Leonard Langman, M.D. Pleads Guilty to Medicare and Health Care Fraud – What motivated his behavior?

For those physicians who provide health care to patients who are covered by Medicare, Workman’s Comp. or other similar types of services, has it become so restrictive that the reduced fees earned is forcing physicians to turn to illegal activities to compensate?

I suspect that as you read this your first reaction is What?  What a reach and crazy question…  But, before your read the account of the doctor who could receive 10 years in Federal Prison below – think about what comes together to create a fraud.  As a business ethics and fraud prevention speaker, I see, all to often, that when three things come together: (1) Need; (2) Opportunity and (3) Rationalization – it creates the PERFECT STORM for fraud.  To be clear, just because those three things are present does not mean that Fraud will occur, rather it means that the conditions are right for the ethical person to make the unethical choice that can lead to illegal activities and fraud.  As I speak to groups internationally the significant question that comes up is not what happened – that is generally evident by the facts, but rather what motivated the perpetrators behavior in the first place?

I don’t know what motivated Leonard Langman, M.D. but you can take to the bank (not literally as Dr. Langman did) that there was some need that was the spark that motivated his behavior.  The question is what?  Read the US Attorney’s news release below for details and perhaps you can comment on his motivation…

PRESS RELEASE

BROOKLYN NEUROLOGIST PLEADS GUILTY IN HEALTH CARE FRAUD SCHEME

WASHINGTON – Leonard Langman, M.D., a neurologist who owned and operated a Brooklyn, N.Y., medical clinic pleaded guilty today for his role in a scheme to defraud Medicare; the U.S. Department of Labor, Office of Workers’ Compensation Programs (OWCP); the New York State Workers’ Compensation Board (NYS-WCB); the New York State Insurance Fund (SIF) and various private health insurance carriers, announced the Departments of Justice and Health and Human Services.

Dr. Langman pleaded guilty before U.S. District Judge Kiyo A. Matsumoto in Brooklyn to one count of health care fraud.

According to court documents, from January 2006 to December 2009, Dr. Langman caused false and fraudulent claims to be submitted to Medicare, OWCP, NYC-WCB, SIF and others.  Langman submitted claims for services that were not provided; misrepresented the services he provided by billing for a level of service higher than that which he performed; double-billed different health care benefit programs for the same service provided to the same beneficiary; and billed for services purportedly performed when he was out of the country.

At sentencing, Dr. Langman faces a maximum sentence of 10 years in prison.  Sentencing is scheduled for Dec. 2, 2011.

The guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, U.S. Attorney Loretta E. Lynch for the Eastern District of New York and Special Agent-in-Charge Thomas O’Donnell of the Department of Health and Human Services, Office of Inspector General (HHS-OIG).

The case is being prosecuted by Trial Attorney James Hayes of the Criminal Division’s Fraud Section.  HHS-OIG, the U.S. Postal Service, Office of Inspector General and the New York State Workers Compensation Board, Office of Inspector General conducted the investigation.  The case 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 New York.

Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,000 defendants who collectively have falsely billed the Medicare program for more than $2.3 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.

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

If you have insight into this case…please share your thoughts.

YOUR COMMENTS ARE WELCOME!

Buusiness Ethics and Fraud Prevention Speaker Chuck Gallagher addresses FBI Conference

“CHOICES: Negative Consequences – Positive Results”

Chuck Gallagher Shares the Impact of Choices

at a Time when Ethical Choices seem to be missing from Business Culture

 CHARLOTTE, NC.  July 7, 2011.  From Prison to Promise, Chuck Gallagher’s presentation:  CHOICES: Negative Consequences – Positive Results –  exposes the power of choice and the negative consequences or positive results that can follow.   Selected to present to the 2011 FBI CPA Conference in Denver, Colorado, this annual FBI conference generally focuses on economic and other white-collar crimes.  Recognizing the importance of ethics and their practical application, Gallagher, as a speaker, is a natural fit for this national conference as he shares from experience how a life can change and the course of history can be altered by one unethical choice. In today’s environment, with so many lives turned “topsy turvy,” CHOICES  - provides a meaningful and practical framework for understanding how an otherwise ethical person can make unethical and potentially illegal choices.  CHOICES –  exposes the impact of unethical choices and the power that ethical choices can have.  As a business ethics and fraud prevention speaker, Gallagher’s presentations provides a foundation for business ethics training that goes beyond case studies and focuses on real life issues.

Chuck Gallagher, author of the new book Second Chances, has lived through it and he has come out a better man, husband, and father.  As a nationally recognized CPA, Gallagher lost it all when he made unethical choices by creating a Ponzi scheme and defrauding his clients and it all began with one bad decision.  He chronicles his fall from a wonderful life of success into the inside of a prison cell and how he managed to take the steps to rebuild his life to one full of meaning, purpose, and promise.

Shortly before his sixth month in prison, Gallagher asked himself, “Where from here?” This ultimately becomes his personal call to action upon which this book is premised. Gallagher states, “You may make a mistake, but YOU ARE NOT A MISTAKE.” So what’s next? What do you do next? How will you put one foot in front of the other to manifest the power over the choices you make now and in the future?

Gallagher’s presentations offer nuts and bolts information relevant to anyone from Main St. to Wall St. It packs hard-hitting, no-nonsense tools that the audience member can actually manifest into the power of ‘choice intelligence’. Through his transparent heart felt presentations, Gallagher says to the his audience, “Take what I’ve learned and apply it in your life and you will transform your destiny.  Explore every God-given opportunity and, in the process, you’ll develop a higher level of consciousness through better choices and a higher purpose. Honor your life, make wise choices, you will make a difference in your own life, the lives of others, and in society.”

Today, Gallagher is COO of a national company and speaks internationally on business ethics – choices and consequences. Chuck openly and candidly shares the lessons his roller coaster ride in life has taught him.  Described as “creative..,” “insightful…,” “captivating…,” and a person that “connects the dots” between behavior, choices, and success, Chuck Gallagher provides his clients, readers, and audiences with what they need to turn concepts into actions and actions into results

Chuck’s presentations drive home the very real issues involved in businesses today.  One unethical errant choice and the media fallout can have an immediate impact on business results.  For information about Gallagher’s ethics presentation contact Chuck at chuck@chuckgallagher.com ,call him at 828.244.1400 or visit his website:  http://chuckgallagher.com.

Burr Oak Cemetery ex-director – Carolyn Towns – sentenced to 12 Years in Prison! What did she do and Why? Comments are welcome!

Perhaps now this chapter of the history of Burr Oak Cemetery located outside of Chicago can be put to rest – much like people would want for those buried there.  Unfortunately Burr Oak, at least in recent day, has been anything but a place of rest rather it was a place where hundreds of graves were dug up and resold.

The former director of a Chicago-area cemetery Carolyn Towns, 51, who ran the Burr Oak Cemetery when the allegations surfaced in 2009, was sentenced to 12 years in prison after she pleaded guilty to all charges against her, including dismembering a human body and theft from a place of worship, according to state prosecutors in Cook County, Illinois.

WHAT DID THEY DO?

In an effort to sell more property (grave spaces) prosecutors allege the grave diggers would exhume bodies, crushing vaults and caskets before dumping human remains at the cemetery’s trash site.  They then would  “double stack” graves, in other words  they would bury existing remains deeper into the ground before placing new remains in the same grave site.

In a CNN report the following is stated:

Towns “is very remorseful, not only for the pain she caused her family, but the families of people who have loved ones at Burr Oak,” defense attorney Susana Ortiz said, according to CNN affiliate WLS. “She accepted responsibility for the allegations in this case, and she would just like to put this behind her and move on with her life.”

As part of the grueling investigation, the CNN report goes on to say:

At the time, Sheriff Thomas J. Dart said the scene at the cemetery was disturbing. “I found bones out there,” he said. “I found individuals wandering aimlessly looking for their loved ones who can’t find them.”

The investigation also extended into “Babyland,” a section of the cemetery intended for children. Dart said he talked to countless women who could not find their children.

Authorities also discovered the original glass-faced casket belonging to 14-year-old Emmett Till, piled in a garage filled with lawn care equipment.

WHAT MOTIVATES SUCH BEHAVIOR?

An Associated Press article provides a clearer explanation as to the motives behind the Burr Oak debacle.  “Prosecutors say Towns stole more than $100,000 from the corporation that owned Burr Oak by keeping the payments for burials and having workers stack bodies or dump remains in unmarked mass graves.” Some published reports say the amount taken was more than 300,000.

According to the Chicago Sun Times, “Towns’ attorney Richard S. Kling said the money she stole fed a terrible gambling addiction, and blinded her sense of what she knew was right.”

As a business ethics and fraud prevention speaker, and also a person who is actively involved in the Death-Care industry, I see, all to often, that when three things come together: (1) Need; (2) Opportunity and (3) Rationalization – it creates the PERFECT STORM for fraud.  To be clear, just because those three things are present does not mean that Fraud will occur, rather it means that the conditions are right for the ethical person to make the unethical choice that can lead to illegal activities and fraud.  As I speak to groups internationally the significant question that comes up is not what happened – that is generally evident by the facts, but rather what motivated the perpetrators behavior in the first place?

It appears that Towns had a need (according to her attorney – support a gambling habit).  Towns also had opportunity as the director of the cemetery she had the power to authorize the maintenance worker to perform inappropriate and illegal conduct (they could have refused, but often in subordinate roles they will not assuming they are protected by doing what their boss tells them).  Lastly, Towns was so likely caught up in the illusion she created that she had no ability to see reality – hence she could rationalize her behavior.

None of this makes what she did right!  Not at all, but rather it, in simple form, shows what might have contributed to her mindset that what she did was right.

The judge in this case got it right!

“The victims in this case are essentially the public,” he said. “The defendant’s actions in these crimes caused ­­— while not physical harm ­— I believe irreparable emotional and psychological harm.

“There is no way to repair the harm done to those grieving families and friends.”

If you were a victim of Carolyn Town actions…feel free to comment here so others can know your feelings!

YOUR COMMENTS ARE WELCOME!

Ronald Munkeboe DUI Attorney arrested for DUI – hum…funny how folks tend to get caught for what they are know for!

So we’re clear…it is not my intention to make fun of or find joy in anothers plight.  Yet, this article shows something that, if you look closely, is a trend when it comes to negative choices and their painful consequences.  Perhaps a psychologist would call it human nature…or perhaps there is another description for it, but more times than not, the negative choices that we make in life tend to revolve around the positive things we naturally do.

Think about it…Bernie Madoff was a brilliant investor and yet his negative choices centered around a Ponzi scheme or his financial work.  John Edwards indiscretions centered around his campaign.  My choices were focused around theft and failure to pay taxes on stolen money, and I was a CPA.  So, it’s no surprise that a DUI attorney would find his legal challenges related to – A DUI!

Here’s the report:

A Nashville DUI attorney was arrested late Tuesday night after nearly running over a Metro police officer as he sped out of a Bellevue gas station.

According to the police affidavit, Officer Mary Taylor saw Ronald Munkeboe pull into the Shell station at the corner of Charlotte Pike and Old Hickory Boulevard and watched as he picked up a tall can of beer from his console and took a sip.

Taylor reported Munkeboe was unsteady on his feet as he walked into the convenience store and she confronted him when he returned to his vehicle.

After identifying herself as a Metro officer, Munkeboe asked her if she was on duty, according to the affidavit.

After Taylor replied yes, and asked him to step out of his car, Munkeboe replied, “I’m alright”, put his vehicle in reverse and sped out of the parking lot.

Officer Taylor was nearly struck in the process.

Munkeboe, 45, was tracked to his home on nearby Wheatfield Court.  He admitted to drinking six or seven beers and was arrested.

He was booked into the Metro jail on charges of DUI and aggravated assault of an officer, among other charges.

Munkeboe graduated from the Nashville School of Law in 1999 and serves as a criminal defense attorney in Nashville with the firm Middle Tennessee Law, according to his Web site.

What are your thoughts?  Do you know Ronald Munkeboe?  Is this just a simple mistake on Munkeboe’s part or a pattern of behavior?  Wouldn’t it have been easier to submit to the officer rather than almost run over him?  After the consequences of his actions becomes clear, don’t you think Munkeboe will have a hard time in the court room defending DUI clients since law enforcement officials likely won’t forget his encounter with one of their own?

Information on his background is here:  http://www.lawyer.com/ron-munkeboe.html

YOUR COMMENTS ARE WELCOME!

Former Loan Officer Michael Pahutski sentenced to 19 years in Prison for Mortgage Fraud Scheme

As you look over the reported facts of this case, it’s sad to see that so many could conspire to defraud.  Do I blame the perpetrators – Yes!  But, when you look more closely we have to evaluate what was happening at the time and how the environment created the opportunity to join together to create such a widespread fraud.

As a business ethics and fraud prevention speaker, I see, all to often, that when three things come together: (1) Need; (2) Opportunity and (3) Rationalization – it creates the PERFECT STORM for fraud.  To be clear, just because those three things are present does not mean that Fraud will occur, rather it means that the conditions are right for the ethical person to make the unethical choice that can lead to illegal activities and fraud.

Read the US Attorney’s news release below for more details…

DEPARTMENT OF JUSTICE

United States Attorney Anne M. Tompkins
Western District of North Carolina

FOR IMMEDIATE RELEASE
FRIDAY, MAY 6, 2011

CONTACT: Lia Bantavani
704.338.3140
Fax: 704.227.0264

LOAN OFFICER SENTENCED TO 19 YEARS IN PRISON CHARLOTTE, NC—Today, the United States Attorney’s Office for the Western District of North Carolina announced that Michael Pahutski, 48, of Gastonia, was sentenced to 19 years imprisonment to be followed by five years of supervised release. Pahutski was also ordered to perform 200 hours of community service and pay restitution of approximately $3.5 million. The sentence is the latest step in an ongoing investigation of mortgage fraud schemes carried out around the Charlotte area, which led to the charging of eight individuals with mail, wire and bank fraud conspiracy, money laundering conspiracy, and related charges in March 2008. The investigation also resulted in the trial of closing attorney and co-defendant Victoria Sprouse in March 2009. Pahutski pled guilty prior to trial, without the benefit of a plea agreement, to all twenty-one counts in the indictment then pending against him.

Joining the U.S. Attorney’s Office in making today’s announcement are Jeannine Hammett, Special Agent in Charge of IRS-Criminal Investigation Division; Chris Briese, Special Agent in Charge of the Federal Bureau of Investigation, Charlotte Division; Inspector In Charge of the U.S. Postal Inspection Service, Keith Fixel; and Wayne Goodwin, Commissioner, North Carolina Department of Insurance.

A federal indictment charging Michael Pahutski with mortgage-fraud- related offenses was originally filed in August 2007, followed by a superseding indictment adding charges and five other defendants in March 2008. To date, all six of those defendants have been either convicted at trial or have entered pleas of guilty. The charges represent the results of a local investigation which stemmed from the detection of an original mortgage fraud scheme in September 2002, and focused on a group operating in and around the Charlotte area. The indictment alleged, and the evidence presented at the sentencing hearing and elsewhere, showed that all the defendants participated in a series of mortgage fraud schemes involving more than $20 million in mortgage loans and hundreds of houses in Charlotte-area neighborhoods. The defendants included Pahutski who served as a loan officer, as well as a closing attorney, a real estate appraiser, another mortgage broker, and two realtors. The indictment also identified two other attorneys, three home builders (including one national homebuilder), and several real estate investors as co-conspirators in these schemes. One of the banks victimized by the schemes closed its doors in mid-2007 after 103 years of business in large part due to the scheme.

The indictment alleged that Pahutski participated in a “flip” mortgage fraud scheme where houses were purchased through fraudulent mortgage applications and use of other false documents. Pahutski was originally indicted in this case in connection with a scheme involving closing attorney Victoria Sprouse and real estate investor Stephen Hawfield, in which approximately 210 houses were purchased in a “flip scheme” through fraudulent mortgage applications to nBank for more than $15 million.

U.S. District Judge Martin Reidinger pronounced the 19 year sentence. In doing so, Judge Reidinger explained that he hoped others would note the sentence, and “see that they do not want to become mortgage fraudsters.” The Judge noted that the offense had caused substantial damage to nBank, which failed, and also had caused substantial damage to our financial system. Judge Reidinger said that the heavy sentence was based in part on the fact that Pahutski had been entrusted by the state of North Carolina with a license, and “was supposed to have been part of the firewall to prevent this [mortgage fraud] from happening, but instead became part of the problem.” Following the sentencing hearing, Judge Reidinger ordered that Pahutski be immediately taken into custody and
detained as a flight risk.

The case was investigated by Special Agents of the FBI, Charlotte, Special Agents of the IRS-CI, U.S. Postal Inspectors, and criminal investigative personnel of the NC Insurance Commission. The case was prosecuted by Assistant U.S. Attorneys Kurt W. Meyers and Jenny Sugar of the U.S. Attorney’s Office, Criminal Division, Charlotte, NC, as well as former Assistant U.S. Attorney Matthew Martens.

United States v. Pahutski, et al
Docket Number: 3:07CR211
Michael D. Pahutski, 48 (Loan Officer)
Charlotte, NC
Guilty plea entered 3/3/09
Sentenced 5/6/11 to 228 months imprisonment to be followed by a five-year term of supervised release, 200 hours of community service, and ordered to pay $3,563,125.27 in restitution

Victoria L. Sprouse, 40 (Closing Attorney)
Charlotte, NC
Jury trial 3/23/09 – 4/1/09
Guilty verdict by jury 4/1/09
Awaiting sentencing

Michael Gee, 61 (Appraiser)
Hilton Head, SC
Guilty plea entered 3/10/2009
Sentenced 6/24/10 to 24 months imprisonment to be followed by a three-year term of supervised release and ordered to pay $3,563,125.27 in restitution

Gregory A. Mascaro, 44 (Real Estate Agent)
Harrisburg, NC
Guilty plea entered 6/9/08
Sentenced 2/27/09 to 24 months imprisonment to be followed by a three-year term of supervised release and ordered to pay $62,361.21 in restitution

Jules Springs, 43 (Loan Officer)
Charlotte, NC
Guilty plea entered 7/7/08
Sentenced 5/19/09 to 24 months imprisonment to be followed by a three-year term of supervised release and ordered to pay $62,361.21 in restitution

Gregory D. Rankin, 36 (Real Estate Agent)
Charlotte, NC
Guilty plea entered 6/25/08
Sentenced 2/27/09 to five years probation, first 23 months under home confinement

If you have knowledge of any of these who were involved in this massive scheme…please feel free to share your insights.

YOUR COMMENTS ARE WELCOME!

Great Article from Chris MacDonald – ‘Doing the right thing:’ A brief guide to the jargon | CanadianBusiness.com

‘Doing the right thing:’ A brief guide to the jargon | CanadianBusiness.com.

This is an excellent article from Chris MacDonald published in Canadian Business.  As a business ethics speaker, I often find that my audience and even at times my clients become confused between the terms: Business Ethics; Corporate Social Responsibility; Sustainability and the Triple Bottom Line.

Chris does a great job in summarizing those for the reader and I’m pleased to feature his article here so others might benefit.

Crystal Dawn Bric Pleads Guilty to Theft of more than $300,000 from SC Probation, Pardon and Parole Bank Account!

Does it seem that South Carolina has the lock of stupid choices?  First our (former) Governor gets lost on the Appalachian Trail and ends up in Argentina and now we find an individual steals from the SC Dept. or Probation, Pardon and Parole.  Maybe its me, but doesn’t it just seem too close for comfort to steal from an organization that is involved with prisons and inmates?

NEWS RELEASE:

Columbia, South Carolina United States Attorney William N. Nettles stated today that a former resident of the Columbia based Restitution Center, Crystal Dawn Bric, age 31, of Columbia, pled guilty on Wednesday to one count of bank fraud, for her scheme to steal more than $300,000 from a Wachovia bank account owned by the South Carolina Department of Probation, Pardon and Parole.

The facts presented at the plea hearing were that during the year 2007, Crystal Bric was on state probation and was housed at the SC Probation, Pardon and Parole Restitution Center in Columbia, SC. Using a check she received from a Probation Pardon and Parole Wachovia bank account, she obtained the bank account number and routing number. She began using the account number to pay her rent, her utilities, and for cell phones for herself and others. She did this using a telephone and making electronic payments. She also used friends social security numbers to open credit card accounts and then electronically paid for the credit cards using these Wachovia account numbers. The scheme was executed from approximately December 2007 through October 2009. Auditors have concluded that Ms. Bric wrongfully took approx. $337,944 in state funds from this Wachovia bank account.

The maximum possible penalty for bank fraud is thirty years and a fine of $1,000,000.00.

Mr. Nettles stated that the case is being investigated by agents of the United States Secret Service and that he has assigned the case to Assistant United States Attorney Debbie Barbier of the Columbia office for prosecution.

As I begin every speech as a business ethics and fraud prevention speaker – “Every Choice Has A Consequence!”

YOUR COMMENTS ARE WELCOME!

Lee B Farkas – Received a 30 Year Prison Sentence – But “I did nothing wrong!”

Convicted of orchestrating a $3 billion fraud as chairman of one of America’s largest private mortgage companies, Taylor Bean & Whitaker, Lee B Frakas was sentenced to 30 years in prison.  Prosecutors sought a life sentence Farkas calling the case against him one of the most significant arising from the nation’s financial meltdown.

A jury convicted Farkas of all 14 counts leveled against him, including securities fraud and conspiracy. Farkas testified that he had done nothing wrong.  Nothing wrong?  Surely by the time he found himself facing a jury and judge he might have concluded that something was wrong – and the common denominator was him!

According to news reports the Farkas fraud began in 2002 and took multiple forms, according to prosecutors.   Taylor Bean overdrew its main account with Colonial Bank by several million dollars and eventually double- and triple-pledged mortgages it held to a variety of investors. Prosecutors also alleged that Taylor Bean sold hundreds of million in worthless mortgages to Colonial.

Prosecutors say Farkas led a lavish lifestyle that included multiple houses — including one on Key West — several dozen classic cars, a private jet and a seaplane.

Farkas, of Ocala, Fla., is the last of seven employees and executives from Taylor Bean and from Colonial to be sentenced. Taylor Bean collapsed in 2009 when the scheme unraveled, putting 2,000 employees out of work.

When the house of cards begins to fall – all I can say is get out of the way!  Reports states that Colonial and two other major banks — Deutsche Bank and BNP Paribas — were collectively cheated out of nearly $3 billion during a scheme that spanned more than seven years.

According to a Time Magazine report: Farkas and his co-defendants also tried to fraudulently obtain more than $500 million in taxpayer-funded relief from the government’s bank bailout program, the Troubled Asset Relief Program (TARP). Neither Taylor Bean nor Colonial ever received any TARP money, even though TARP at one point gave conditional approval to a payment of roughly $550 million, investigators say.

U.S. District Judge Leonie Brinkema told Farkas she detected no remorse as she sentenced him to 30 years — twice the 15-year sentence requested by his attorneys.

QUESTION:

How is it that someone who has some obvious intelligence can be so caught up in the illusion of their actions that they fail to accept reality and comprehend the gravity of their choices?

If you have insight into the mind of Farkas or were caught up in the inner operations of what brought down the private mortgage company…feel free to comment!

YOUR COMMENTS ARE WELCOME!

Medicare Fraud earns Dr. Rene De Los Rios 235 months in Federal Prison. Comments by Ethics and Fraud Prevention speaker Chuck Gallagher

The following is a news release from the Department of Justice.  Please note – EVERY CHOICE HAS A CONSEQUENCE!  As an ethics and fraud prevention speaker to numerous governmental agencies including the FBI – it is clear that regardless of how clearly wrong choices like this may be, the fact remains that unless there are safeguards put in place to remove one of the three components that allow an ethics person to make unethical and illegal choices, we will continue to have frauds like this and the consequences that follow.

If you know of Dr. Rene De Los Rios and have insight into the doctors thinking…feel free to share your comments below!

WASHINGTON – Miami doctor Rene De Los Rios, 72, was sentenced today to 235 months in prison for his participation in a $23 million HIV injection and infusion Medicare fraud scheme , announced the Departments of Justice and Health and Human Services (HHS).

U.S. District Court Judge Joan A. Lenard of the Southern District of Florida also sentenced De Los Rios to three years of supervised release following his prison term and ordered him to pay a minimum of $11.7 million in restitution, jointly with his co-defendants.  The final amount of restitution will be determined at a later hearing.   On April 14, 2011, De Los Rios was convicted by a jury of one count of conspiracy to commit health care fraud and four counts of submission of false claims.  De Los Rios was remanded to the custody of the U.S. Marshals Service after his conviction and has been detained since that time.

According to evidence presented at trial and sentencing, De Los Rios worked at multiple fraudulent medical clinics and signed medical documents authorizing tests and treatments that were medically unnecessary or never provided.   The court found De Los Rios responsible for a total of $46 million in fraudulent billings to Medicare.

According to evidence presented at trial, De Los Rios was hired by the owner of Metro Med of Hialeah Corporation, an HIV infusion clinic that purportedly provided injection and infusion therapies to HIV-positive Medicare beneficiaries.   Evidence presented at trial established that De Los Rios ordered unnecessary tests, signed medical analysis and diagnosis forms, and authorized treatments to make it appear that legitimate medical services, including injection and infusion therapies, were being provided to Medicare beneficiaries at Metro Med.  However, the injection and infusion therapies were medically unnecessary and never provided.   De Los Rios also signed medical charts, often without seeing the patient, indicating that certain treatments were medically necessary, when, in fact, he knew they were not.

Evidence at trial established that De Los Rios diagnosed almost all of the patients at Metro Med with the same rare blood disorders, which the patients did not have, in order to ensure maximum reimbursement from Medicare.  The evidence at trial also showed that De Los Rios prescribed expensive medications, including Winrho, Procrit and Neupogen, to patients for the sole purpose of receiving reimbursement from the Medicare program.  From approximately April 2003 through October 2005, Metro Med submitted approximately $23 million in claims to the Medicare program for injection and infusion treatments that were not medically necessary and were never provided.  The Medicare program paid approximately $11.7 million in claims.

The owner and operator of Metro Med, Damaris Oliva, and three other individuals have each pleaded guilty for their roles in the Metro Med fraud scheme.   Oliva was sentenced in December 2010 to 82 months in prison.   Co-defendants Estrella Rodriguez, Jose Diaz and Lisandra Aguilera were sentenced to 57 months in prison, 54 months in prison and 70 months in prison, respectively.

Evidence at trial and sentencing also established that De Los Rios engaged in almost identical conduct at additional sham HIV injection and infusion therapy clinics in South Florida during the same time period.  At J&F Community Medical Center Inc.  and Rochris Medical Center Inc., De Los Rios prescribed the same medications that he prescribed at Metro Med to patients who he knew did not need them.

In a two-and-half-year period, De Los Rios made more than $587,000 in profits from the fraud schemes.

At sentencing, the court also found that De Los Rios obstructed justice by testifying falsely at his trial; that as a doctor, De Los Rios occupied a position of trust, which he violated; and that by prescribing medically unnecessary injections and infusions for HIV-positive patients, De Los Rios caused a reckless risk of serious bodily injury to those patients.

The court declared a mistrial in De Los Rios’ first trial in March 2011.

Today’s sentence was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent-in-Charge of the FBI’s Miami Field Office; and Special Agent-in-Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

The case was prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section and Robert J. Luck, Assistant U.S. Attorney for the Southern District of Florida.   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 Southern District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,000 defendants and organizations that collectively have billed the Medicare program for more than $2.3 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 .

YOUR COMMENTS ARE WELCOME!

Roger Clemens on Trial for Lying to Congress! Whose going to put Congress on Trial for lying to Us? Guest Blog by Brent Clanton

From time to time I am honored to have guest bloggers featured.  Today a friend of mine, Brent Clanton is featured with an interesting take on the Roger Clemens trial.  His comments will certainly make you think…

I am bemused to hear Roger Clemens will be going on trial for lying to Congress over controlled substances, when they’ve been lying to the American public for years over the substance of legislation they control. Or just lying outright.

The most-obvious recent example of this is the embarrassing saga of NY Rep. Anthony Weiner—a ten day media romp in which he repeatedly prevaricated as to his prowess as a sexting lothario. And wasn’t it an American politician who made “hiking the Appalachian Trail” the newest euphemism for cheating on a spouse?

Never mind the fact that our Congressmen and women haven’t been able to get their collective acts together long enough to pass legislation on fiscal-stimulus. So how is it they can find time to rake Roger over the coals for physical-enhancement stimulus?

Maybe if Clemens’ trainer, Brian McNamee had injected the House members with a little extra octane, we wouldn’t be facing a Government shut-down in August. Perhaps, had  the Senate been dosed with some exotic B-12 to goose their brain-function, we’d be closer to closing the gap between spending and revenues.

I wonder if the Congressional Inquisition will pay as close attention to Clemens’ testimony as they do to the nuances and details they present to We the People on a regular basis. Recently Sen. Dick Durban opined that the United States borrows from China most of the money it spends—to the rate of 40-cents on the dollar. According to Fact-Check.org, China only holds 8% of the total US debt ticket—a mere $1.15 Trillion of the $14+ Trillion in outstanding obligations. And the ratio is only 38-cents on the dollar. Don’t you feel better now? Here, take this pill…

Utah Gov. John Huntsman claimed this Spring that Social Security, Medicare, and interest payments on our collective debt would “consume every dollar of Federal revenue” within a decade. According to the Government Accounting Office, assuming all the current tax provisions are left in place, only 92-cents of each revenue dollar would be spent on interest and social entitlement expenses. Don’t spend the remaining 8-cents all in one place.

Lies or mis-statements? Only your Congressional speechwriter knows for sure—or should. It’s just galling that instead of allowing the MLB to handle this tempest on the pitching mound, Congressional brain power, time and tax dollars are being squandered over the word of a sleazy athletic trainer vs a potential Baseball Hall of Famer at a time when the very people doing the questioning have bigger fish to fry. Or should.

Brent Clanton is a Talk Radio Host based in Houston, Texas. 

His musings can be mulled at http://brentclanton.blogspot.com

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