Assistant Attorney General Brian A. Benczkowski of the
Justice Department’s Criminal Division announced today an expansive health care
fraud enforcement operation across the Gulf Coast, involving charges against a
total of 11 individuals across four federal districts for their alleged
involvement in various schemes to defraud Medicare, Medicaid and TRICARE and to
obtain oxycodone and other controlled substances by fraud. The conduct allegedly resulted in more than
$515 million in fraudulent billings.
Those charged included physicians, licensed social workers, as well as
other medical and business professionals.
In addition, in the state of Louisiana, 22 defendants, including 19
certified mental and home health professionals, have been charged with
defrauding Medicaid out of approximately $300,000. These cases were
investigated by Louisiana’s Medicaid Fraud Control Unit (MFCU).
Today’s enforcement actions were led and coordinated by the
Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction
with its Medicare Fraud Strike Force (MFSF) partners, a partnership among the
Criminal Division, U.S. Attorney’s Offices, the FBI, the Drug Enforcement
Administration (DEA), and U.S. Health and Human Services-Office of Inspector
General (HHS-OIG). In addition, the
operation includes the participation of IRS-Criminal Investigations (IRS-CI),
Mississippi Bureau of Narcotics (MBN) and various other federal law enforcement
agencies and state MFCUs.
The charges announced today aggressively target alleged
schemes billing Medicare, Medicaid, TRICARE (a health insurance program for
members and veterans of the armed forces and their families) and private
insurance companies for medically unnecessary services, such as psychotherapy
and other behavioral health services, and items, including durable medical equipment
and compounded medications.
“Fraud against our nation’s vital federal health care
programs amounts to theft from American taxpayers,” said Assistant Attorney
General Brian A. Benczkowski of the Justice Department’s Criminal
Division. “The Department of Justice,
together with our law enforcement partners, will continue to investigate and
prosecute aggressively those who bill these programs for medically unnecessary
services, whether in the Gulf Coast or elsewhere in the United States.”
“Health care fraud steals valuable resources from those
truly in need and tarnishes the hard-earned respect of honest health care
providers who deliver legitimate health care for their fellow Americans every
day,” said U.S. Attorney Brandon J. Fremin of the Middle District of Louisiana.
“It is especially egregious when carried out by health care professionals who
are betraying the trust given them by the community. As demonstrated by this takedown, this office
remains committed to working with our outstanding partners in the Strike Force
including federal, state, and local law enforcement and prosecutors in
Louisiana and throughout the country to aggressively pursue those who defraud
our health care systems. Our message is
consistent: we will bring every available resource to bear in seeking justice
through investigations and convictions of those who commit health care
fraud. I want to commend the hard work
of all who have been instrumental in this nationwide effort.”
“The charges announced today reinforce The U.S. Department
of Justice’s mission to aggressively pursue those individuals and medical
providers who attempt to prey on our most vulnerable citizens,” said U.S.
Attorney Peter G. Strasser of the Eastern District of Louisiana. “Our office, along with our law enforcement
partners, will continue to seek justice for those impacted by Health Care Fraud
schemes.”
“Law enforcement works tirelessly to detect health care
fraud, and we will continue to use every lawful tool at our disposal to
prosecute those who defraud public programs of their limited funds,” said U.S.
Attorney Lawrence Keefe of the Northern District of Florida. “This indictment is the next step in holding
these two defendants accountable for their actions.”
“Healthcare fraud harms us all," said U.S. Attorney
Mike Hurst of the Southern District of Mississippi. "When individuals put their greed above
the interests and well-being of our men and women in uniform and our veterans,
this office will be there to swiftly bring them to justice.”
“Medicaid welfare fraud not only jeopardizes resources from
our most needy but it also steals from our taxpayers,” said Louisiana Attorney
General Jeff Landry. “So I applaud my Medicaid Fraud Control Unit and our law
enforcement partners for their efforts to find, arrest and prosecute Medicaid
welfare fraudsters.”
“Healthcare Fraud continues to impact the cost of healthcare
in America and is amplified when trusted professionals abandon their ethical
code in the name of greed. These
unethical practices are damaging the lives of individuals and families
throughout this country,” said Special Agent in Charge Thomas J. Holloman for
the IRS-CI Atlanta Field Office.
“Medical professionals who illegally dispense prescription narcotics are
no better than street level drug dealers and must be held accountable for their
actions, therefore IRS-CI
will continue to work with our law enforcement partners and
the US Attorney's Office to address these public challenges.”
“Healthcare fraud harms patients and diverts taxpayer funds
from vitally important federal healthcare programs that exist for the sole
purpose of providing care to beneficiaries with medical needs,” said Special
Agent in Charge C.J. Porter of the HHS-OIG Dallas Region. “As this takedown demonstrates, we will continue
to work with our law enforcement partners to crack down on and bring to justice
those who disregard the medical needs of patients and betray the public’s trust
for their own personal enrichment.”
“Along with our partners, the FBI has dedicated significant
time, manpower, and resources toward investigating criminal enterprises engaged
in defrauding Medicare, Medicaid, private insurance companies and prescription
drug schemes,” said Special Agent in Charge Bryan Vorndran of the FBI’s New
Orleans Field Office. “Organizations or
individuals providing dangerous and unnecessary medical services to any citizen
and billing fraudulently is unacceptable and will continue to be high priority
investigations of the FBI. The illegal
prescribing and dispensing of oxycodone and other controlled substances for
distribution to citizens who battle addiction will not be tolerated and adds to
the escalating opioid epidemic in this country.”
“The Defense Criminal Investigative Service, with our
investigative partners, is committed to thoroughly investigate and bring to
justice anyone who defrauds TRICARE or endangers our nation's brave soldiers,
sailors, airmen, marines, retirees and military families,” said Special Agent
in Charge Cynthia Bruce of the DCIS Southeast Field Office. “Our agency is stepping up our efforts to
combat the opioid problem facing our nation.
These complex and expansive fraud schemes diverted significant taxpayer
funds that should be spent on critical medical care.”
*********
Among those charged in partnership between Strike Force
attorneys and U.S. Attorney’s Offices are the following:
In the Southern District of Mississippi, three defendants
have been charged.
Wade Ashley Walters, 52, of Hattiesburg, Mississippi, a
co-owner of numerous compounding pharmacies and pharmaceutical marketing
companies, was charged for his alleged role in a scheme to defraud TRICARE and
other private health insurance companies by paying kickbacks to practitioners
and marketers for the prescribing and referring of fraudulent prescriptions for
medically unnecessary compounded medications that were ultimately dispensed by
his pharmacies, as well as for his alleged role in a scheme to launder the
proceeds of the fraud scheme. The
indictment alleges that, based on these fraudulent prescriptions, Walters
caused TRICARE and other health care benefit programs to reimburse his and
other compounding pharmacies more than $510 million. The case is being prosecuted by Assistant
Deputy Chief Dustin Davis and Trial Attorney Sara Porter of the Fraud Section,
Trial Attorneys Amanda Wick and Stephanie Williamson of the Criminal Division’s
Money Laundering and Asset Recovery Section and Assistant U.S. Attorney Mary
Helen Wall of the Southern District of Mississippi.
Gregory Auzenne, M.D., 49, of Meridian, Mississippi, and
Tiffany Clark, 45, of Meridian, Mississippi, were charged for their alleged
participation in a scheme to defraud TRICARE and other private health insurance
companies by prescribing medically unnecessary compounded medications in
exchange for kickbacks and bribes. The
indictment alleges that Auzenne and Clark caused the submission of over $1.6
million in fraudulent claims to TRICARE.
The case is being prosecuted by Trial Attorneys Jared Hasten and Sara
Porter of the Fraud Section and Assistant U.S. Attorney Mary Helen Wall.
In the Middle District of Louisiana, four defendants have
been charged.
J. Foster Chapman, D.O., 40, of Alexandria, Louisiana, was
charged for his alleged participation in a scheme to prescribe medically
unnecessary durable medical equipment, namely orthotics, to Medicare
beneficiaries whom he never examined and in the absence of any doctor-patient
relationship. According to the indictment,
Chapman concealed the fraud with falsified orders that stated, among other
things, that he consulted with the beneficiaries and conducted diagnostic
tests, which were not conducted. The
indictment alleges that Chapman caused the submission of over $4.8 million in
fraudulent claims to Medicare. The case
is being prosecuted by Trial Attorney Justin M. Woodard of the Criminal
Division’s Fraud Section and Assistant U.S. Attorney Kristen L. Craig of the
Middle District of Louisiana.
Victor Clark Kirk, 70, of Baton Rouge, Louisiana, and
Marilyn Brown Antwine, 51, of Baton Rouge, Louisiana, the former CEO and COO,
respectively, of a federally qualified health center, were charged for their
alleged roles in a scheme to defraud Medicaid.
Specifically, the indictment alleges that Kirk and Antwine directed
employees to falsely diagnose students with significant mental health disorders
and subsequently submit false claims to Medicaid falsely claiming that
psychotherapy services were provided, when in fact they were not. According to the indictment, during the
relevant time period, the health center’s claims for purported group
psychotherapy services totaled more than $1.8 million. The case is being prosecuted by Trial
Attorney Justin M. Woodard and Assistant U.S. Attorney Jessica M.P. Thornhill
of the Middle District of Louisiana.
In the Eastern District of Louisiana, three defendants have
been charged.
Aaron Denn, 34, of Metairie, Louisiana, was charged for his
alleged role in a scheme to obtain and divert oxycodone pills to the black
market. The case is being prosecuted by
Trial Attorney Jared Hasten.
Christie Lynn Browning, 40, of Metairie, Louisiana, was
charged for her alleged role in a conspiracy to obtain oxycodone by fraud and
to then distribute those oxycodone pills.
The case is being prosecuted by Trial Attorney Jared Hasten and
Assistant U.S. Attorney Myles Ranier of the Eastern District of Louisiana.
In the Northern District of Florida, two defendants have
been charged.
Helen Elizabeth Storey, 37, of Tallahassee, Florida, and
Stephanie Lynn Fleming, 42, of Tallahassee, Florida, the owner of, and a
licensed mental health counselor at, a Tallahassee-based counseling center,
were charged for their alleged participation in a scheme to defraud Medicaid by
submitting false and fraudulent claims for purported behavioral health
services, including psychotherapy, that were not provided. According to the indictment, Fleming and
Storey submitted approximately $250,000 in false and fraudulent claims to Medicaid. The case is being prosecuted by Assistant
U.S. Attorney Justin Keen of the Northern District of Florida.
*********
The charges and allegations contained in the indictments are
merely accusations. The defendants are
presumed innocent until proven guilty beyond a reasonable doubt in a court of
law.
The Fraud Section leads the Medicare Fraud Strike Force
(MFSF), which is part of a joint initiative 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 its inception in March 2007, MFSF maintains 15 strike forces
operating in 24 districts and has charged nearly 4,000 defendants who have
collectively billed the Medicare program for more than $14 billion. In addition, HHS Centers for Medicare &
Medicaid Services, working in conjunction with HHS-OIG, are taking steps to
increase accountability and decrease the presence of fraudulent providers.
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