Chicago’s Sacred Heart Hospital Owner, Executive, and Four Doctors Arrested in Alleged Medicare Kickback www.privateofficer.com
U.S. Attorney’s Office
CHICAGO IL April 17 2013—The owner and another senior executive of Sacred Heart Hospital and four physicians affiliated with the west side facility were arrested today for allegedly conspiring to pay and receive illegal kickbacks, including more than $225,000 in cash, along with other forms of payment, in exchange for the referral of patients insured by Medicare and Medicaid to the hospital, announced U.S. Attorney for the Northern District of Illinois Gary S. Shapiro.
Agents from the FBI and the U.S. Department of Health and Human Services Office of Inspector General today also began executing search and seizure warrants in connection with an ongoing investigation of alleged Medicare and Medicaid fraud schemes at the hospital involving emergency room evaluation, testing, and observation services that were not medically necessary, as well as medically unnecessary sedation, intubation, and tracheotomy procedures performed on patients. Approximately $2 million in Medicare reimbursement payments was seized today from various bank accounts.
Arrested were Edward J. Novak, 58, of Park Ridge, Sacred Heart’s owner and chief executive officer since the late 1990s; Roy M. Payawal, 64, of Burr Ridge, executive vice president and chief financial officer since the early 2000s; and Drs. Venkateswara R. “V.R.” Kuchipudi, 66, of Oak Brook, Percy Conrad May, Jr., 75, of Chicago, Subir Maitra, 73, of Chicago, and Shanin Moshiri, 57, of Chicago.
Sacred Heart Hospital is a 119-bed acute care facility located at 3240 West Franklin Blvd. in Chicago. Approximately 40 in-patients were in the hospital this morning, and representatives of the HHS Centers for Medicare and Medicaid Services (CMS) were on site and coordinating with the Illinois Department of Healthcare and Family Services to ensure continuity of patient care.
“These charges and the affidavit’s other allegations outline a kickback conspiracy to bribe doctors to refer patients to Sacred Heart where they would be treated in in an environment in which the quality of care and appropriate medical analysis were less important than maximizing the numbers of patients funneled into the hospital,” said Gary S. Shapiro, United States Attorney for the Northern District of Illinois.
“The payment of kickbacks or bribes in exchange for the referral of Medicare or Medicaid patients, regardless of the form in which they are paid, is a crime,” said Lamont Pugh, III, Special Agent in Charge of the Chicago Region of HHS-OIG. “The Office of Inspector General will continue to work closely with our law enforcement partners to aggressively investigate alleged illegal patient referral schemes and hold accountable those who seek to exploit vulnerable patients and the Medicare and Medicaid programs.”
“Today’s arrests demonstrate our commitment to enforcing the laws intended to prevent abuses of the Medicare and Medicaid programs and to preserve the ability of those programs to provide appropriate medical services to the elderly and the needy,” said Cory B. Nelson, Special Agent in Charge of the Chicago Office of the Federal Bureau of investigation.
The defendants were charged in a complaint that was filed yesterday and unsealed today after the arrests. All six defendants were scheduled to appear beginning at 3 p.m. before U.S. Magistrate Judge Daniel Martin in Federal Court.
A 90-page affidavit in support of the criminal complaint and search and seizure warrants states that former Sacred Heart Physician A began cooperating in the investigation in October 2011, and Administrator A and Administrator B began assisting in January 2013 and February 2012, respectively. Each of them made consensual recordings of meetings and telephone conversations with other executives, administrators, physicians, and employees that are described in the affidavit.
According to the complaint—at Novak’s direction and with his approval and Payawal’s assistance—Sacred Heart implemented a scheme to pay kickbacks to physicians in return or referrals of Medicare and Medicaid patients. Novak and Payawal allegedly tried to conceal the scheme by masking payments as fictitious rental payments; paying the salaries of physicians’ employees; providing physicians ghost contracts for duties without any real responsibilities; creating alternative billing arrangements; and purporting to pay physicians to supervise and teach non-existent medical students.
In a conversation that Administrator A recorded on February 28, 2013, Novak and Payawal allegedly identified Drs. Moshiri, Maitra and May as physicians receiving regular kickback payments who Administrator A should pay.
Between January 2010 and February 2013, May allegedly received $74,000 in the form of 37 checks, for $2,000 each, disguised as “rental payments”; Moshiri, a podiatrist, allegedly received $86,000 in 38 checks pursuant to a purported contract to teach podiatry students; and Maitra allegedly received $68,000 in 34 checks pursuant to a purported teaching contract—and the $228,000 total in alleged kickbacks were all in exchange for their referral of patients to Sacred Heart, the charges allege.
In a recorded conversation last month, Maitra allegedly explained to Administrator A that he used to make Novak “so much money” performing almost daily penile implant procedures on patients, but that he no longer performed as many of those procedures because Medicare had decreased its rates of reimbursement for the procedure. Maitra did not comment on whether the patient need for the procedure had somehow changed, according to the affidavit.
Regarding Dr. Kuchipudi, Administrator A told agents that he was one of Sacred Heart’s most prolific patient referral sources and, according to Physician A, was known within the hospital as the “king of nursing homes.” According to Administrator A, Sacred Heart paid Kuchipudi for Medicare patient referrals in two ways: first, by paying most of the salaries of a physician’s assistant and a registered nurse who were effectively employed by Kuchipudi, and second, by paying Physician B for treating Kuchipudi’s patients at Sacred Heart, despite the fact that Kuchipudi, and not the hospital, billed insurers for the services Physician B provided to those patients. These arrangements allegedly benefited Kuchipudi as a result of the hospital absorbing employee salary costs that Kuchipudi would normally have to pay himself.
The investigation is also probing claims that Sacred Heart Physician D, a pulmonologist, allegedly performs a high number of unnecessary intubations and prolongs them by directing heavy sedation of his patients, often resulting in tracheotomies being performed by Sacred Heart surgeons that may not have been medically necessary. Administrator A told agents that during a lunch with Novak and Payawal in December 2012, they both explained that tracheotomy cases provide substantial insurance reimbursement income for the hospital. On March 1, 2013, Administrator A recorded Novak stating that tracheotomies are Sacred Heart’s “biggest money maker” and the hospital can make $160,000 for a tracheotomy if the patient stays 27 days. On March 7, 2013, the Intensive Care Unit case manager told Administrator A that she must often “stretch” a tracheotomy patient’s stay to 28 days to maximize Medicare reimbursements “to make Novak happy.”
Novak’s Business Interests
According to the affidavit, Novak has direct or indirect ownership interest in various related entities, including Superior Home Health LLC, a home health care company; the Golden L.I.G.H.T. clinics, which are family practice/internal medicine clinics operated as divisions as Sacred Heart; the Chen Medical center; the Garfield Kidney Center LLC, an outpatient dialysis center; and the Bentley Insurance Group, a medical malpractice insurance company. Novak also owns various real estate and corporate management holding companies, and prior to June 2012, he operated the Chicago R.E.A.C.H Foundation, a purported non-profit, senior citizen program financed by the state of Illinois.
In a series of recorded conversations over the last two months, Payawal told Administrator A that a substantial part of Sacred Heart’s revenue comes from Medicare and Medicaid reimbursements and explained various ways in which revenue generated from the hospital is transferred to and among Novak’s other corporate interests.
Conspiracy to violate the federal anti-kickback statute carries a maximum penalty of five years in prison and a $250,000 fine and restitution is mandatory. If convicted, the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
The government is being represented by Assistant U.S. Attorneys Joel Hammerman, Terra Reynolds, and Ryan Hedges.
The public is reminded that a complaint is not evidence of guilt. The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.
The case falls under the umbrella of the Medicare Fraud Strike Force, which expanded operations to Chicago in February 2011, and is part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Justice Department and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. More than five dozen defendants have been charged in health care fraud cases since the strike force began operating in Chicago.
To report health care fraud to learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to http://www.stopmedicarefraud.gov.
Detroit MI April 10 2013
U.S. Attorney’s Office April 10, 2013
•Eastern District of Michigan (313) 226-9100
A 45-year-old Fenton man was sentenced today to 13 years in prison in connection with a multi-million-dollar mortgage fraud conspiracy, United States Attorney Barbara L. McQuade announced.
Joining McQuade in the announcement was Special Agent in Charge Robert D. Foley, III, head of the Detroit Division of the Federal Bureau of Investigation (FBI).
U.S. District Judge Julian Abele Cook, Jr. also sentenced Ronnie Edward Duke to pay a $1 million fine and $94 million in restitution. Duke led the scheme for close to four years, ending in July 2007 when the FBI executed seven search warrants in metropolitan Detroit and Florida.
The scheme involved more than 450 fraudulent mortgage loans, more than 100 straw buyers, and approximately 180 different residential properties in metropolitan Detroit that were used as collateral for the loans. Most of these loans went into default and foreclosure. The loans ranged from roughly $350,000 to $600,000. Lenders were deceived by counterfeit purchase agreements, fake closing documents, and fictitious title companies that were actually controlled by Duke and his co-conspirators. The warranty deeds and mortgages associated with the majority of the loans went unrecorded, leaving the lenders completely unsecured. Such loans were commonly referred to as “ghost” loans by the defendants during the scheme.
“Mortgage fraud not only harms lenders, but it also affects all of us when foreclosures lead to vacant homes, which reduce property values and create havens for criminal activity,” McQuade said.
“Those who orchestrate and conduct mortgage fraud schemes that steal millions of dollars from innocent victims will face severe consequences for their crimes,” Foley said. The FBI remains committed to pursuing and prosecuting anyone who engages in these illegal acts.”
Fifteen of Duke’s co-conspirators were previously sentenced, including:
•Ryan Andrew Zundel, 38, of Brewton, Alabama—10 years
•Nicole Lynn Rothe (formerly Nicole Lynn Turcheck), 34, of Gibraltar—10 years
•William Camsell Wells, III, 42, of Howell—eight-and-a-half years
•Wilinevah Richardson, 35, of Davison—five years
•Donna Marie Walbrook, 50, of Westland—five years
•Anthony Edward Peters, 75, of Monroe—41 months
•Robert Brierley, 46 of Westland—33 months.
Duke spent his fraud proceeds to operate a car racing business called Hardcore Racing Inc. He purchased numerous sports cars, race cars, boats, motorcycles, and a helicopter. Duke’s co-defendants used their proceeds to finance unrelated businesses and to purchase luxury items, including cars, boats, motorcycles, race horses, residential properties, and travel to the Caribbean and other overseas vacation destinations.
Duke’s criminal history includes embezzlement, credit card fraud, receiving and concealing stolen property, escape, aggravated stalking, and disturbing the peace.
This case was prosecuted by Assistant United States Attorneys Erin Shaw and Stephen Hiyama and investigated by the FBI, with the assistance of the U.S. Secret Service.
U.S. Attorney’s Office
PHILADELPHIA PA Feb 15 2013—H. Warren Hogeland, 75, of Richboro, Pennsylvania, and Kenneth Miller, 76, of Brookhaven, Pennsylvania, pleaded guilty today to taking part in a fraud scheme involving seven other judges at Philadelphia Traffic Court. Hogeland was a Bucks County Senior Magisterial District Judge; Miller was a Delaware County Senior District Judge. Both accepted assignments with the traffic court when their services were requested. The two defendants admitted to participating in the practice of giving breaks on traffic citations to friends, family, the politically connected, and business associates. Specifically, Hogeland presided over a ticket issued to Miller’s son and declared Miller’s son not guilty without him having to make an appearance. Additionally, Miller arranged for a ticket, received by “J.B.,” to be declared not guilty. Both defendants pleaded guilty to mail fraud; Hogeland also pleaded guilty to conspiracy.
As part of the scheme, tickets were fixed by either being dismissed, finding the ticket holder not guilty, or finding the ticket holder guilty of a lesser offense. In many cases, the ticket holder did not even appear in traffic court, yet their ticket was fixed. As a result, the ticketholders paid lesser or no fines and costs and evaded the assessment of points on their driver’s record. This widespread ticket fixing defrauded both the commonwealth of Pennsylvania and the city of Philadelphia of funds and allowed potentially unsafe drivers to remain on the roads.
U.S. District Court Judge Robert F. Kelly scheduled sentencing hearings for both Hogeland and Miller on May 24, 2013. Each defendant faces a possible advisory sentencing guideline range of zero to six months in prison before variances or departures.
This case was investigated by the Federal Bureau of Investigation. It is being prosecuted by Assistant United States Attorneys Denise S. Wolf and Anthony J. Wzorek.
Thomas Anderson, 75, of San Jose, was arraigned Wednesday on eight counts of lewd or lascivious act on a child under 14 years of age.
Anderson was arrested on July 24 after two witnesses reported seeing him act inappropriately with a child during a soccer game earlier this month, according to the district attorney’s office.
Anderson has been a local volunteer security guard in Santa Clara for two years and has worked with area soccer teams for about 20 years.
He is expected to enter a plea in court at 2 p.m. on Aug. 3 at the Hall of Justice in Santa Clara.
If convicted as charged, Anderson faces a maximum sentence of 22 years in prison.
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