Former Owner of Rest Assure Home Medical Equipment Pleads Guilty in Federal Court to Health Care Fraud Charges

Medicare Scammed Out of $175,923.83

LAFAYETTE, LA—United States Attorney Stephanie A. Finley announced today that the former owner of Rest Assure Home Medical Equipment, located in Rayne, Louisiana, made an appearance in federal court and pleaded guilty to one count of health care fraud related to her obtaining $175,923.83 in Medicare reimbursements to which she was not entitled.

Dorothy Cole, age 59, of Rayne, Louisiana, was charged by bill of information on June 20, 2012, with five counts of health care fraud. According to court documents filed today, Cole was the owner and president of Rest Assure Home Medical Equipment. Rest Assure Home Medical Equipment provided durable medical equipment such as power wheelchairs and scooters to Medicare beneficiaries. Beginning in August of 2007 and continuing through April of 2009, Cole billed Medicare for a more expensive type of wheelchair, but provided her customers with scooters, which were not reimbursable by Medicare, and less expensive wheelchairs that were reimbursed by Medicare at a lower rate.

During the guilty plea hearing, Cole acknowledged that she submitted false claims to Medicare and obtained $175,923.83 in Medicare reimbursements to which she was not entitled.

At sentencing, this defendant faces a term of imprisonment of not more than 10 years, a fine of not more than $250,000, or both, and a term of supervised release of at least one year but not more than three years. Sentencing will be scheduled at a later date.

The case was investigated by the Department of Health and Human Services, Office of Inspector General, and the Federal Bureau of Investigation, Lafayette Resident Agency, and is being prosecuted by Assistant United States Attorney Kelly P. Uebinger.

Three Arrested in San Antonio Health Care Fraud Investigation

Investigation Focused on Fraudulent Medicare and Medicaid Billing Scheme

In San Antonio today, federal and state authorities arrested 38–year-old Andey Gray, of San Antonio, owner of Crown Consulting and Billing, as well as 54–year-old Michael Farris and 47–year-old Sherry Trouten, of Castroville, Texas, directors of Tejas Ambulance, Inc. (Tejas) in connection with an estimated $2.5 million fraudulent Medicare and Medicaid billing scheme, announced United States Attorney Robert Pitman, FBI San Antonio Division Special Agent in Charge, Armando Fernandez, HHS-OIG Dallas Regional Office Special Agent in Charge Mike Fields, and Texas Attorney General Greg Abbott.

The defendants are charged in a 13-count federal grand jury indictment returned on Wednesday and unsealed today. The indictment charges the defendants with 10 counts of health care fraud and two counts of theft or embezzlement in connection with health care fraud. In addition, Farris is charged with one count of making a false statement.

According to the indictment, Farris and Trouten worked for different ambulance companies—Farris, as director of Medina Valley Emergency Medical Services (Medina Valley), director of Tejas, and interim director for Community Emergency Medical Services, Inc. (Community); Trouten, as an administrator for Community, bookkeeper for Medina Valley, and business manager for Tejas. Gray, through his business, processed medical claims for Medina Valley, Community, and Tejas.

The indictment alleges that in March 2011, Farris and Trouten began surreptitiously diverting Medina Valley and Community incoming calls for service to Tejas Ambulance. Because Tejas Ambulance was not an authorized Medicare or Medicaid provider, the defendants began using numbers assigned to other entities, including Medina Valley and Community, to fraudulently submit claims for ambulance services either performed by Tejas, or not even performed at all. The indictment further alleges that the defendants then embezzled those Medicare and Medicaid funds from Medina Valley and Community, diverting them to Tejas Ambulance and ultimately, to themselves. As a result of the defendants’ scheme, Medicare and Medicaid paid just under $600,000 for claims that were not qualified for reimbursement from Medicare and Medicaid.

Upon conviction, the defendants face up to 10 years in federal prison per health care fraud related count. Farris is also subject to a maximum of five years in federal prison upon conviction of the false statement charge.

This case was investigated by the Texas Attorney General’s Medicaid Fraud Control Unit together with the Federal Bureau of Investigation, U.S. Department of Health and Human Services Office of Inspector General, and the U.S. Department of Labor, Employee Benefits Security Administration. Special Assistant United States Attorney Kimberly Johnson is prosecuting this case on behalf of the government.

An indictment is merely a charge and should not be considered as evidence of guilt. The defendants are presumed innocent until proven guilty in a court of law.

Phony Psychiatrist Sentenced to Six Years in Prison for Defrauding Patients, Doctors, and Insurance Companies

PHILADELPHIA—Jo Benoit, a.k.a. Elissa Jo Benoit, 77, of King of Prussia, Pennsylvania, was sentenced today to 72 months in prison for a health care fraud scheme that included posing as a psychiatrist when she was not one and writing prescriptions for people who suffered from serious mental health issues, including bipolar disorder, posttraumatic stress disorder, and other serious conditions. More than 50 patients were victims of Benoit’s scam. In addition to the patients she defrauded and exposed to improper treatment, Benoit stole the identifying information of legitimate psychiatrists and forged prescriptions in their names. She also used one psychiatrist’s identity to bill insurance companies more than $500,000 for patient visits. Benoit was convicted by a federal jury on June 12, 2012, of 76 counts of health care fraud, aggravated identity theft, distribution of controlled substances, and distribution of controlled substances to minors.

The defendant was immediately taken into custody to begin serving her six-year prison sentence. In addition, the defendant was ordered to pay forfeiture and to pay restitution in the full amount that she defrauded patients and insurance companies. In total, she is required to make the victims whole in the amount of $422,583.62. In addition, she was ordered to pay a special assessment of $7,600, and she is subject to three years of supervised release.

Benoit was the CEO and founder of a mental health clinic called Transition Phase III from February 4, 2009, until the clinic was closed after a search warrant was executed in July 2011. She advertised the clinic as a trauma-specific mental health clinic directed at victims of trauma, children, and members of the military and their families. Benoit provided forged prescriptions to the patients at the clinic and medicated the patients that she purported to be treating. Benoit also wrote prescriptions to children, one as young as 4 years old. During the course of her fraud, the defendant exposed those patients to a serious risk of harm and left them without appropriate treatment.

“This case demonstrates the many serious problems associated with health care fraud,” said Special Agent in Charge Nick DiGiulio, of the Inspector General’s Office for the United States Department of Health and Human Services in Philadelphia. “Jo Benoit illegally prescribed dangerous drugs to children and military veterans. She lied to patients about her credentials, provided sham psychiatric services to those with serious mental traumas, stole the identities of legitimate health care professionals, and lied to our insurance programs for money. We will continue to work tirelessly with our law enforcement partners to protect our citizens from these atrocious crimes.”

The case was investigated by the U.S. Department of Health and Human Services Office of Inspector General, the Defense Criminal Investigative Service, and the Federal Bureau of Investigation. It is being prosecuted by Assistant United States Attorney Matthew J.D. Hogan.

Rossville Man Sentenced in Health Care Fraud and Tax Evasion Case

HAMMOND, IN—United States Attorney David Capp announced that Chad Shedron, 36, of Rossville, Indiana, was sentenced by Chief Judge Philip Simon to 57 months’ imprisonment and one year of supervised release after pleading guilty to a two-count Information charging him with the felony offenses of executing a scheme to defraud the Indiana Medicaid health benefit program and evading federal income tax.

According to the plea agreement filed in this case, Shedron agreed to a money judgment in the amount of $3,521,961.22, which represents the dollar amount of proceeds derived from the health care fraud. He also agreed that the tax loss for 2007 was approximately $189,009.00, and further agreed that he is responsible for tax losses of $164,728.99 in 2008; $141,623.00 in 2009; and $32,310.00 in 2010. Further, Shedron agreed to forfeit his personal residence, $65,000 in cash, a brokerage account, jewelry, and a baseball card collection with an estimated value of over $200,000.

This case was the result of an investigation by the Department of Health and Human Services-Office of the Inspector General; the Internal Revenue Service-Criminal Investigations; the Federal Bureau of Investigation; and the Indiana Medicaid Fraud Control Unit. This case was prosecuted by Assistant United States Attorney Diane Berkowitz.

President of Miami Medical Clinic Pleads Guilty to Health Care Fraud Charges

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; Michael B. Steinbach, Acting Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; and Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), announce that defendant Arbilio Yanes pled guilty today to Medicare fraud and related offenses before U.S. District Judge Cecilia M. Altonaga.

More specifically, Yanes pled guilty to one count of conspiracy to commit health care fraud and to pay health care kickbacks (count one); two counts of health care fraud (counts two and three); four counts of payment of health care kickbacks (counts four through seven); four counts of money laundering (counts eight through 11); and two counts of money laundering (counts 12 and 13). Sentencing is scheduled for November 5, 2012. At sentencing, Yanes faces a statutory maximum sentence of up to five years in prison on counts one and four through seven; up to 10 years in prison on counts two, three, 12, and 13; and up to 20 years in prison on counts eight through 11.

According to statements made in court at the plea hearing, Yanes was the president of Research Center of Florida Inc., a purported medical clinic located in Miami-Dade County, Florida. Between October 13, 2003 and November 5, 2004, Research Center submitted claims to Medicare for $21,043,982, almost exclusively for purported treatment of HIV+ Medicare beneficiaries by administration of prescription drugs. Based on these claims, Medicare paid Research Center $11,098,388.93. In fact, Research Center personnel generally administered smaller doses of the medications than the clinic billed in its claims or no treatment at all.

Yanes paid more than $1.6 million to shell companies controlled by outside patient recruiters. Those shell companies did no business with Research Center, but the recruiters located Medicare beneficiaries who were willing to attend Research Center as purported patients and paid the beneficiaries to do so. Yanes also paid himself over $1.3 million in profits from the scheme. Of that sum, Yanes paid more than $650,000 to two shell companies he controlled, which did no business with Research Center.

Efren Mendez, the vice-president of Research Center; Damian Beltran, a medical assistant at the clinic; and Barbara Perez and Caridad Perez, patient recruiters for the clinic, have all previously pled guilty to conspiracy to commit health care fraud in related cases.

Mr. Ferrer commended the investigative efforts of the FBI and HHS-OIG. This case was prosecuted by Assistant U.S. Attorney Marc Osborne.