Property Crimes

Published on: February 28, 2011

Massive Los Angeles Medicare Fraud Bust – Five Suspects Accused of Cheating Medicare of $28 million

Last week, 700 FBI and Health and Human Services agents rounded up 111 suspects in nine cities – including five people suspected of Los Angeles Medicare fraud – in the “largest-ever Federal health care fraud takedown” in the United States, according to government officials. The Los Angeles Times reports that five LA defendants “cheated the government out of more than $225 million in false billing schemes that included fraudulent claims, kickback operations, money laundering and identity theft.”

A spokesperson for the Justice Department’s Criminal Division, Assistant Attorney General Lanny Breuer, said “our message is clear… we are determined to put Medicare fraudsters out of business.”

The Justice Department’s task force has really revved up, since its inception in early 2007. So far, nearly 1,000 people have been charged for false billing schemes – approximately 75% of these people have been convicted. The average prison sentence has been quite substantial – 43 months (more than 3.5 years). In 2010 alone, national, state, and local task forces raked in about $4 billion in fines and recovery payments.

Published on: February 21, 2011

Glendale DUI Doozy: Man Arrested for DUI after Telling Police He was “Trying to Mow the Sidewalk”

by Michael Kraut

In fairness, anyone who gets pulled over for suspicion of driving under the influence in Southern California might act a little strange. Indeed, this blog has covered accounts of DUI drivers hiding goats in their car and operating boats, mopeds, and even lawn mowers while under the influence of alcohol and/or narcotics.

But a new level of total bizarreness might just have been reached last week, when an Ohio man attempted to weasel his way out of trouble by claiming that he was just “mowing the sidewalk” when the cops found his car stuck in a snow bank, revving furiously and going nowhere.

Obviously, crimes such as driving under the influence in Glendale, DUI in Burbank, DUI in Pasadena, and Los Angeles DUI should be taken seriously. But it’s important to acknowledge the absurdities that sometimes occur during DUI stops – not just to amuse readers but also to remember just how stressful DUI stops can be and how they can warped our judgment.

But anyway, back to the story. Steve Urbansky drove his car into a snow bank in the city of Lorain, Ohio early last Sunday morning. As Urbansky vainly tried to free his vehicle, the commotion attracted the attention of an officer, who found the 46-year-old sitting in his vehicle, desperately trying to get it unstuck. In addition to telling the officer that he was “just trying to mow the sidewalk,” Urbansky admitted to having consumed alcohol and failed field sobriety tests. The officer also found an open can of beer in his glove box. To top it off, Urbansky has two DUI convictions on his record – one in 1997, one in 1999.

Standard Glendale DUI field sobriety tests are almost certainly similar to the FSTs that Mr. Urbansky got put through.

The officer who pulls you over will ask you to perform a variety of tasks, both mental and physical, to assess your fitness for driving and determine whether to give you a chemical test, such as a breathalyzer or a blood test, to check your blood alcohol concentration.

DUI tests are fairly straightforward. For instance, you may be asked to walk up and down the white line on the side of the road – the so-called “walk the line test.” Or you may be asked to recite the alphabet backwards, count backwards, balance on one leg, allow the officer to shine a flash light in your eyes (horizontal gaze nystagmus test), and engage in other more complicated tests like the finger to the nose test.

You might think that these assessments would accurately separate DUIs from sober drivers. But they often yield inconclusive results or even false positives. Someone who has had a lot of balance training – such as a martial arts master or a gymnast – may have a relatively easy time completing the FSTs, even if he or she is over the limit. On the other hand, someone who is fatigued, uncoordinated, or simply anxious and confused, might fail, even though he or she is completely sober or at least definitively not over the California legal limit of 0.08% BAC.

A competent Glendale or Los Angeles criminal defense attorney can provide essential services during your legal crisis. Michael Kraut of the Kraut Criminal & DUI Lawyers (offices in Glendale at  121 W Lexington Dr, Glendale, CA 91203 Phone: (818) 507-9123) can provide a free and important case evaluation today. Attorney Kraut is a widely admired figure in the Los Angeles DUI community. Not only did he serve for a long time as a prosecutor with the city (he thus understands how prosecutors think) but he also attended Harvard Law School and he boasts an excellent record at jury trials.

Published on: February 14, 2011

Los Angeles Medical Fraud News Alert: Eight Nurses Going to Jail for Defrauding Medicare

by Michael Kraut

When you picture Southern California medical, dental, or chiropractic fraud arrests, you might envision a surly doctor conspiring with a criminal cohort to develop sophisticated white collar crime techniques.

You might not imagine that eight nurses (between the ages of 32 and 55) would be capable of pulling off a scam that bilked Medicare out of nearly $19 million.

But that’s exactly what the Department of Justice has alleged against eight RNs in Miami. The owners of two health care agencies, Florida Home Health Care Providers Inc. and ABC Home Health Inc., allegedly charged Medicare for unnecessary services (or services that never got provided) to the tune of $18.7 million. Last Tuesday, the eight nurse-owners – Diana Sanabia, Daisy Santos, Roberto Rodriguez, Marlene Magadan, Maria Perez, Alberto Alvarez, Yanisley Chao, and Leonardo Malagon — got sentenced to prison time as well as forced restitution (upwards of $700,000) for their roles in the Medicare scam.

Published on: January 31, 2011

Los Angeles Healthcare Fraud Case among 2010’s Biggest Busts, According to CNN

by Michael Kraut

Last Monday, a federal government report announced that over $2.5 billion in Southern California Medicare fraud (and fraud elsewhere) was recovered in 2010. The 84 page report from the Justice and Health & Human Services found that the government’s anti-fraud programs appear to be working well – returning $5 for every dollar spent to combat fraud. Defendants have included hospitals, physicians, manufacturers of medical devices, and pharmaceutical companies.

A CNN report singled out the fraud case of a Tustin, California CFO as “one of the most blatant cases” last year. The CFO pled guilty in April 2010 to charges of recruiting homeless people to engage in unnecessary services in exchange for kickbacks. He was one of 726 different defendants convicted for crimes like Los Angeles healthcare fraud and insurance fraud.

2011 may be an even more vigorous year for anti-fraud activists. The Justice and Health and Human Services report says that over 1,100 new fraud probes will be launched in 2011. 1,700 criminal investigations are pending. And the universe of potential defendants may expand to 2,000+ people. Since the late 1990s, the government has collected approximately $18 billion from individuals and institutions that have committed fraud against Medicare and other healthcare programs.

Published on: January 17, 2011

Southern California Medicare Fraud News Alert — Another Multimillion Dollar Bust Barely Makes a Blip on the News Radar: Why?

by Michael Kraut

Many colorful stories of Los Angeles medical, dental, and chiropractic fraud have hit the news over the past year or so. The public may simply be too exhausted to pay attention to them anymore.

This claim sounds absurd at first. After all, you’d think that stories about high crime involving multi-millions of dollars would enrage citizens or at least stir debate – especially during this prolonged economic malaise. But the shocking reality is that many fascinating stories of Southern California insurance fraud, medical fraud and credit card fraud are simply flying under most people’s radars.

To wit, consider a crazy case out of Gary, Indiana that you no doubt missed:

Published on: January 10, 2011

Pasadena DUI Newsflash: Look Out for 18-Year Olds Plowing into Parked Cars. Yikes!

by Michael Kraut

Whether you are a pedestrian or motorist, you regularly fear encountering someone driving under the influence in Pasadena. Those fears may get ratcheted up when you read the tale of 17-year old Robert Leigh, an Isla Vista resident who crashed into an unbelievable 8 (that’s “eight” as in 1-2-3-4-5-6-7-8!) parked cars on the morning of January 6th up in Santa Barbara.

Before we delve into this amazing story, we should note that anyone who has recently been pulled over for driving under the influence in Pasadena, DUI in Burbank, DUI in Glendale, or driving under the influence in Los Angeles should avail themselves of critical legal counsel as soon as possible.

Okay, having said that, let’s examine the Leigh crash in more detail. According to California Highway Patrol reports, the teenager had been driving his 2009 Toyota Tacoma on El Colegio Road at 3 a. m., when he drifted into the cars like something out of a pinball game. Here is a quote from a local Santa Barbara paper about it:

“He reportedly drifted to the right, striking one parked car, continued on El Colegio and hit four parked vehicles, then negotiated through the Camino Corto intersection. He allegedly struck three more vehicles before he was stopped by a UC police officer.”

Once the CHP arrived at the scene of the multiple accidents, Leigh was booked for DUI and taken to Santa Barbara County jail. Fortunately – and probably this is because the accidents occurred at 3 a. m – no injuries were reported.

No one expects to be involved in a pinball-like Pasadena DUI car accident – especially one with injuries. For good reason, too. California Vehicle Code Sections 23153(a) and 23153(b) will essentially take a typical misdemeanor Los Angeles DUI charge and shoot it up to a felony charge. The difference between a misdemeanor and felony is enormous. It could mean extra years in jail, for instance. It could also mean thousands of dollars more in fines, extremely strict probation terms, longer alcohol school time, and permanent long-term problems for you. For instance, convicted felons often find it extremely difficult to get work and to lease a car or an apartment. You will also be forever prohibited from voting in national elections. Furthermore, you may have to pay hiked up insurance costs and restitution to any victims that you hurt.

The silver lining – if there is any – is that charge of Pasadena DUI with injury is a difficult one for prosecutors to prove. Prosecutors can’t simply say that you hurt someone while DUI; thus, therefore you should be convicted. After all, perhaps you had been driving normally (i.e., not committing any traffic infractions) when a pedestrian darted in front of you. Yes, you hit the pedestrian. But it was his fault! So even that you were DUI and did hurt somebody, in this situation, prosecutors would be hard pressed to make the DUI with injury charge stick.

The general point here is that the laws abounds with nuances and subtleties. Thus, it’s in your best interest to find someone who has lots of experience with Pasadena DUI law — such as Pasadena criminal defense attorney Michael Kraut. Connect with the Kraut Criminal & DUI Lawyers at 790 East Colorado Boulevard, 9th Floor, Pasadena, California 91101 (626-345-1899). Here are some reasons why Attorney Kraut stands head and shoulders above the competition:

• He is Harvard Law School educated
• He is a former prosecutor with 14 plus years as a Deputy DA for the city
• He has a huge success rate at jury trials
• He has maintained numerous excellent relationships with local prosecutors and judges
• He is often called in as an expert on local and national media to talk about DUI matters
• He offers a compassionate and proven process to help his clients.

Published on: January 3, 2011

Los Angeles Medical Fraud News Alert: Doctor Sentenced for Having a Receptionist Pose as MD

by Michael Kraut

The annals of Southern California medical, dental and chiropractic fraud are replete with pretty crazy stories. But a breaking story out of Columbus, Ohio may have even the most tawdry recent Los Angeles white collar crime stories beat. An Ohio area doctor, Charles Njoku, has been sentenced for manipulating his receptionist into posing as a doctor to treat patients and bilk Medicare and Medicaid.

Judge Algenon L. Marbley sentenced Dr. Njoku in District Court to a year of home confinement, three-years of probation, and 416 hours of community service. He must also pay over $130,000 in restitution to Medicare and Medicaid programs. Dr. Njoku — whose medical license has not yet been suspended, according to the Columbus Dispatch — should be counting as blessings. The judge could have sentenced him to three decades behind bars and a fine of $1.5 million for his crimes.

His receptionist and co-conspirator, Veronica Scott-Guiler, was also arrested for medical fraud back in January. Scott-Guiler also pled guilty and received a similar sentence. She, too, could have been hit with much harsher penalties – including up to 15 years behind bars. Although the judge did let the Nigerian-born Njoku off relatively easily, he had harsh words for the defendant: “You should be ashamed… you don’t have the excuse [of a poor upbringing] that many of the defendants who come before me have…the good deeds [you] have done are eviscerated by the nefarious deeds committed.”

Published on: December 27, 2010

Southern California Medicare Fraud Alert: Miami-based Medicare Scam Explodes — Tens of Millions of Dollars Allegedly Stolen

by Michael Kraut

Although Southern California healthcare fraud is an enormous and perennial problem – witness the massive Armenian Mafia Medicare scam story that broke in October 2010 – the city of Miami, Florida remains the “national epicenter for Medicare fraud,” according to a story in the AP from five days ago.

The latest big breaking Medicare scam involves the drug Arformoterol, an emphysema and bronchitis drug. The Department of Health and Human Services reports that, over a year-and-a-half long period, Miami-Dade County healthcare providers paid out $34 million for drugs that should have only cost about $3.7 million. Medicare paid for 7 million units but only received 750,000 units. The fraud, which totaled more than $30 million, sounds like a big deal. But $30 million is peanuts compared with the total Medicare fraud committed annually in Miami – “roughly $3 billion,” according to the AP.

The arformoterol overbilling scheme is just one of dozens of similar scams recently perpetrated by technically savvy crooks. According to the AP, “The spike in arformoterol only came after authorities tried to crack down on another inhaler drug… as authorities have caught onto one scam, crooks have moved on to another, such as by shifting from durable medical equipment and HIV drug scams to physical therapy and home healthcare fraud.”

Published on: December 13, 2010

Massive Los Angeles Healthcare Fraud (and Elsewhere) Settlement Makes Taxpayers Livid

by Michael Kraut

The Wall Street Journal, Washington Post, Bloomberg News and other major media services are reporting on an enormous Los Angeles medical fraud (and elsewhere) settlement involving three pharmaceutical firms: Abbott Laboratories, B. Braun Medical of Bethlehem, Pennsylvania, and Roxane Laboratories of Columbus, Ohio. All told, the $420+ million settlement stemmed from a whistleblower charge pursuant to the False Claims Act.

Essentially, the drug companies overinflated their benchmark pricing to government insurers. In other words, they gave pharmacies and doctors a discounted price, and then they inflated how much the drugs cost and passed that difference onto the taxpayers. This illegal inflation became so well known that the benchmark — called the Average Wholesale Price (AWP) — soon became known among everyone in the industry as “ain’t what’s paid.” A spokesman for the Justice Department put it bluntly: “The only persons who paid the inflated, reported drug price were you, the American taxpayers.”

Cases of medical, dental, and chiropractic fraud, insurance fraud, credit card fraud, and other Southern California white collar crimes are significant and troubling. But the typical local cases pale in comparison with the national Medicare and Medicaid schemes unraveled by the Justice Department recently. Here is a quick recap of a few jaw dropping settlements:

Published on: November 30, 2010

Southern California Medicare Fraud Alert: Florida Couple Pays More Than $22 Million to Resolve Fraud Allegations

by Michael Kraut

A 70-year old cardiologist, Dr. Walter Janke, and his wife, Lalita Janke, have agreed to pay $22.6 million to resolve Medicare fraud allegations – a stunning move that has analysts who follow events in the world of Los Angeles Medicare fraud talking.

The Jankes had owned two large organizations – Medicare Advantage and America’s Health Choice Medical Plans – and allegedly overstated patient diagnoses to garner extra money from the federal government. Lawyers for the U.S. in District Court argued that Jankes’ acts violated the False Claims Act. The U.S. has frozen $20 million of the Jankes’ assets. The settlement will be paid out of those assets as well as out of their personal funds.

The Centers for Medicaid and Medicare Services (CMS) has been engaged in a long and heated battle with the Jankes, according to an article in South Florida Business Journal. The cardiologist’s attorney lamented the situation: ”there has been a long history of clear animosity directed at the Janke’s from CMS.” The attorney argued that the Medicare audit done to determine the settlement amount was unfair – essentially, by extrapolating based on a fraction of a percentage of patient cases, CMS might have erred by as much as 30%.