Angeles Medicare Fraud Analysis: How and when should academics be punished?

by Michael Kraut

A provocative article by author Jon Wiener in the August 7 issue of The Nation magazine raises intriguing questions about Los Angeles Medicare fraud. Specifically, Wiener asks whether academics who indirectly create/perpetuate medical fraud in Southern California and elsewhere should be punished. And if so, how?

Wiener’s editorial concerns recent GlaxoSmithKline healthcare fraud charges. The giant drug maker pled guilty on July 3rd and agreed to pay out approximately $3 billion in connection with promoting antidepressant pharmaceuticals for uses that had not been approved. At the center of the case was a medical journal article that seemed to give Paxil a pass. The article essentially said Paxil was safe and effective for helping children with depression.

The authors who contributed to the article included Dr. David Feinberg, the head of UCLA’s hospital. But a Department of Justice investigation found out that the pharmaceutical company had paid for that journal article – which critics said “dangerously misrepresented dangers and [hid] information indicating that the drug promoted suicidal behavior among teenagers.”

Published on: August 14, 2012

Defendants of Medicare Fraud in Los Angeles Beware: What Happened to Irina Shelikhova Can Happen to You!

by Michael Kraut

If you’ve been charged with the crime of Medicare and Medical fraud in Los Angeles, here is what not to do:

Do not ignore your charges and flee the country!

This advice should be obvious enough, but 49-year-old Irina Shelikhova, who’s suspected in a giant $70 million Medicare fraud scam in New York City, chose to ignore this common sense.

Published on: August 6, 2012

$7 Million in Los Angeles Medicare Fraud Verdict: How Much Will You Have to Pay?

by Michael Kraut

51-year-old Camillus Ehigie, a Nigerian owner of a Southland medical supply company, has been ordered to pay $7 million, after being convicted of Los Angeles Medicare fraud charges.

U.S. judge Stephen Wilson also sentenced Ehigie to 42 months in a federal prison for his attempt to bilk Medicare out of $20 million. Together with 49-year-old Evans Oniha of Rancho Palos Verdes, Ehigie had operated a home health agency, Prosperity Home Health Services, Inc. and another company, Caravan Medical Supplies.

In 2011, Oniha was convicted of four Los Angeles healthcare fraud counts, one count of conspiracy to commit healthcare fraud, and another count of making false statements. Oniha was hit with an eight-year prison sentence back in February and compelled to pay a significant portion of the $7 million restitution. According to prosecutors, Oniha and Ehigie attempted to con Medicare by hiring outside marketers to solicit information from beneficiaries. They then leveraged fraudulent prescriptions and medical equipment documents to bill the federal government for services never provided.

Published on: July 20, 2012

Medicare Fraud in Los Angeles News Alert: PA Man Faces 23-count Indictment in $5.4 Million Scheme

by Michael Kraut

Are you under investigation for committing Medicare fraud in Los Angeles or elsewhere throughout the Southland?

If so, you may find it instructive to read about the disappointing case of William V. Hlushmanuk, also known as “Bill Le,” a 35-year-old ambulance driver in Pennsylvania who has been charged with trying to defraud Medicare out of over $5.4 million, from 2006 to 2011. Last week, an indictment against Hlushmanuk was unsealed, hitting him with 21 charges of healthcare fraud on top of aiding and abetting in a false statement and conspiring to commit healthcare fraud.

Hlushmanuk, who had a criminal record, created a “straw owner” to open a service called Starcare Ambulance to transport kidney dialysis patients. These patients had the capacity to walk, so Medicare should not be required to pay for their transportation, but Hlushmanuk apparently worked out a scheme to bill the government anyway.

Published on: July 12, 2012

Medical Identity Theft in Los Angeles Can Cost Victims $100,000+, Says New Study

by Michael Kraut

Medical identity theft bonks the U.S. economy to the tune of over $41 billion and costs victims over $20,000 on average, according to a provocative new study by the Ponemon Institute.

If you’ve been charged with Medicare fraud or identity theft in Southern California, you might find it educational to learn about what happens to victims of medical identity theft. Perhaps, for instance, you aided and abetted someone – that is, lent your healthcare information to a family member or sick friend – and now you face criminal charges. The study out of Michigan looked at 757 cases of medical identity theft. Here are some of the stats:

• 41% of victims lost their coverage and had to find new healthcare;

Published on: July 7, 2012

Big Spike in New Type of Los Angeles White Collar Crime?

by Michael Kraut

Los Angeles white collar crimes are just getting more and more diverse. We spend a lot of time on this blog dissecting crimes like medical fraud, insurance fraud, and petty theft in Southern California. But today we’re going to shake things up a bit and explore some innovative terrain to help you put your crime — and your possible defensive options — in perspective.

We’re going to look at computer crimes in L.A.

And one of the “hot new trends” in the world of computer crime is something called “smishing.” This is a cousin to the email crime known as phishing, in which a criminal uses spam and other “email lures” to get users to give away personal information, financial passwords, etcetera. Whereas “phishing” takes place in the arena of email messaging; “smishing” takes place in the arena of text messaging – a.k.a. Short Message Service (SMS) messaging.