Kepler's UnclesFraud Cases
Fraud detection efforts lead to hundreds of convictions per year. This sample gives an idea of the types of fraud that are prosecuted and the penalties for fraud. These vary greatly by state, depending on state laws and special control efforts. Some states publicize convictions more than others. The number of fraud convictions reported is not a good measure of the effectiveness of fraud control efforts.
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54 min 3 sec agoJuly 27, 2009
21:48
You may have noticed that I haven’t be updating the site in a long time. I’m taking a break from this field.
I hope you find the information helpful. If you’re trying to report fraud, contact your state’s Attorney General. This site includes links to Attorney General offices, but they may be out of date.
Friends and colleagues feel free to contact me. The contact information you have is still correct and I will receive your messages, phone calls, etc. You can also find me on LinkedIn.com.
May 29, 2008
17:57
Florida Businessman Sentenced in Health Care Fraud Scheme - Leonardo Pita, the owner of a durable medical equipment company based in Miami-Dade County, Florida, was sentenced to 42 months in prison, followed by three years of supervised release, and ordered to pay over $519,000 in restitution following his convictions for Medicare fraud and money laundering. [Google Reader]
17:46
Alabama Couple to Plead Guilty to Medicare Fraud - William Lloyd King, Jr. and Marie Weller King, both of Birmingham, Alabama, have each agreed to plead guilty to their involvement in a Medicare fraud scheme.
12:57
12:56
Local doctor indicted on drug, fraud charges
Norman Transcript, OK - 8 hours ago
The indictment alleges Phung illegally billed the Medicaid program, through the Oklahoma Health Care Authority, for the evaluation and management of …
12:44
12:42
12:41
Fact Sheet: Department of Justice Efforts to Combat Health Care …
PR Newswire (press release), NY - 22 hours ago
Federal and state agents included personnel from HHS-OIG, the FBI, City of Hialeah Police Department, and the Florida Medicaid Fraud Control Unit. …
09:50
09:47
August 9, 2007
19:31
Attorney General’s News Release
August 7, 2007
Nixon recovers $462,926 in ongoing Medicaid fraud investigation in Dekalb County
Jefferson City, Mo. — Attorney General Jay Nixon announced today that the Missouri Medicaid program will be receiving $462,926 from a pharmacy in DeKalb County that is under investigation for Medicaid fraud. Nixon said the Medicaid Fraud Control Unit in his office has recovered the money from the Randolph Drug Store in Maysville.
19:18
Press Release
The United States Attorney’s Office
Southern District of Texas
August 6, 2007
LOCAL PHYSICIAN SENTENCED TO PRISON FOR DEFRAUDING INSURANCE COMPANIES OF $10 MILLION
(HOUSTON) Dr. Ira Klein, a physician who specialized in treating Hepatitis C patients, has been sentenced to more than 11 years in federal prison, without parole, for health care and mail fraud, United States Attorney Don DeGabrielle announced today.
August 6, 2007
12:49
December 9, 2006
08:57
AUSTIN, Dec. 7, 2006 - Texas Attorney General Greg Abbott today announced Texas will receive more than $15.7 million under a national settlement with one of the nation’s largest pharmaceutical companies.
November 14, 2006
06:50
Any test which doctors provide themselves (self-referral) is an opportunity for fraud. To identify suspect cases, measure the number of tests per 1,000 patients for doctors performing the test themselves, compared to those who refer patients to another provider. You may need to make adjustments for patient diagnosis or health status.
Of course looking to evidence is most important. Are these doctors qualified to perform the service? Is the diagnostic test effective as a screening tool or should its uses be more limited? Does the test result in more treatment? Is the treatment effective?
Here are some highlights from an article from the New York Times about a product with high fraud potential:
05:55
October 26, 2006
20:43
AP Wire | 10/24/2006 | Dentist who diagnosed nonexistent cavities reaches agreement
“ANGOLA, Ind. - A dentist accused of diagnosing cavities that did not exist will not face prison time, according to an agreement filed in Steuben Circuit Court.
20:36
Tuesday, October 24, 2006
Attorney General Abbott’s Investigators Arrest Pharmacy Owner Indicted For Medicaid Fraud
Erasmo Cantu arrested in Brownsville; over $5 million in theft alleged
BROWNSVILLE - Texas Attorney General Greg Abbott today announced the arrest of a Cameron County pharmacy owner who was indicted by a grand jury on Oct. 18 for felony offenses involving more than $5 million in alleged fraudulent Medicaid reimbursements for excessive prescription refills.
20:21
Medicaid billing fraud settled - Wyoming Tribune -
Medicaid billing fraud settled
Wyoming Tribune, WY
… “Wyoming’s piece is part of a $25 million settlement to be split among the United States, 30 states and the District of Columbia.
The government charged Pediatrix improperly billed Medicaid for its services between January 1996 and December 1999.
20:15
Medicaid fraud alleged - New York Daily News -
Medicaid fraud alleged
New York Daily News, NY - 7 hours ago
… Dept. to investigate the home and the clinic for possible Medicaid fraud. … The Medicaid fraud units of both the Health Dept. and …
20:11
National Medicaid transport probed — The Washington Times
“Since so much money is involved here, the federal government certainly has a very keen interest in how it is spent,” Donald White, spokesman for the HHS inspector general, said yesterday of the nationwide look at Medicaid transportation costs.
19:59
Major Medicaid Fraud Ring Dismantled - North Country Gazette -
“ALBANY-Following after a four-month undercover investigation conducted by the state Attorney General’s office and the state Medicaid Inspector General’s office, prosecutors and investigators have dismantled a Medicaid fraud ring which involving a doctor, pharmacists, several city pharmacies, millions in fraudulent Medicaid billings and large monetary transfers to individuals in Pakistan.
Sixteen individuals and five corporations have been indicted in the ongoing investigation and a civil action has been filed against 20 individuals and entities freezing assets and seeking the recovery of more than $22 million…”
19:44
Federal Audit of Medicaid Transportation Costs To Determine … - Kaiser network.org -
Federal Audit of Medicaid Transportation Costs To Determine …
Kaiser network.org, DC
… Health care consultant Robin Mathias said Medicaid programs can lose as much as 30% to 50% of nonemergency transportation spending to fraud and abuse, adding …
US probing Medicaid transportation Science Daily (press release)
US probing Medicaid transportation Market-Day.net
08:18
Department of Law
The State Capitol
Albany, NY 12224
For More Information:
518.473.5525
For Immediate Release
October 25, 2006
STATE INVESTIGATION REVEALS WIDESPREAD MEDICAID FRAUD
Doctor and pharmacists among those indicted for multi-million dollar fraud
Attorney General Eliot Spitzer and State Medicaid Inspector General Kimberly O’Connor today announced that, after a 4-month undercover investigation, prosecutors and investigators have dismantled a Medicaid fraud ring involving a doctor, pharmacists, several city pharmacies, millions in fraudulent Medicaid billings and large monetary transfers to individuals in Pakistan.
May 17, 2006
11:34
Mississippi AG announces two Medicaid fraud arrests - Biloxi Sun Herald
JACKSON - Mississippi Attorney General Jim Hood has announced one arrest and one guilty plea stemming from investigations by his office’s Medicaid fraud unit.
April 7, 2006
09:51
Here’s an interesting article I ran across about a politician who may have some connections to Medicare fraud. I don’t have inside information on this one, but I thought people would find it interesting.
newtimesbpb.com | News | What’s a Little Medicare Fraud Between Friends?
Coconut Creek Commissioner Jim Waldman is running for the state House in a district dominated by senior voters.
09:42
Blount County couple arrested for TennCare fraud
Michael Dolinger is accused of four counts of aiding and abetting his wife in fraudulently obtaining TennCare benefits by using her card to pay for forged prescriptions for the painkiller hydrocodone and alprazolam. It’s used to treat anxiety disorders and panic attacks.
April 1, 2006
10:36
Lafayette Doctor Indicted on 94 Counts of Healthcare Fraud
A Lafayette doctor is at the center of a major federal investigation.
Cardiologist Mehmood Patel has been indicted on 94 counts of healthcare fraud involving 94 different patients.
The indictment alleges Dr. Mehmood Patel performed unnecessary heart procedures at Our Lady of Lourdes and Lafayette General.
January 26, 2006
10:21
Duluth News Tribune | 01/25/2006 | Lawsuit alleges Medtronic bribed doctors
BY CHRIS WILLIAMS
ASSOCIATED PRESS
MINNEAPOLIS - A whistleblower lawsuit alleges medical device maker Medtronic Inc. improperly paid millions of dollars to more than a dozen doctors around the United States, prompting them to perform unnecessary spinal surgeries and otherwise affecting their judgment.
10:08
TRENTON - Division of Criminal Justice Director Vaughn L. McKoy announced that a former North Jersey chiropractor was sentenced for practicing chiroprac
10:03
Therapist and Wife Sentenced for Fraud - Los Angeles Times
A therapist who ran a group home for the mentally ill was sentenced in Wichita to 30 years in prison for enslaving its residents, forcing them to work naked and making them perform sex acts. His wife received seven years behind bars.
January 13, 2006
15:00
NewsNet5.com - Print This Story - Local Doctor Convicted On Healthcare Fraud Charges
CLEVELAND — A doctor was convicted of health care fraud and other charges for prescribing painkillers that prosecutors say resulted in the deaths of two patients under his care.
Dr. Jorge Martinez contends his clinics in Parma and Boardman in northeast Ohio offered people relief from chronic pain.
January 6, 2006
15:09
Officials in Rockland Question Medicaid Billings of $13 Million - New York Times
Last fall, the state’s Department of Health granted a group of 12 New York counties permission, for the first time, to comb through Medicaid bills filed by doctors, pharmacists, nursing homes, hospitals and others, and look for odd patterns that might signal abuse of the system.
15:08
A Winston County pharmacist has been arrested on federal healthcare fraud charges.
63-year-old Gerald Max Burleson of Haleyville is charged with health care fraud and drug mis-branding.
15:08
Kentucky Surgeon Sentenced to Prison for Felony Medicaid Fraud
Louisville, Ky. oral surgeon Robert Michael Clear has been sentenced to three years in prison on felony Medicaid fraud charges according to Attorney General Greg Stumbo.
The Jefferson Circuit Court sentence was probated for five years on the condition that Clear pay restitution to Medicaid in the amount of $18,175.66.
December 29, 2005
18:21
December 7, 2005
14:23
Businessman guilty in wheelchair fraud case - abc13.com -
Businessman guilty in wheelchair fraud case
abc13.com, TX - 8 hours ago
… 24th for a San Antonio businessman convicted in a Medicare and Medicaid billing scheme. … He was convicted Friday on six counts of federal health care fraud. …
14:17
Probe into Medicaid - Newsday -
Probe into Medicaid
Newsday, NY - 9 hours ago
13:39
Six caregivers plead guilty - Rochester Democrat and Chronicle -
Six caregivers plead guilty
Rochester Democrat and Chronicle, NY - 7 hours ago
13:20
Albany Oncologists To Repay Medicaid $1.2 Million
ALBANY ONCOLOGISTS TO REPAY MEDICAID $1.2 MILLION
Physicians Group Overbilled for Drugs Dispensed to Patients
Attorney General Eliot Spitzer today announced that a group of upstate physicians and their management company have paid the State of New York more than $1.2 million to settle a lawsuit that the group improperly billed Medicaid for physician-administered drugs.
13:16
Pharmacy Owner Receives Jail In Medicaid Fraud
PHARMACY OWNER RECEIVES JAIL IN MEDICAID FRAUD
Will pay $1.1 Million to Resolve Civil and Criminal Liability
Attorney General Eliot Spitzer announced today that a Central Valley pharmacy owner was sentenced to jail for stealing $257,000 from the Medicaid program.
13:12
Unlicensed Therapist Convicted For Stealing $450,000 From Medicaid
UNLICENSED THERAPIST CONVICTED
FOR STEALING $450,000 FROM MEDICAID
Faces up to 3 years in State prison
Attorney General Eliot Spitzer today announced that a Brooklyn man has pleaded guilty in Albany County Court to stealing more than more than $450,000 from the Medicaid program.
13:04
United States Attorney
Southern District of New York
FOR IMMEDIATE RELEASE
DECEMBER 6, 2005
UNITED STATES INTERVENES IN FALSE CLAIMS ACT LAWSUIT
AGAINST CABRINI MEDICAL CENTER ALLEGING ILLEGAL
MEDICAID PATIENT REFERRAL SCHEME
MICHAEL J. GARCIA, the United States Attorney for the Southern District of New York, announced today that on December 2, 2005, the Government filed a civil complaint against CABRINI MEDICAL CENTER (“CABRINI”). The complaint alleges that CABRINI entered into an illegal patient referral scheme with APPLIED CONSULTING, INC. (“CONSULTING”), and then falsely billed Medicaid for the care of these illegally-referred patients. CABRINI also allegedly billed Medicaid for alcohol and substance abuse detoxification treatment that it was not certified to provide.
12:44
OIG Proposes To Exclude Miami Hospital from Participation in Federal Health Care Programs
December 7, 2005 Washington, DC 20201
OIG Proposes To Exclude Miami Hospital from
Participation in Federal Health Care Programs
Inspector General Daniel R. Levinson announced today that the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) notified Miami’s South Shore Hospital and Medical Center (South Shore) of an impending exclusion from Medicare, Medicaid, and all other Federal health care programs. Today’s action resulted from South Shore’s material breach of the terms of a corporate integrity agreement (CIA) it negotiated with OIG in 2002, as part of the resolution of a False Claims Act case against the hospital.
December 6, 2005
17:55
Herald.com | 12/02/2005 | Four arrested in AIDS drug scam
BY JOHN DORSCHNER
jdorschner@herald.com
In what could be the start of a massive crackdown on scams involving HIV/AIDS patients, law enforcement officials announced the arrest of four persons, including two doctors, charged with illegally diverting millions of dollars in drugs.
November 24, 2005
02:45
BY Jim Muir
THE SOUTHERN
BENTON - Benton dentist Dr. W. David Rommel was sentenced to 63 months in federal prison and ordered to repay $827,000 to the Illinois Department of Public Aid during a sentencing hearing Tuesday morning in U.S. District Court in Benton.
November 23, 2005
13:52
U.S. Newswire : Releases : “Kansas Couple Convicted on Involuntary Servitude Charges…”
WASHINGTON, Nov. 7 /U.S. Newswire/ — The Justice Department announced today that Arlan Kaufman, 69, and his wife, Linda Kaufman, 62, were convicted on federal charges for forcing mentally ill patients to perform sexually explicit acts on videotape and to perform physical labor in the nude. The jury found Arlan Kaufman guilty on 31 federal counts and Linda Kaufman guilty on 30 federal counts, including involuntary servitude, forced labor, conspiracy, healthcare fraud, mail fraud, and Medicare fraud.
13:49
icSurreyOnline - Man cheated hospital of £8,000 with false timesheets
Nov 23 2005
A MAN who tried to fleece the NHS out of more than £8,000 was given a three-month suspended sentence this week.
11:31
STLtoday - News - St. Louis City / County
Nursing home figure enters not guilty plea in fraud case
By Peter Shinkle
ST. LOUIS POST-DISPATCH
11/22/2005
Robert D. Wachter, the former operator of a chain of nursing homes in the St. Louis area, pleaded not guilty Tuesday to charges that he conspired to defraud the government by providing substandard care at his facilities.
November 22, 2005
11:57
Hospital billing is complex and opportunities for fraud and gaming vary considerably by payment methodology. Cost-plus billing rewarded hospitals for having high overhead and inflating costs. Per diem systems encourage long lengths of stay and low complexity caseloads. DRG systems often have problems with upcoding (reporting a diagnosis or complication that increases payment). The lesson is that any payment system needs checks and balances.