Wifredo A. Ferrer, United States Attorney for the Southern District of Florida; John V. Gillies, Special Agent in Charge, Federal Bureau of Investigation (FBI), Miami Field Office; Christopher B. Dennis, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG); and Henry Gutierrez, Postal Inspector in Charge, U.S. Postal Inspection Service, Miami Division, announced that 59 South Florida residents were charged for their alleged participation in various schemes to defraud Medicare out of more than $137 million. The charges in South Florida are part of a nationwide takedown by Medicare Fraud Strike Force operations in seven cities that resulted in charges against 107 individuals, including doctors, nurses and other licensed professionals, for their alleged participation in Medicare fraud schemes involving approximately $452 million in false billing. This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in strike force history.

The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud. Approximately 400 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the national takedown.

U.S. Attorney Wifredo A. Ferrer stated, “The Medicare program is a valuable and limited trust fund to provide much needed services for the poor, the elderly and the sick. Among the dozens of fraudsters charged in South Florida in this operation are clinic owners, nurses, therapists, patient recruiters, pharmacy owners, accountants, former social workers, and even beneficiaries, all of whom stole precious health care dollars through a variety of schemes. These get rich quick schemes at the expense of the most vulnerable in our society are unacceptable. We will continue to fight health care fraud on all fronts: we will prosecute each link in the fraud chain and each evolving fraud scheme.”

“The results we are announcing today are at the heart of an administration-wide commitment to protecting American taxpayers from health care fraud, which can drive up costs and threaten the strength and integrity of our health care system,” said Attorney General Eric Holder. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain. As today’s takedown reflects, our ongoing fight against health care fraud has never been more coordinated and effective.”

“More than half of those charged in a record setting health care fraud takedown today were from the Miami area. The local fraud totaled more than $137 million. Sadly, in Miami, multi-million-dollar health care fraud cases are no longer shocking in their magnitude or frequency,” said John V. Gillies, Special Agent in Charge of the FBI’s Miami Office. “Here’s my message clear and simple: you can run, but as evidenced by today’s nationwide takedown, you can’t hide.”

“Medicare fraud diverts precious resources from those who are eligible and need it most,” said Christopher B. Dennis, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General’s region covering Florida. “Today’s action should send a strong message that we will continue to track the evidence to ensure that those involved are held accountable.”

U.S. Postal Inspector in Charge Henry Gutierrez stated, “Medicare fraud is an assault on resources for our most needy and vulnerable citizens. This joint effort by the South Florida law enforcement community demonstrates that those who engage in these illegal schemes will be prosecuted to the full extent of the law.”

The South Florida defendants are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, health care fraud, violations of the anti-kickback statutes and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services such as home health care, mental health services, and physical and occupational therapy. According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and oftentimes never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided.

Specifically, the South Florida cases announced as part of the nationwide Medicare Fraud Strike Force takedown include:

U.S. v. Odalys Fernandez, Kelvin Soto, Yumidia Naranjo, Jose Guerra, Yanuris Lima, and Servando Raya, Case No. 12-20230-CR-Ungaro

In this six-defendant case, two registered nurses employed by Ideal Home Health (Odalys Fernandez and Kelvin Soto) are charged with conspiracy to commit health care fraud for purportedly providing services, such as skilled nursing and physical therapy, to homebound beneficiaries. In fact, however, the services were either medically unnecessary or were never provided. As part of the scheme, the defendants falsified medical paperwork to make it appear as if they had provided the services. Four other defendants (Yumidia Naranjo, Jose Guerra, Yanuris Lima, and Servando Raya) are alleged to be patient recruiters who paid Medicare beneficiaries so they would serve as patients at Ideal Home Health. Ideal, in turn, submitted more than $40 million in false billings to Medicare. This case is being prosecuted by Assistant U.S. Attorney Daniel Bernstein.

U.S. v. Eulises Escalona, Case No. 12-20293-CR-Lenard

This indictment charges Eulises Escalona with one count of conspiracy to commit health care fraud, one count of conspiracy to defraud the United States and to receive and pay health care kickbacks, and five counts of payment of health care kickbacks stemming from a $42 million home health care fraud scheme. According to the indictment, Escalona owned and operated Willsand Home Health, Inc. (Willsand), a home health agency that purportedly provided home health and physical therapy services to eligible Medicare beneficiaries. In fact, however, from January 2006 through November 2009, Escalona and others paid kickbacks to Medicare beneficiaries to induce them to become patients at Willsand regardless of medical need and to falsely attest that they had received the purported services. In addition, Escalona and others paid kickbacks to patient recruiters and to doctors who signed fraudulent prescriptions and plans of care (POCs) for unnecessary home health services for patients at Willsand. To execute the scheme, Escalona and others falsified patient files and POCs to make it appear as if the patients had qualified for and actually received home health services. In this way, Willsand allegedly submitted approximately $42 million in false claims to Medicare for services it claimed to have provided to approximately 622 beneficiaries. This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.

U.S. v. Rodolfo Nieto, Jr., Case No. 12-20290-CR-Altonaga

This indictment charges Rodolfo Nieto, Jr., owner and operator of Ronat Home Health Care, Inc. (Ronat), with one count of conspiracy to defraud the United States and to receive and pay health care kickbacks and three counts of receipt of kickbacks for his participation in a $60 million home health care fraud scheme. According to the indictment, from January 2006 through November 2009, Nieto accepted kickbacks in return for recruiting Medicare beneficiaries for placement at Nany Home Health, Inc. (Nany). Nieto allegedly caused Nany to submit claims to Medicare for home health services, including insulin injections and physical therapy, purportedly provided through Ronat. According to the indictment, Nany submitted approximately $60 million in false claims to the Medicare program for services that it purportedly provided to approximately 1474 beneficiaries. This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.

U.S. v. Maggie Leon, Yuderkis Pena Garcia and Eduardo Vilau, Case No. 12-20274-CR-Seitz

In this case, defendants Maggie Leon, Yuderkis Pena Garcia, and Eduardo Vilau, owners of Leon Medical and Leah Medical, were charged with conspiracy to commit health care fraud and health care fraud for submitting false claims to private insurance companies that were Medicare Advantage contractors under Part C of the Medicare program. As alleged in the indictment, the defendants submitted approximately $1,826,000 in false claims for expensive cancer and HIV injections that were not medically necessary and were not actually provided to the Medicare beneficiaries. In addition, the indictment alleges that the defendants conspired to pay kickbacks to Medicare beneficiaries so that they would serve as patients at Leah and Leon. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.

U.S. v. Ricardo Martinez, Case No. 12-20316-CR-Martinez

This indictment charges defendant Ricardo Martinez with health care fraud and paying kickbacks to patients. The indictment alleges that the defendant paid kickbacks and bribes to beneficiaries so that they would serve as patients at Rima Medical. The indictment further alleges that Martinez, through Rima Medical, submitted approximately $1,706,701 in false claims for expensive cancer and HIV injections to private insurance companies that were Medicare Advantage contractors under Part C of the Medicare program. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.

U.S. v. Yaquelin Colls, Pedro Colls, and Jesus Fernandez, Case No. 12-20315-CR-Seitz

This indictment charges defendants Yaquelin Colls, Pedro Colls, and Jesus Fernandez with conspiracy to commit health care fraud, substantive health care fraud, conspiracy to pay health care kickbacks, and substantive charges of paying kickbacks. More specifically, the indictment alleges that the defendants owned and operated Ma Medical and Therapy Services, Inc. (Ma Medical), and caused the submission of $972,068 in false medical claims for expensive cancer and HIV injections to a private insurance company that was a Medicare Advantage provider under Part C of the Medicare program. In a similar scheme, the defendants submitted $55,642 in false claims to another private insurance company under Part C of the Medicare program through a second clinic, Healthy Touch Rehab Center Inc. (Healthy Touch), which they also owned and operated at the same address as Ma Medical. The indictment further alleges that the defendants conspired to pay kickbacks and bribes to beneficiaries so that they would serve as patients at Ma Medical and Healthy Touch. This case is being prosecuted by Assistant U.S. Attorney Christopher J. Clark.

U.S. v. Roberto L. Valdes Gonzalez, Francisca Gema Valdez, Gilberto Faure, and Alberto Sotolongo, Case No. 12-20275-CR-Moore

In this case, defendants Jose L. Valdes Gonzalez, a/k/a “Roberto Gonzalez,” Alberto Sotolongo, a/k/a “Ruben,” Gilberto Faure, and Francisca Gema Valdes were charged with conspiracy to commit health care fraud and substantive counts of health care fraud in connection with the operation of Ilva Pharmacy, Inc. More specifically, the indictment alleges that between 2009 and 2011, the defendants caused Ilva Pharmacy to submit approximately $1.3 million in false claims for prescription drugs that were not provided to Medicare and private insurance companies that were Medicare Advantage contractors under Part D of the Medicare program. The indictment additionally charges Gonzalez and Sotolongo with offering and paying kickbacks to Medicare beneficiaries to induce them to serve as patients at Ilva Pharmacy. This case is being prosecuted by Assistant U.S. Attorney John Couriel.

U.S. v. Alina De Armas, Case No. 12-20282-CR-Zloch

In this case, defendant Alina De Armas is charged with health care fraud and with paying kickbacks to patients. The information alleges that De Armas offered and paid kickbacks to Medicare beneficiaries to induce them to serve as patients at Ultratech Medical Supplies, Inc., d/b/a Guines Pharmacy. In this way, from 2007 through 2011, De Armas caused the submission through Guines Pharmacy of approximately $3.6 million in false claims for prescription drugs to Medicare and private insurance companies that were Medicare Advantage contractors under Part D of the Medicare program. This case is being prosecuted by Assistant U.S. Attorney John Couriel.

U.S. v. Isaura Bou-Melendez and Gricel Font, Case No. 12-20113-CR-MGC

In this case, Isaura Bou-Melendez and Gricel Font are charged with conspiracy to commit health care fraud. Bou and Font, licensed therapists, owned and operated a comprehensive outpatient rehabilitation facility, Font & Bou Rehab Associates, Inc. The information alleges that from January 2006 through February 2010, Font and Bou allegedly submitted approximately $6.9 million in false claims to Medicare for physical and occupational therapy services that were not medically necessary or not provided as claimed. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.

U.S. v. Maritza Claudia Fernanda Lorza Ramirez, and James Arley Velasco Gonzalez, Case No. 12-60090-CR-KMW

This indictment charges defendants Maritza Lorza Ramirez and James Velasco Gonzalez with conspiracy to commit money laundering and substantive counts of money laundering. More specifically, the indictment alleges that between January 2006 and December 2010, Lorza and Velasco laundered approximately $3 million in health care fraud proceeds for several companies using their own corporations, including Celebration Home Services, Inc., 4 All Your Needs, Inc., VPP Staffing, Inc, and Work Force Innovations, Inc. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.

U.S. v. Orlando Conrado Piedra Jr., Case No. 12-60091-CR-KMW

This indictment charges Orlando Piedra, an accountant, with conspiracy to commit money laundering and substantive counts of money laundering. More specifically, the indictment alleges that between June 2007 and September 2009, Piedra laundered approximately $500,000 in health care fraud proceeds for several companies through his own company, Media Health Consultants, Inc. This case is being prosecuted by Assistant U.S. Attorney Jon Juenger.

U.S. v. Armando “Manny” Gonzalez, John Thoen, Wondera Eason, Paul Thomas Layman, Alexandra Haynes, Serena Joslin, Ivon Perez, Daniel Martinez, Raymond Rivero, Case No. 12-20291-CR-Altonaga

Armando “Manny” Gonzalez, John Thoen, Wondera Eason, Paul Thomas Layman, Alexandra Haynes, and Serena Joslin are charged with one count of conspiracy to commit health care fraud through a company called Health Care Solutions Network (HCSN). Additionally, defendants Gonzalez, Daniel Martinez, Raymond Rivero, and Ivon Perez are charged with conspiracy to receive and pay health care kickbacks; defendants Martinez, Rivero, and Perez are charged with substantive counts of soliciting and receiving health care kickbacks; defendants Gonzalez and Thoen are charged with one count of conspiracy to commit money laundering; and defendant Gonzalez is charged with substantive counts of money laundering. More specifically, the indictment alleges that between November 2004 and March 2011, Gonzalez, Thoen, Eason, Layman, Haynes, and Joslin conspired to submit approximately $63 million in false claims to Medicare and Medicaid for mental health services that were neither necessary nor provided. The indictment also alleges that Gonzalez conspired with owners of Assisted Living Facilities (ALFs), including Martinez, Rivero, and Perez to pay and receive health care kickbacks in exchange for referring Medicare beneficiaries to HCSN. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Sarah Da Silva Keller, Case No. 12-20289-CR-Cooke

Sarah Da Silva Keller is charged with one count of conspiracy to commit health care fraud. More specifically, the criminal information alleges that between April 2006 and February 2008, Keller conspired with others at HCSN to submit false claims to Medicare for mental health services that were neither medically necessary nor provided. The information further alleges that HCSN submitted approximately $63 million in false claims to Medicare. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Alba Serrano, Case No. 12-20285-CR-Seitz

Alba Serrano is charged with one count of conspiracy to commit health care fraud. The criminal information alleges that Serrano, the owner of Elsa’s House of the Elderly, a Miami-Dade ALF, referred residents from her ALF to American Therapeutic Corporation (ATC) in exchange for kickbacks. ATC was a Community Mental Health Center (CMHC) that submitted false claims for intensive mental health services, called Partial Hospitalization Program, based on Serrano’s Medicare beneficiary referrals. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Bobby Ramnarine, Case No. 12-20288-CR-Middlebrooks

Bobby Ramnarine is charged with one count of conspiracy to commit health care fraud. The criminal information alleges that Ramnarine, the owner of Elmina’s ALF, in Broward County, recruited residents from Elmina’s to become patients at ATC in exchange for kickbacks. ATC submitted false claims for PHP services based on Ramnarine’s Medicare beneficiary referrals. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Giuseppe Pellerito, Case No. 12-20292-CR-Cooke

In this case, defendant Giuseppe Pellerito is charged with conspiracy to receive health care kickbacks and substantive counts of receiving kickbacks. The indictment alleges that Pellerito, the owner of Florida Sober House (FSH), received kickbacks for recruiting residents from FSH to become patients at ATC. ATC, in turn, submitted false claims for PHP based on Pellerito’s referrals. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Hassan Collins, Case No. 12-20286-CR-Moore

Hassan Collins is charged with one count of conspiracy to pay and receive health care kickbacks. According to the criminal information, Collins was the owner of New Way Recovery Inc. (NWR), which operated several halfway houses in Broward County. Collins allegedly received kickbacks for recruiting Medicare beneficiaries who resided at NWR to become patients at ATC. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Jean Luc Veraguas, Case No. 12-20287-CR-Moreno

Jean-Luc Veraguas is charged with one count of conspiracy to commit health care fraud. The criminal information alleges that Veraguas was the owner of Neu Ways Inc., which operated several halfway houses in Broward County. Veraguas allegedly referred residents at his houses to ATC in exchange for kickbacks. This case is being prosecuted by Trial Attorney Steven Kim of the Criminal Division’s Fraud Section.

U.S. v. Pablo Orama, Vivian Augustine, a/k/a Vivian Salazar, Ariane Marchioro Amorim, Jose Orelvis Ortega, Marlen Diosdada Garcia, Ivon Perez, Marianela Terrero, Jose Abreu-Gonzalez, Elba M. Caicedo, Carlos A. Herrera, Marisela Sherwood, Nancy Diaz, Daymi Fuentes Gil, Olga Martinez Rodriguez, Yuria Perez Rivero, and Joel Loyola, Case No. 12-20265-CR-Middlebrooks(s)

In this case, 16 defendants are charged with conspiracy to pay and receive health care kickbacks and substantive counts of paying and receiving kickbacks in connection with a federal health care program. According to the indictment, defendant Pablo Orama was the owner of Superstar Home Health, a Miami-Dade County home health agency that purportedly provided skilled nursing services and physical therapy to homebound Medicare beneficiaries. Vivian Augustine and Ariane Amorim were employees of the company. Jose Orelvis Ortega, Marlen Garcia, Ivon Perez, Marianela Terrero, Jose Abreu-Gonzalez, Elba Caicedo, Carlos Herrera, Marisela Sherwood, and Nancy Diaz were recruiters who offered money to Medicare beneficiaries in return for their agreement to serve as patients at Superstar. Defendants Daymi Fuentes Gil, Olga Rodriguez, Yuria Rivero, and Joel Loyola were Medicare beneficiaries who accepted kickbacks in return for agreeing to serve as patients at Superstar. This case is being prosecuted by Assistant U.S. Attorney Eric E. Morales.

U.S. v. Jorge Luis Reyes and Waldo Gonzalez, Case No. 12-14030-CR-Moore

This indictment charges Jorge Luis Reyes and Waldo Gonzalez, owners of a medical clinic that purported to treat HIV-positive Medicare beneficiaries at locations in Miami-Dade and St. Lucie Counties. According to the indictment, between November 2005 and January 2009, the defendants submitted approximately $15,201,162 in fraudulent claims to Medicare for treatment that was not provided, and in many cases would not have been medically necessary. The majority of the fraudulent claims (more than $13.6 million) were submitted to private insurance companies that were a Medicare Advantage contractor under Part C of the Medicare program. This case is being prosecuted by Assistant U.S. Attorney Marc Osborne.

U.S. v. Manotte Bazile, Case No. 12-20284-CR-Lenard

Defendant Manotte Bazile, a former social worker and licensed intern at Biscayne Milieu, was charged with health care fraud conspiracy for purportedly treating patients who did not qualify for PHP treatment. This case is part of larger indictment involving of Biscayne Milieu, a CMHC that was involved in the submission of $57 million in false claims to Medicare for purportedly providing PHP services to Medicare beneficiaries who did not qualify for or receive the treatments that were billed to Medicare. In this case, Bazile assisted non-U.S. citizen patients by completing immigration forms on their behalf that falsely indicated that the patients suffered from mental illnesses, thereby fraudulently enabling the patients to avoid taking the citizenship test. This case is being prosecuted by Assistant U.S. Attorney Alicia Shick.

U.S. v. Roselyn Nicole Charles, Case No. 12-20283-CR-Ungaro

Defendant Roselyn Nicole Charles, a former patient recruiter at Biscayne Milieu, was charged with conspiracy to pay health care fraud kickbacks. More specifically, the criminal information alleges that Charles recruited patients to participate in Biscayne Milieu’s PHP in exchange for kickbacks. These patients, who did not qualify for PHP treatment, were promised assistance with their U.S. citizenship applications in exchange for their participation in Biscayne Milieu’s PHP. This case is part of larger indictment of Biscayne Milieu, a CMHC that was involved in the submission of more than $57 million in false claims to Medicare for purportedly providing PHP services to Medicare beneficiaries who did not qualify for PHP treatment or receive the treatments that were billed to Medicare. This case is being prosecuted by Assistant U.S. Attorney Alicia Shick.

The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams comprised of attorneys from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices for the Southern District of Florida, the Eastern District of Michigan, the Southern District of Texas, the Central District of California, the Middle District of Louisiana; the Northern District of Illinois, and the Middle District of Florida; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 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 their inception in March 2007, Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. Miami was the first Strike force city in the nation, and the model for others that followed.

An indictment or information is only an accusation and defendants are presumed innocent until proven guilty.

A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida at www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.

- Related Department of Justice press release

Fifty-Nine South Florida Residents Charged as Part of Nationwide Coordinated Takedown by Medicare Fraud Strike Force Operations | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

WASHINGTON—EUSA Pharma (USA) Inc. has agreed to pay the United States $180,000 to resolve claims that it violated the False Claims Act by allegedly encouraging doctors to submit inflated claims to Medicare for imaging scans, the Justice Department announced today. EUSA Pharma (USA) is headquartered in Langhorne, Pennsylvania.

The United States alleged that EUSA Pharma, which makes and sells ProstaScint, a radiopharmaceutical, advised health care providers to submit multiple claims for certain imaging scans performed following use of ProstaScint, after the Society of Nuclear Medicine informed the company that only one claim should be submitted for these scans.

“Today’s settlement demonstrates our commitment to ensuring that the Medicare Trust Fund is used to pay for necessary medical care and is not depleted as a result of marketing schemes intended to increase sales by inflating government reimbursements,” said Stuart F. Delery, Acting Assistant Attorney General of the Justice Department’s Civil Division. “We will continue to hold accountable those who abuse public health care programs at the expense of taxpayers.”

Today’s settlement resolves a lawsuit filed by former EUSA Pharma employee Ann-Marie Williams under the qui tam, or whistleblower provisions, of the False Claims Act. Under the False Claims Act, private citizens can bring suit on behalf of the United States and share in any recovery. Williams will receive $30,600 as her share of the government’s recovery.

This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services, in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover nearly $6.7 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $8.9 billion.

The investigating agencies were the FBI’s Washington Field Office and the Office of Criminal Investigations of the U.S. Food and Drug Administration.

Pennsylvania-Based EUSA Pharma (USA) Inc. to Pay U.S. $180,000 for Allegedly Submitting Inflated Claims to Medicare | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

DENVER—Anthony Paul Breaux, of Palisade, Colorado, was sentenced this morning to serve four years in federal prison for health care fraud and money laundering greater than $10,000 in connection with his actions to defraud government funded health care programs meant to compensate nuclear weapons workers and certain miners. The sentence was handed down by U.S. District Court Judge Christine M. Arguello. Following his prison sentence, Breaux was ordered to spend three years on supervised release. The defendant was also ordered to pay restitution of over $3,500,000 to the victims of his crime. Breaux is to surrender to a Bureau of Prisons facility within 30 days of designation. To date, the government, using asset forfeiture, has seized approximately $1,300,000.

Breaux was indicted by a federal grand jury on September 1, 2011. He pled guilty on November 10, 2011. He was sentenced today, Friday, March 16, 2012.

According to public court documents, including the indictment and the stipulated facts contained in the plea agreement, in October 2009, Breaux created and was acting as a registered agent for Honor-Bound Healthcare Providers (HBHP), a Colorado Corporation. Breaux owned 100 percent of Honor-Bound and was in the business of providing home health care services to patients in Colorado, Oregon, Arizona, and elsewhere.

Part of Honor-Bound’s patients were nuclear weapons workers or miners, millers, and transporters. In order to be reimbursed for providing medical services to these individuals, Breaux billed Energy Employees Occupational Illness Compensation Program (EEOICP) pursuant to the Radiation Exposure Compensation Act (RECA). EEOICP is a health care benefit program that provides lump-sum compensation and health benefits to eligible Department of Energy nuclear weapons workers. RECA provides coverage to eligible uranium miners, millers, and transporters. Coverage is extended under both acts to certain eligible survivors with lump-sum compensation that would have otherwise been payable to the workers. The United States Department of Labor (DOL), Office of Workers’ Compensation Programs, Division of Energy Employees Occupational Illness Compensation (DEEOIC) is responsible for administering EEOICP.

From June 2010 until June 2011, Breaux, doing business through Honor-Bound, knowingly and willfully executed and attempted to execute a scheme to defraud these health care benefit programs by submitting and causing to be submitted bills for payment knowing those bills already had been paid. In other cases, the defendant submitted invoices for services never provided. He obtained payments on the claims in part by submitting false supporting documentation. In total, the fraud the defendant perpetrated is over $3.5 million.

Breaux recruited individuals to provide care to the DEEOIC claimants he recruited who lived on the Indian Reservation in Arizona, and these individuals were family members who were already taking care of the beneficiaries. Breaux told the family members HBHP could pay them $13 per hour for care they were providing. The individuals who provided the care to the claimants in Arizona were not registered nurses, but Breaux billed DEEOIC at the registered nurse rate, $90 to $100 per hour, for the care the family members provided. Breaux knew this was not right, but he did it because of the large amount of money he was able to bring into HBHP. Breaux also forged doctor signatures he submitted to DEEOIC so that DEEOIC would authorize 24-hour, seven days a week home health care.

On or about December 4, 2010, Breaux knowingly engaged in a monetary transaction of criminally derived property of a value of $18,235.47 by writing, delivering, and causing the depositing and cashing of a check by a person Breaux used to recruit patients eligible as claimants; those funds had been derived from unlawful activity. The parties stipulated that the aggregate loss to the victims in this case was in excess of $3,400,000.

“Health care fraud is in part responsible for higher health care costs: whenever a government program is defrauded, every taxpayer is a victim,” said U.S. Attorney John Walsh. “Breaux defrauded a well-meaning program designed to address persons afflicted with serious conditions related to radiation exposure inherent in their jobs. The defendant’s conduct was reprehensible in light of the persons who should have benefitted from the funds associated with the program.”

“Today’s sentencing highlights our efforts to investigate fraud against the Department of Labor’s Energy Employees Occupational Illness Compensation Program, which was designated to provide compensation to persons who have become ill as a result of work at nuclear weapons facilities. The Office of the Inspector General and its law enforcement partners remain committed to combating these types of crimes,” stated David C. Wickersham, Special Agent in Charge for the Dallas Regional Office of the U.S. Department of Labor’s Office of Inspector General, Office of Labor Racketeering and Fraud Investigations.

“Health care fraud harms everyone as it increases the cost of legitimate health care for everyone,” said Sean Sowards, Special Agent in Charge, IRS Criminal Investigation, Denver Field Office. “This successful investigation was due to the cooperative efforts of our law enforcement partners—U.S. Attorney’s Office, the FBI, and the Department of Labor’s Office of Inspector General.”

“FBI investigations involving health care and government fraud are among some of our highest priorities. We continue to work with our federal, state, and local partners to ensure the public’s interest and taxpayer’s monies are not being abused by those interested in defrauding the system,” said FBI Denver Special Agent in Charge James Yacone. “It is our hope that today’s sentence will send a strong message to all who have been granted a trust in our health care system. On behalf of the FBI, I would like to express my sincere appreciation to our partners at the Department of Labor-OIG, the IRS-CI, and the U.S. Attorney’s Office for their hard work and long hours in bringing Breaux to justice.”

This case was investigated by the Department of Labor Office of the Inspector General (DOL OIG), the Internal Revenue Service-Criminal Investigation (IRS-CI), and the Federal Bureau of Investigation (FBI).

The defendant was prosecuted by Assistant U.S. Attorneys Jaime Pena and Tonya Andrews.

Palisade Man Sentenced for Defrauding Health Care Programs for Nuclear Weapons Workers and Certain Miners | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

ATLANTA—The United States Attorney’s Office announced today that it has reached a settlement with ROBERT M. RITCHEA, M.D., 49, of Phenix City, Alabama, to resolve allegations under the False Claims Act that RITCHEA submitted more than $2.2 million in false or fraudulent claims to Medicare. Pursuant to the settlement, RITCHEA will be excluded from payment from all federal health care programs for a period of seven years. The payment prohibition applies to RITCHEA, anyone who employs or contracts with him, and any hospital or other provider for which he provides services. RITCHEA will also pay the United States the proceeds from the sale of a second home and $5,000 immediately. In the settlement process, a defendant’s ability to pay is taken into consideration when determining the settlement amount.

Sally Quillian Yates, United States Attorney for the Northern District of Georgia, said, “Our office is committed to pursuing doctors who put money before the health and safety of their patients. Dr. Ritchea admitted to allowing an unlicensed medical assistant to inject patients with pain medications and billing Medicare for these injections. As a result he will be excluded from all federal health care programs for seven years.”

The civil settlement resolves a complaint filed by the United States against RITCHEA, United States v. Robert M. Ritchea, M.D., 1:10-cv-02410-JOF. The complaint alleges that RITCHEA violated the False Claims Act by improperly billing Medicare for unnecessary pain injections administered by an unlicensed medical assistant. As a condition of the settlement, RITCHEA admitted that he allowed the unlicensed medical assistant to administer at least 80% of the pain injections. He also admitted to both the Alabama State Board of Medical Examiners and the Georgia Composite State Board of Medical Examiners that the injections were unnecessary.

The United States’ settlement is part of the government’s emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department used to recover approximately $2.4 billion nationwide in fiscal year 2011 in cases involving fraud against federal health care programs. The Justice Department’s total health care fraud recoveries under the False Claims Act since January 2009 have been over $6.6 billion.

This settlement also highlights another powerful tool to protect federal health care programs and beneficiaries and to hold accountable those that commit health care fraud—the exclusion authority of the United States Department of Health and Human Services Office of Inspector General (HHS-OIG). Section 1128 of the Social Security Act gives HHS-OIG the authority to exclude individuals and entities from participation in federal health care programs for fraud or other misconduct.

This case was investigated by special agents of the Federal Bureau of Investigation. The civil settlement was reached by Assistant United States Attorneys Christopher J. Huber and Lena Amanti.

Doctor Banned from Federal Health Care Programs for Seven Years | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

PROVIDENCE, RI—Rhode Island Hospital will reimburse federal health care programs approximately $2.6 million dollars and will pay the federal government approximately $2.7 million in double and triple damages for ordering medically unnecessary overnight patient hospital stays and then submitting claims for payment to federally funded Medicare and Medicaid programs.

An investigation by the United States Attorney’s Office for the District of Rhode Island; Office of Inspector General of the U.S Department of Health and Human Services (OIG-HHS); and the Federal Bureau of Investigation determined that during the period from January 1, 2004, through December 31, 2009, medically unnecessary overnight hospital admissions were ordered for approximately 260 patients who underwent stereotactic radiosurgery, otherwise known as Gamma Knife treatment. The investigation also revealed that Rhode Island Hospital’s claims for reimbursement for the overnight admissions to Medicare and Medicaid falsely represented that the admissions were medically necessary when, in fact, they were not.

According to a Civil Settlement Agreement, OIG-HHS reserves all rights to institute, direct, or to maintain any administrative action seeking exclusion against Rhode Island Hospital and/or its officers, directors, and employees from Medicare, Medicaid, and all other federal health care programs. In addition, the Agreement stipulates that the federal government does not release Rhode Island Hospital from any criminal liability or liability to the Internal Revenue Service in this matter.

“Health care organizations accused of billing for medically unnecessary services by abusing Medicare and Medicaid rules to put the profit motive before quality health care services will be identified and held responsible,” said Susan J. Waddell, Special Agent in Charge of the region covering Rhode Island for the Office of Inspector General of the Department of Health and Human Services. “This settlement reflects the determination of OIG and the Department of Justice to protect taxpayer funded health care services for those in need.”

The investigation for the United States Attorney’s Office was led by Assistant U.S. Attorney Dulce Donovan. The matter was also investigated by the Office of Inspector General of the U.S Department of Health and Human Services and the Federal Bureau of Investigation

Rhode Island Hospital to Pay $5.3 Million for Ordering Unnecessary Hospital Stays Billed to Federal Health Care Programs | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

February 6, 2012

In 2004, concerns about antidepressant drugs increasing suicidal thoughts and behaviors in young patients prompted the FDA to issue a rare “black box warning.” Now, a new analysis of clinical trial data finds that treatment with the antidepressant fluoxetine did not increase — or decrease — suicidality in children compared to placebo treatment.

An analysis built on data from 41 trials and more than 9,000 patients also found that two different popular antidepressant drugs were effective at reducing suicidal behavior and depressive symptoms in adult and geriatric patients. The findings are published online Feb. 6 in the journal Archives of General Psychiatry.

The failure to replicate the link between antidepressants and suicide should reassure doctors about prescribing these drugs to depressed patients, said first author Robert Gibbons, PhD, professor of medicine, health studies, and psychiatry at the University of Chicago Medicine.

“The key finding here, when we re-analyze all the patient-level longitudinal records in these studies, is that antidepressants neither increase nor decrease suicidal thoughts or behavior in children,” Gibbons said.

The FDA decision on the black box warning was based on retrospective data from 25 clinical trials of newer antidepressant medications, including the serotonin reuptake inhibitor drug fluoxetine, marketed as Prozac or Sarafem. A meta-analysis combining adverse event data (primarily based on self reports of suicidal thoughts) from the trials revealed a small, but significant, increase in suicidal thoughts and behavior in children and young adults up to the age of 25.

For the new analysis, Gibbons and colleagues from the University of Illinois at Chicago, the University of Miami and Columbia University obtained individual-level, longitudinal clinical trial data — some of it unpublished — from pharmaceutical producers and a large National Institute of Mental Health collaborative study of fluoxetine and venlafaxine. The data included weekly screening of each trial subject for depression and suicidal thoughts, allowing researchers to compare the effect of drug or placebo over time on these measures.

In the analysis of the adult and geriatric trials testing fluoxetine or venlafaxine, both antidepressants were found effective in reducing suicide risk and depression symptoms. These two effects were also found to be statistically associated, suggesting that the drugs reduced suicidality by alleviating depression. Therefore, Gibbons said, effective treatment of major depressive disorder is important for a patient’s safety.

“Basically, the results say that the mechanism by which the antidepressants affect suicide rates is by decreasing depression,” Gibbons said. “It follows that if a treatment is not working for an individual, the risk for suicidal behavior and perhaps worse remains high.”

To analyze the effects of antidepressants in children, the researchers used four trials of fluoxetine, which until recently was the only antidepressant approved for pediatric use. Once again, a reduction in depressive symptoms was observed in the drug-treated population compared to placebo. However, no significant change in suicide risk was detected between the two patient groups.

“I think that this paper supports the general idea that the effects of antidepressants in kids and adults are not really the same, since we don’t see anything but beneficial effects of antidepressants in adults and geriatrics,” Gibbons said. “In kids, we don’t see a harmful effect, but we do see a disassociation between the beneficial effects on depression and the potential beneficial effect on suicide.”

“This raises continued questions about what’s going on in children,” he continued. “Maybe children think about suicide in part because of depression, but also maybe due to other reasons not related to depression that are not affected by antidepressants.”

Gibbons, who sat on the Food and Drug Administration panel that considered placing the black box warning on antidepressants, said he hoped the new results would reassure clinicians about the safety of the drugs. Previous research by his group found that the addition of the warning significantly reduced antidepressant prescriptions to both children and adults and correlated with a spike in suicide rates.

“I hope that the warnings will not prevent depressed children and adults from getting treatment for depression,” Gibbons said. “The greatest cause of suicide is untreated or undiagnosed depression. It’s very important that this condition be recognized and appropriately treated and not discarded because doctors are afraid to be sued.”

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Antidepressant-suicide link in youths absent in new analysis | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

MCALLEN, TX—The owner of a purported health care resource center has been charged by a federal grand jury with one count of conspiracy to defraud the United States and two counts of soliciting and receiving kickback payments in violation of the federal anti-kickback statute, United States Attorney Kenneth Magidson announced today.

Alicia Vasquez, of San Juan, Texas, the owner of David’s Star Loving Vision Resource Center (DSLV), was charged in a three-count indictment returned under seal on Nov. 1, 2011. The indictment was unsealed this morning, following the arrest of Vasquez by FBI and Department of Health and Human Services-Office of Inspector General (DHHS-OIG) agents. Vasquez, 51, is scheduled to appear in McAllen federal court later this morning for an initial appearance.

The federal anti-kickback statute prohibits individuals and entities from knowingly and willfully paying or offering to pay, as well as soliciting or receiving, remuneration (money or other things of value) in return for the referral of patients for medical services or items which are benefits under a federal health care program, such as Medicare or Medicaid. A violation of the anti-kickback statute is a felony offense that is punishable by up to five years in federal prison without parole and a $25,000 fine.

According to allegations in the indictment, from September 2009 through April 2011, Vasquez solicited numerous Medicare and Medicaid beneficiaries through DSLV for the purpose of referring them to a variety of health care providers in Hidalgo and Cameron Counties including durable medical equipment (DME) companies, physicians and home healthcare agencies.

Over time, Vasquez allegedly referred the Medicare and Medicaid beneficiaries to these providers in exchange for a total of at least $70,000 in payments in violation of the anti-kickback statute. In turn, the providers billed hundreds of thousands of dollars to the Medicare and Medicaid programs as a result of the allegedly illegal referrals. The indictment further charges that Vasquez, and the providers to which she referred beneficiaries, undertook a variety of measures to conceal Vasquez’s involvement with respect to the referrals. For example, the indictment alleges one owner of a DME company paid kickbacks to Vasquez through a third-party—referred in the indictment as “Person A.” The kickbacks were allegedly deposited into Person A’s bank account, from where the money was later diverted to Vasquez.

The ongoing investigation in this case is being conducted by the FBI and DHHS-OIG. Assistant United States Attorney Greg Saikin is prosecuting the case.

McAllen-Area Health Care Marketer Arrested for Conspiracy and Anti-Kickback Violations | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

WASHINGTON—A Miami-area nurse pleaded guilty today for his participation in a $25 million home health Medicare fraud scheme, the Department of Justice, the FBI and the Department of Health and Human Services (HHS) announced today.

Jorge Pineiro, 42, pleaded guilty before U.S. District Judge Joan A. Lenard in Miami to one count of conspiracy to commit health care fraud. Pineiro was originally charged in a February 2011 indictment.

According to plea documents, Pineiro was a registered nurse who worked for ABC Home Health Care Inc. and Florida Home Health Care Providers Inc., two Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. Pineiro and his co-conspirators operated ABC and Florida Home Health for the purpose of billing Medicare for expensive services that were not medically necessary and/or were never provided. The medically unnecessary services were prescribed by doctors, including, but not limited to, Pineiro’s co-defendant, Dr. Jose Nunez.

According to court documents, beginning in approximately June 2008, and continuing until approximately March 2009, Pineiro and his co-defendant nurses falsified patient files for Medicare beneficiaries to make it appear that they qualified for home health care and therapy services. Pineiro knew that the beneficiaries did not actually qualify for and did not receive the services. Pineiro and his co-defendant nurses described in nursing notes and patient files symptoms that were non-existent, such as tremors, impaired vision, weak grip and inability to walk without assistance. They included these symptoms to make it appear that the patients were unable to self-inject insulin and were homebound, thus appearing to qualify for home health care benefits under Medicare.

Pineiro admitted that he knew these files were falsified so that Medicare could be billed for medically unnecessary therapy and home health-related services. As a result of Pineiro’s participation in the illegal scheme, the Medicare program was billed approximately $118,000 for purported home health care services that were not medically necessary and/or were never provided.

Pineiro also recruited Medicare beneficiaries who allowed Florida Home Health to bill Medicare for services that were medically unnecessary and/or never provided. Pineiro solicited and received kickbacks and bribes from the owners and operators of Florida Home Health in return for allowing the agency to bill Medicare on behalf of the patients he recruited. The patients that Pineiro recruited did not qualify for the services that were billed to the Medicare program. Pineiro knew that the patient files for his recruited patients were falsified to make it appear that the patients qualified for services from Florida Home Health.

Eighteen co-defendants, including Nunez, Licet Diaz, and Lisandra Alonso, have pleaded guilty for their roles in the fraud scheme. Nunez, Diaz, and Alonso were sentenced to 40 months, 87 months and 78 months in prison, respectively. Two remaining defendants, Dr. Francisco Gonzalez and Odalys Alvarez-Medina, are scheduled for trial on Feb. 14, 2012. An indictment is merely a charge, and defendants are presumed innocent until proven guilty.

Sentencing for Pineiro has been scheduled for April 9, 2012.

The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. The defendant also faces fines and supervised release, as well as forfeiture of any property or proceeds derived from his criminal activities.

Today’s guilty plea 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.

This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section. 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 Miami.

Since their inception in March 2007, strike force operations in nine locations have obtained indictments of more than 1,160 individuals who collectively have falsely billed the Medicare program for more than $2.9 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.

Miami-Area Nurse Pleads Guilty in $25 Million Health Care Fraud Scheme | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

January 19, 2012

The impact of efforts by the U.S. Food and Drug Administration to notify the general public and health care providers about unanticipated risks from approved medications has been “varied and unpredictable,” according to a systematic review of published studies about FDA warnings and alerts over the last 20 years.

Although some communication efforts had a strong and immediate effect, many had little or no impact on drug use or health behaviors and several had unintended consequences, researchers report in the journal Medical Care.

“Communicating risk to large groups of people is a complex science,” said study director G. Caleb Alexander, MD, associate professor of medicine at the University of Chicago. “But success or failure at this can have significant consequences. As such efforts become more and more common — with the FDA’s mandate to establish a more active surveillance system — we will need a better understanding of how to make them work and where they can go wrong. And we need more and better studies of the successes and failures of this process.”

The FDA has several standard tools to disseminate new evidence about drug safety. These include “Dear Healthcare Provider” letters to prescribers, “public health advisories” and “Safety Alerts” targeting the general public, and “black box warnings” added to a label when a drug’s risks may be particularly severe or affect a large population. Despite numerous studies examining single alerts, advisories and label changes, no prior study has systematically examined the effect of these risk communications.

The researchers — from the University of Chicago Medical Center, North Shore University HealthSystem, Johns Hopkins Medicine and Harvard Medical School — combed through the literature on the topic. They screened 1,432 articles published between 1990 and 2010. Only 49 reports had a primary goal of assessing the consequences of FDA risk communications for prescription drugs. One-third of those articles focused on antidepressants.

The researchers sorted FDA risk communications into four categories: warnings about serious adverse events, recommendations against use in specific patient populations, preventing harmful drug-drug interactions, and calls for increased laboratory or clinical monitoring.

The most effective notices were those warning the public about potential serious adverse events, but even these varied in their impact. For example, several studies found that patients shifted away from the diabetes drug rosiglitazone after an FDA alert noted an increased risk of cardiovascular events with this drug. This led to decreased use of rosiglitazone and increased use of other, less risky anti-diabetes drugs.

A similar 2010 FDA warning for asthma patients, however, had little effect. It stressed that one class of asthma medications known as long-acting beta agonists should not be used without an asthma controller medication, such as inhaled corticosteroids. Rates of controller medication use with long-acting beta agonists were low before the FDA warning and did not significantly increase after the advisory was issued.

Recommendations that specific groups of patients avoid certain medications sometimes decreased use, but also produced unintended consequences. The most notable was a series of advisories about the use of antidepressants among children and adolescents. The widely publicized alerts significantly decreased use of these medications by adults as well as children, and one study suggested an unexpected increase in suicides among children and adolescents due to increases in untreated depression.

FDA warnings about harmful drug-drug interactions had some impact, although reductions in co-prescribing that occurred often required repeated risk advisories and took months to years. For example, initial messages to reduce the use of cisapride with contraindicated products were first sent in February 1995, but large changes in cisapride co-prescribing were not observed until after the third alert sent in June 1998.

A fourth category, recommendations to increase clinical or laboratory monitoring for patients taking certain drugs, produced “no evidence of a large or sustained impact of the FDA recommendations.” For example, recommendations to monitor patients using antipsychotic medications for hyperlipidemia and diabetes showed no changes in glucose testing following the FDA advisory.

Part of the problem, the authors emphasize, is the challenge of communicating complex risk messages to a large, diverse audience. “The most effective communications were the simplest, those that were specific, where alternatives were available, and where the messaging was reinforced over time,” said Stacie Dusetzina, PhD, lead author from Harvard Medical School.

The study was funded by the Agency for Healthcare Research and Quality and an NIH Clinical and Translational Science Award to the University of Chicago. Additional authors include Haiden Huskamp from Harvard; Ashley Higashi, Rena Conti and Shu Zhu from the University of Chicago; Ray Dorsey from Johns Hopkins; and Craig Garfield from North Shore.

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Study: Communicating health risk is a risky task for FDA | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

BALTIMORE—U.S. District Judge James K. Bredar sentenced Larry Bernhard, age 56, a podiatrist who operated his business from his home in Gambrills, Maryland, today to 54 months in prison followed by three years of supervised release for health care fraud and aggravated identity theft related to a scheme to fraudulently bill Medicare for more than $1.1 million. Judge Bredar also entered an order requiring Bernhard to pay restitution of $1,122,992.08.

The sentence was announced by United States Attorney for the District of Maryland Rod J. Rosenstein; Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services; and Special Agent in Charge Richard A. McFeely of the Federal Bureau of Investigation.

“Health insurance programs trust providers to bill honestly for medical services, so it is essential to punish doctors who betray that trust,” said U.S. Attorney Rod J. Rosenstein. “Dr. Larry Bernhard flagrantly ripped off Medicare Advantage by fabricating claims for services that he never provided, collecting more than $1 million in new false claims even after he was caught and prohibited from billing federal health care programs.”

According to his plea agreement, Bernhard has been a licensed podiatrist in Maryland since 1981 and operated a podiatry practice from his home known as Chesapeake Wound Care Center. On October 30, 2007, Bernhard entered into a Settlement Agreement with the government to resolve allegations that from April 1, 2002 through October 11, 2004, he had submitted 80 claims to Medicare for podiatry services purportedly provided at skilled nursing facilities, when in fact the patients were in hospitals. As part of the settlement, Bernhard agreed to be excluded from “Medicare, Medicaid, and all other Federal health care programs” for a period of three years.

Bernhard admits that immediately after signing the Settlement Agreement, and from October 31, 2007 to July 20, 2010, he fraudulently billed Medicare Advantage plans for which he was paid at least $1.1 million. All of the fraudulent billing occurred while Bernhard was excluded from billing all federal health care programs, including Medicare Advantage plans. Of the $1.1 million received by Bernhard, at least $1 million was for services that were not rendered. Bernhard admits that he used the names and personal identifying information of approximately 200 nursing home patients to submit false bills for podiatry care that he never performed.

United States Attorney Rod J. Rosenstein commended the HHS-Office of Inspector General and FBI for their work in the investigation. Mr. Rosenstein thanked Assistant United States Attorney Paul E. Budlow, who prosecuted the case.

Gambrills Podiatrist Sentenced to Over Four Years in Prison for Fraudulently Billing Medicare Over $1.1 Million | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

United States Attorney Robert Pitman announced that in El Paso today, 57-year-old Anthony Francis Valdez was sentenced to 25 years in federal prison followed by three years of supervised release in connection with an estimated $42 million fraudulent health care benefit program billing scheme. Valdez, a former physician, was the owner of the Institute of Pain Management with clinics in El Paso and San Antonio.

“Valdez preyed on the most vulnerable members of our society—the poor, the disabled and the elderly. In doing so, he sought to enrich himself by billing health care entitlement programs, such as Medicare, Medicaid and Tri-Care, of more than $42 million during a five-year period for services he did not perform. As a result, Valdez has lost his medical license, his reputation, his property and most of all his freedom. We hope his sentence of 25 years serves as a deterrence to others who would contemplate defrauding these federally funded health care programs,” stated United States Attorney Robert Pitman.

In addition, Senior United States District Judge David Briones ordered that Valdez pay $13,356,645.44 restitution; and, forfeit more than $1.7 million in cash, his residence in El Paso, his residence in San Antonio, as well as five vehicles. Judge Briones also handed down a monetary judgement against Valdez for $9,741,649.

“Today’s sentencing of Anthony Valdez represents the FBI’s commitment to investigating threats associated with Health Care Fraud in the El Paso area and prosecuting those individuals responsible for defrauding government and private health care benefit programs. It was through the dedication and hard work of the special agents and professional support staff of the El Paso FBI as well as several other state, local, and federal agencies, that this investigation was successfully completed,” stated Federal Bureau of Investigation Special Agent in Charge Mark Morgan, El Paso Division.

On July 1, 2011, Valdez was convicted by a jury of one count conspiracy to commit health care fraud, six counts of health care fraud, six counts of false statements related to health care matters, and three counts of money laundering. Evidence during trial revealed that beginning in January 2005 and continuing through December 2009, Valdez caused fraudulent claims to be submitted to Medicare, Medicaid, and TRICARE for procedures which he did not perform or were non-reimbursable.

“These kinds of criminals, like Anthony Valdez, hurt the very nature of our health care system by falsely inflating the cost of health care for all of us. Valdez’s punishment is well justified and will serve as a warning to other unscrupulous health care professionals,” stated Internal Revenue Service-Criminal Investigation Special Agent in Charge Steve McCullough.

This case was investigated by agents with Federal Bureau of Investigation, Drug Enforcement Administration, Internal Revenue Service-Criminal Investigation, U.S. Postal Inspection Service, Defense Criminal Investigative Service–Southwest Field Office together with the Texas Attorney General’s Office. Assistant United States Attorneys William F. Lewis, Jr., and Juanita Fielden prosecuted this case on behalf of the government.

Former Texas Pain Management Physician and Psychiatrist Sentenced to Federal Prison on Health Care Fraud Charges | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

ARLINGTON HEIGHTS, Ill., Dec. 5, 2011 /CHICAGOPRESSRELEASE.COM/ — Mark A. Frey has been named President and Chief Executive Officer of the Alexian Brothers Health System. He succeeds Brother Thomas Keusenkothen, C.F.A., who retired from the position on December 1, 2011.

(Photo: http://photos.CHICAGOPRESSRELEASE.COM.com/prnh/20111205/CG16676)

An Alexian Brother Health System employee for more than 25 years, Mr. Frey previously served as President and Chief Executive Officer of Alexian Brothers Behavioral Health Hospital, Chief Executive Officer of Alexian Rehabilitation Hospital, and Vice President of the Alexian Brothers Health System Neurosciences Institute before being named Alexian Brothers Health System Executive Vice President in 2007. He will become the first layperson appointed as President and Chief Executive Officer in the Health System’s history.

“With a wealth of experience as a healthcare leader, and with a deep understanding of the Alexian Brothers’ mission and values, Mark is uniquely suited for his new role,” stated Brother Jim Classon, C.F.A., Provincial of the Congregation of Alexian Brothers. “As healthcare consolidation presents new challenges, Mark’s insight and pragmatism played a key role in the Alexian Brothers’ decision to seek a healthcare partner whose resources could help our own healthcare and housing ministries continue to serve the communities that depend on them.”

In September Alexian Brothers Health System signed a definitive agreement to become part of St. Louis-based Ascension Health, the largest Catholic healthcare system in the nation. The partnership between the two organizations is expected to be finalized in the coming weeks.

Mr. Frey completed his undergraduate degree at the University of Illinois at Chicago, his Master’s of Social Work at Loyola University of Chicago, and his Juris Doctor at the Illinois Institute of Technology/Chicago-Kent College of Law, and has held a number of administrative and teaching positions. Prior to Alexian Brothers, Frey was CEO of Linden Oaks Hospital in Naperville, Illinois.

About Alexian Brothers Health System

Ranked among the nation’s best-performing health systems, the Alexian Brothers Health System is comprised of four hospitals and a center for mental health; immediate care centers, diagnostic imaging facilities, occupational health centers and primary care groups that serve more than two million people every year in the Chicagoland area with innovative care, world-class medical specialists, clinical research initiatives, and state-of-the-art technology providing highly specialized care. The Alexian Brothers Health System also has an enduring commitment to identifying and developing an effective response to the unique health and housing needs of older adults through a dynamic senior ministries program that operates an array of residential, retirement and community resources in Missouri, Tennessee, and Wisconsin. For more information visit: www.alexianbrothershealth.org

SOURCE Alexian Brothers Health System

http://www.alexianbrothershealth.org

Alexian Brothers Health System Names New President and Chief Executive Officer | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

CHICAGO – Dec. 2, 2011. Governor Pat Quinn today joined with Walgreens to encourage Illinoisans to get a seasonal flu shot. Governor Quinn also highlighted Walgreens’ recent announcement that it is working with the U.S. Department of Health and Human Services to offer more than $10 million worth of free flu shot vouchers to Americans without health insurance and those unable to afford one.

“We have a responsibility to each other to stay healthy this flu season and I commend Walgreens for its ongoing illness-prevention and wellness efforts,” Governor Quinn said. “Getting a flu shot is convenient and helps to guard against sickness that impacts our families and our work.”

Deerfield-based Walgreens offers flu immunizations daily at all of its more than 600 locations across Illinois, including all Walgreens pharmacies and Take Care Clinics. Flu shots are available during all pharmacy and clinic hours with no appointment necessary. For information about the flu shot voucher program in Illinois, consumers can contact their local health department, which can be found by visiting the Illinois Department of Public Health website at www.idph.state.il.us/flu/.

“We appreciate Governor Quinn reinforcing and recognizing the need for protection and prevention by receiving his flu shot today,” said Kermit Crawford, Walgreens president of pharmacy, health and wellness services and solutions. “Flu activity in the U.S. peaks in January and February more than 70 percent of the time so there’s still a long way to go. With the dedication and support of our pharmacists and Take Care Clinic nurse practitioners in communities statewide, we hope to help keep Illinois healthy throughout flu season.”

According to the U.S. Centers for Disease Control and Prevention (CDC), each year an estimated 5 to 20 percent of the U.S. population gets the flu. On average, influenza in the U.S. results in approximately 200,000 hospitalizations and more than 25,000 deaths annually. Flu symptoms may include a fever of 100 degrees Fahrenheit or above, headache, body aches, exhaustion, chills and weakness.

The influenza virus can be spread through coughing or sneezing. People can also get the flu by touching objects carrying the virus, such as telephones and door knobs, and then touching their mouth or nose.

The CDC recommends flu shots for everyone over the age of six months. Young children, pregnant women, people with chronic medical conditions and the elderly are at higher risk of complications from influenza. Side effects are mild; some individuals may experience mild flu-like symptoms for a few days after vaccination and soreness at the injection site.

For more information about the seasonal flu shot, visit www.idph.state.il.us/flu/, www.flu.gov, or www.walgreens.com/flu.

Governor Quinn Receives Seasonal Flu Shot – Encourages Everyone in Illinois to Prepare for Upcoming Flu Season | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

WASHINGTON—The owner and operator of a Pompano Beach, Florida-area assisted living facility pleaded guilty today for his role in a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company and a Medicaid fraud scheme that billed for assisted living services that were never provided, announced the Department of Justice, the FBI, the Department of Health and Human Services (HHS) and the Medicaid Fraud Control Unit (MFCU) of the Florida Office of the Attorney General.

Joseph B. Williams, 41, pleaded guilty before U.S. District Judge Jose E. Martinez in Miami to two counts of conspiracy to commit health care fraud. Williams was the owner and operator of Avondale Manors Retirement Home, an assisted living facility operating in Pompano Beach, and a company called Diversified Marketing Group Inc.

Williams admitted that in exchange for illegal health care kickbacks, he agreed to provide Medicare beneficiaries who resided at Avondale to American Therapeutic Corporation (ATC) for intensive mental health treatment called partial hospitalization program services. ATC purported to operate partial hospitalization programs in seven different locations throughout south Florida and Orlando. According to court documents, Williams was paid approximately $30 per beneficiary per day the beneficiary attended ATC. ATC paid the kickbacks mostly by check made out to Diversified.

According to his plea, Williams knew that ATC fraudulently billed Medicare for the partial hospitalization program treatment that his referrals purportedly received.

According to court documents, ATC’s principals paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and its related company, the American Sleep Institute (ASI). In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for partial hospitalization program services. Ultimately, ATC and ASI billed Medicare for more than $200 million in medically unnecessary services.

Williams also admitted that he billed Medicaid for assisted living services purportedly provided at Avondale when, in fact, those services were never provided. Williams paid owners and operators of halfway houses to obtain the personal identifiers of Medicaid enrollees who resided in those halfway houses and used that information to bill Medicaid fraudulently. Williams also billed Medicaid for assisted living services provided to residents of Avondale at times when they were not receiving any services.

According to the plea agreement, Williams’ participation in the fraud resulted in more than $2 million in fraudulent billing to the Medicare and Medicaid programs. At sentencing, scheduled for Feb. 8, 2012, Williams faces a maximum of 10 years in prison and a $250,000 fine for each count.

ATC, its management company Medlink Professional Management Group Inc., and various owners, managers, doctors, therapists, patient brokers and marketers of ATC, Medlink and ASI, were charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed on Feb. 15, 2011. ATC, Medlink and nine of the individual defendants have pleaded guilty or have been convicted at trial. Other defendants are scheduled for trial April 9, 2012, before U.S. District Judge Patricia A. Seitz.

Today’s guilty plea 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 B. Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

The case is being prosecuted by Trial Attorneys Steven Kim and Jennifer L. Saulino of the Criminal Division’s Fraud Section. The case was investigated by the FBI, HHS-OIG and MFCU 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 1,140 defendants that collectively have billed the Medicare program for more than $2.9 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.

Pompano Beach, Florida-Area Assisted Living Facility Owner Pleads Guilty to Fraud and Kickback Scheme | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

By Benjamin Yount | Illinois Statehouse News

SPRINGFIELD — Illinois’ seven endangered prisons and mental health facilities will stay open for at least the next six months after lawmakers gave Gov. Pat Quinn the power to shift nearly $300 million inside the state budget.

But more importantly, lawmakers also said they sent the governor this clear message: He must not threaten to close state facilities to get what he wants from the state budget.

Lawmakers on Tuesday approved this new spending authority for Quinn. The House approved it with a 92-20 vote and the Senate with a 50-5 vote.

The money, which was taken from Illinois’ regional superintendents, school transportation accounts and the Medicaid budget by delaying payment on more Medicaid bills, will keep the seven sites open through the end of June.

The sites are:

• Chester Mental Health Center in Chester;
• H. Douglas Singer Mental Health Center in Rockford;
• Tinley Park Mental Health Center in Tinley Park;
• Jacksonville Developmental Center in Jacksonville;
• Jack Mabley Developmental Center in Dixon;
• Illinois Youth Camp Murphysboro in Murphysboro;
• Logan Correctional Center in Lincoln.

Quinn has said he wants to close Illinois’ “institutional sites” and move residents with mental health issues to community care centers. That means the long-term future of the Singer, Tinley Park, Mabely and Jacksonville centers is still in doubt.

There is little support in the Legislature to close the Logan Correctional Center, Murphysboro youth camp or Chester Mental Health Center because of safety concerns. Murphysboro is home to dozens of juvenile inmates and Chester to inmates receiving mental health treatment rather than serving prison terms.

A final decision on the future of the Singer, Tinley Park, Mabely and Jacksonville centers is expected in the spring. And state Rep. Patti Bellock, R-Hinsdale, said Quinn will need to play a role in the decision.

“I see that the governor is starting to show that he wants to work with the legislators and share ideas,” Bellock said.

Lawmakers and statehouse insiders have criticized Quinn for introducing a budget plan, then walking away from the budget-making process. Bellock said the governor cannot take that approach this spring.

University of Illinois at Springfield political science professor Kent Redfield is quick to say Quinn’s critics are not wrong.

“I think it’s a fair criticism to say Gov. Quinn was absent from the budget-making process last year,” Redfield said.

The professor said Quinn can play a role in crafting the next state budget, but he must show lawmakers that he can change.

“People have an image of Pat Quinn as full of bombast,” said Redfield. “I think it’s going to take real work on the part of the governor to change that image.”

State Rep. Frank Mautino, D-Spring Valley, who helped write the Democratic spending plan last spring, said he expects Quinn to do that hard work.

“I think the governor will be more engaged, earlier on,” Mautino said. “I think the governor is going to be more active, because next year’s budget is going to be more difficult than this year.”

Illinois will need:

• At least $1 billion more to cover rising pension costs;
• $490 million for rising Medicaid costs;
• $1.5 billion for unpaid Medicaid bills from this year.

And lawmakers will be seeking more money for schools or social service programs that some say have been shorted in funds during the past few years.

State Rep. Will Davis, D-Crestwood, another Democratic budget architect, said he opposes another austere budget because he cannot tell his schools that they will once again have to do with less.

“In some cases, some of us wanted to say there is an opportunity to add additional dollars to other things,” Davis added.

Davis said he will not support another legislative cap on state spending, but lawmakers may have to craft a budget that relies on less money than the current spending plan.

Lawmakers are expected to have a new state budget in place by May 31. Illinois’ current budget expires June 30.

Originally reported by Illinois Statehouse News. Read the original article here.

Prisons, mental facilities saved; Quinn friendlier on budget | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

The U.S. Centers for Disease Control and Prevention awarded the one-year grant, which builds on previous funding to UIC’s Center of Excellence in the Elimination of Disparities to help reduce diabetes and cardiovascular disease among Latino and African-American populations in the Chicago area.

The UIC center “is working to ensure that food contributes to health among Latinos and African Americans rather than to chronic diseases,” says Sheila Castillo, associate director of the Midwest Latino Health Research, Training, and Policy Center and principal investigator on the grant.

The UIC center is one of 18 grantees addressing health disparities nationwide.

Castillo said the UIC center has built a coalition of businesses, institutions, and individuals dedicated to changing social factors underlying health disparities.

“We are looking to change policies and systems that will result in changes in the environment, so that there is more access to healthy food,” she said.

Castillo said the center focuses on increasing the equitable distribution of healthy food and increasing health literacy, but also funds community projects. The center provided grants to organizations operating in the Pilsen, Englewood, Humboldt Park, Roseland, Austin, and Logan Square neighborhoods of Chicago.

“Through our work to increase health literacy, we will increase demand for healthier food — and through our work to increase the equitable distribution of healthy food, we will increase supply,” she said.

“Everyone eats.”

In 1999, the CDC announced the Racial and Ethnic Approaches to Community Health 2010 (REACH 2010) Initiative. UIC, in partnership with community-based organizations, received a five-year grant to address diabetes disparities in Southeast Chicago and also collaborated with the Chicago Department of Public Health to address cardiovascular disease disparities in the North and South Lawndale areas. In 2007, UIC received a REACH U.S. grant that supported the creation of national centers of excellence in the elimination of disparities and the continuation of community initiatives.

UIC ranks among the nation’s leading research universities and is Chicago’s largest university with 27,000 students, 12,000 faculty and staff, 15 colleges and the state’s major public medical center. A hallmark of the campus is the Great Cities Commitment, through which UIC faculty, students and staff engage with community, corporate, foundation and government partners in hundreds of programs to improve the quality of life in metropolitan areas around the world.For more information about UIC, please visit www.uic.edu.

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CHICAGO, Nov. 27, 2011 /CHICAGOPRESSRELEASE.COM/ — At the 97th Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA), from November 27 to December 2 in Chicago, Siemens Healthcare (NYSE: SI) (Booth #822, East Building/Lakeside Center at McCormick Place, Hall D) again leads the way in medical imaging innovation by offering industry-redefining advancements in computed tomography, molecular imaging, ultrasound technology and more – while demonstrating an increasing cost consciousness that expands the availability of its cutting-edge systems to a wider range of customers than ever before.

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“This RSNA, Siemens underscores its commitment to the customer by continuing to deliver cutting-edge technology while demonstrating sensitivity to the increasing cost pressures of the international health care community,” said Hermann Requardt, CEO, Siemens Healthcare. “As an essential part of the new global initiative Agenda 2013, Siemens will further extend the portfolio of systems in the middle price segment, demonstrating how it leads the way in health care innovation by helping to manage price pressures without sacrificing optimal patient care.”

At RSNA 2011, Siemens will showcase the following technologies:

Angiography
Siemens introduces new features to the Artis zeego, the only interventional imaging system on the market utilizing robotic technology. For the first time, an angiography system can rotate 360 degrees in just six seconds with the new syngo® DynaCT 360 application, which provides soft tissue images with a large (35 x 25 cm, 13.8 x 9.9 inches) field of view. The syngo DynaCT 360 enables visualization of the entire tumor anatomy and feeding vessels for chemoembolizations, radiofrequency ablations and chemoperfusions in interventional oncology as well as the entire abdomen to improve graft positioning, check endoleaks, etc. Possessing a shorter acquisition time than the regular and Large Volume syngo DynaCT, the syngo DynaCT 360 also facilitates less dose and contrast media than the Large Volume syngo DynaCT.

All new Artis zee systems now possess all dose reduction/reporting applications as a standard. Available at no extra cost to all existing Artis zee customers, Siemens CARE (Combined Applications to Reduce Exposure) package reduces radiation and simplifies the post-examination documentation of dose values. Applications such as radiation-free collimation and patient positioning, pulsed fluoroscopy and automated Cu-filtration reduce patient and physician exposure up to 75 percent. A new addition to Siemens already comprehensive dose-saving portfolio, the CARE Analytics dose analysis application enables medical staff to evaluate previously recorded dose data and make future improvements.

Siemens is also showcasing new functions to its syngo Embolization Guidance imaging software to facilitate the minimally invasive embolization of tumors. An updated version of the software aids with treatment planning based on pre-intervention MR images and delivery, and allows the user to monitor treatment outcomes. Syngo Embolization Guidance can accelerate interventional procedures, helping to reduce contrast medium and dose.

Computed Tomography
The ability to deliver outstanding images at low dose is central to innovations developed by Siemens CT. The groundbreaking technologies, which will be on display at RSNA ’11, are designed with patient care in mind to help healthcare professionals perform CT examinations faster, safer and more efficiently. For example, the SOMATOM Definition Flash can perform pediatric examinations without the need for sedation and cardiac imaging without the need for beta-blockers. Additionally, FAST CARE – a technology platform for CT scanners – helps hospital staff perform CT examinations faster and more efficiently, while enabling doctors to keep the patient dose as low as possible.

With the SOMATOM line of Siemens CT scanners, patients benefit from lower radiation dose and shorter examination times because the system automates many operating procedures, suggests parameter settings for image quality and dose reduction, and standardizes processes, which makes results readily reproducible.  

Healthcare Policy and Clinical Affairs
At this year’s RSNA, the Siemens Healthcare Policy and Clinical Affairs department will share information on “Preparing for Tomorrow’s Healthcare,” detailing ways in which health care entities can deliver better, more cost-effective patient care. The booth presentation will examine future trends in healthcare, provide an overview of imaging reimbursement, chart global imaging trends, examine public perception vs. reality in U.S. imaging, and describe the ways in which Siemens will lead the way in the coming diagnostic revolution.

Imaging IT
syngo®.via(1) means efficiency and ease of use in advanced visualization, anywhere.(2) It automatically preselects the information and workflow, and provides insightful guidance on disease-specific requirements. Now at RSNA ’11, unleash syngo.via’s full potential with its latest version, which enables more than double the applications. Thousands of new features and improvements open up a broad range of clinical fields and new use cases, making syngo.via a one-of-a-kind solution. With syngo.via Mobile Applications, physicians and referrers within and outside the hospital can securely access images and reports for viewing in a standard Web browser or on an Apple® mobile device.(3)

syngo.plaza is the agile PACS for clinical routine, offering 2D, 3D and 4D reading in one place. With more than 150 installations already in clinical production worldwide, the new version of syngo.plaza is scheduled for release in December. Highlights of syngo.plaza VA20C are increased loading performance and support of central application management(4) to reduce complexity and costs. Through case-specific reading and a wide application range, syngo.plaza supports users in efficiently reading complex multimodality cases. It allows a smooth transition between different applications and helps speed up the reading workflow in small and large hospitals alike.

Finally at RSNA ’11, Siemens will spotlight the Cardiovascular Workplace, which provides personalization of the healthcare provider workspace by bringing together the power of syngo Dynamics for multi-modality cardiovascular imaging and information, and syngo.via for advanced visualization and auto case preparation. The Cardiovascular Workplace provides a holistic patient-centric view of the cardiovascular record and enables exam review, reporting and distribution through a single point of control. Anytime, anywhere access to reporting, imaging and user management is provided through Web-accessible applications.(2)

Magnetic Resonance
Dot™ (Day optimizing throughput) – Siemens MRI workflow solution for consistent, more reproducible results and increased productivity – is currently available on the MAGNETOM Aera 1.5T and MAGNETOM Skyra 3T. It enables up to 50 percent more productivity(5) by offering exam personalization, user guidance and workflow automation. Three new Dot engines – the Breast Dot Engine,(6) Spine Dot Engine(6) and Large Joint Engine(6) – for additional clinical indications complementing the existing seven Dot engines are in the pipeline for the MAGNETOM Aera 1.5T and MAGNETOM Skyra 3T. Next in Siemens pipeline is Dot for the MAGNETOM Avanto(6) 1.5T and MAGNETOM Verio 3T. (6)

After proven innovation leadership on the receive side with Tim (Total imaging matrix) integrated coil technology, Siemens will expand on the transmit side: TimTX TrueShape(6) is Siemens upcoming architecture for parallel transmit (pTX) imaging.(6) Based on this technology, the first parallel transmit application syngo ZOOMit(6) is introduced, enabling the technologist to zoom into an MRI image, accelerating the scan. This new technology and application will be fully integrated into the MAGNETOM Skyra 3T.

A year after its global introduction, the Biograph mMR – the first fully integrated whole-body molecular MR offering simultaneous MR and positron emission tomography (PET) imaging – has been embraced by research institutions, as well as private practices and the clinical environment. The Center for Modern Diagnostics (CEMODI) in Bremen, Germany, is the first private practice facility to use the Biograph mMR for routine patient examinations. More than 20 Biograph mMR units have been ordered by university hospitals, research sites and private practices worldwide. Clinical cases and images from around the world support this pioneering imaging system’s arrival into the clinical world.

Molecular Imaging
At this year’s RSNA, Siemens will highlight its Symbia™ family of SPECT and SPECT-CT scanners, as well as exciting new areas in imaging biomarker production and distribution. Symbia offers a broad range of specialty diagnostic tools and can satisfy the needs of virtually all facilities through innovative technologies such as IQ-SPECT and automated productivity features.

Addressing two of the most challenging issues facing physicians today – improving patient safety and increasing productivity – Symbia IQ-SPECT technology enables routine scans using half dose and double speed. Its proven technologies provide a comprehensive cardio workup, while easing the burden of the global molybdenum shortage via a reduction in technetium dose. Diagnostic SPECT-CT, including calcium scoring, uses half of the typical technetium dose and cuts acquisition time from approximately 20 minutes to less than five minutes with the addition of IQ-SPECT.

In the area of imaging biomarker production and distribution, PETNET Solutions, a wholly owned subsidiary of Siemens Medical Solutions USA, Inc., is continuing to expand to meet the growing demand for PET radiopharmaceuticals. PETNET Solutions recently entered into a nationwide commercial agreement with Eli Lilly and Company that grants Siemens PETNET Solutions the right to manufacture and distribute Lilly’s molecular imaging agent that is currently under review by the U.S. Food and Drug Administration (FDA) for positron emission tomography (PET) imaging.

Radiography and Surgery
Luminos Agile is the first patient-side controlled system with a dynamic flat detector, height-adjustable table and true dual-use capability for fluoroscopy and radiography. Luminos Agile’s 17 x 17 inch dynamic flat detector yields an image that is up to 116 percent larger and allows for better patient coverage than a 13 inch image intensifier, enabling users to view objects without repositioning the patient or changing the field of view, and reducing overall fluoroscopy time and dose. Luminos Agile’s 606 lb. table weight capacity and 24 inch wide opening provide easy access for bariatric and immobile patients, and the space-saving open design enables easy access from all table sides.

The Ysio sets the industry standard in digital radiography with fingertip convenience, digital speed and future reliability. Offering excellent flexibility in every dimension as well as a wireless detector, fully automated positioning and a wide variety of configurations, the system is as individual as your routine.

Siemens also is showcasing the Mobilett Mira, the company’s first mobile digital X-ray system with a wireless detector that transmits image data via W-LAN to an integrated imaging system, facilitating examinations of critically ill patients with limited mobility. One of the smallest mobile X-ray systems available and possessing a resolution exceeding 7 million pixels, the Mobilett Mira features a detector that delivers image quality comparable to high-resolution stationary systems, and works with very short exposure times beyond one millisecond. Furthermore, its mobile X-ray swivel arm system not only moves vertically but also rotates up to 90 degrees.

The ARCADIS Avantic mobile C-arm X-ray system offers an overall ergonomic concept that redefines clinical workflow in many fields of practice. Features include powerful performance (generator power of 25 kW, high tube currents of up to 250 mA, and surpassing endurance through 2.57 Mega Heat Units heat capacity) and precise imaging with a larger field of view. Thanks to its optimally matched and fully digital 1K(2) imaging chain from image acquisition to viewing and archiving, its Mu-metal shielded 33 cm (13 inch) image intensifier, and EASY (Enhanced Acquisition System) with automatic dose, contrast and brightness control, ARCADIS Avantic yields brilliant images in every situation.

Refurbished Systems
High-quality economical and ecological solutions are what Siemens Refurbished Systems is all about – which is why Siemens is proud to launch its new Ecoline product portfolio at RSNA ’11. Ecoline provides customer solutions in two vital areas: cost-efficient, high-quality care, courtesy of Siemens five-step Proven Excellence refurbishment process, coupled with an environmentally friendly impact. Due to healthcare’s changing demands, Ecoline now fulfills an expanded range of medical imaging and economical needs, offering a new scalable solution that allows customers to select system refurbishment options that are tailored to their needs, as well as the latest refurbished technology that has undergone Siemens in-depth Proven Excellence quality process to produce a like-new system. And Siemens Proven Excellence refurbishment process can reduce annual CO2 emissions by as much as 20,000 tons, since refurbished systems boast an average material reuse rate of 98 percent.

Siemens debuts its Ecoline portfolio at RSNA ’11 even as it celebrates 11 years of customer satisfaction for refurbished systems, offering a broad product line that includes X-ray, angiography, CT, molecular imaging (SPECT-CT, PET, PET-CT), MRI, ultrasound and oncology. Siemens Proven Excellence quality seal – which represents the fulfillment of strict specifications of relevant international norms and standards, as well as safety regulations – ensures a high level of performance for all Ecoline systems.

Ultrasound

Siemens will showcase the 3.0 release of its ACUSON S2000™ ultrasound system at RSNA ’11. This latest version of Siemens ACUSON S2000 platform is designed to provide users with powerful imaging performance and penetrating insights to achieve optimal diagnosis. The 3.0 release adds two transducers to its existing suite: the 6C1 HD (high-density) abdominal imaging transducer and the V7M TEE (transesophageal echocardiogram) pediatric cardiology transducer. It also offers sensitivity enhancements to Siemens Cadence™ contrast pulse sequencing technology.(7)

Additionally, the ACUSON S2000 system features second-generation Virtual Touch™ technology(8) – Siemens proprietary implementation of Acoustic Radiation Force Impulse (ARFI) imaging for the evaluation and quantification of tissue stiffness.

The ACUSON S2000 ultrasound system represents the pinnacle of innovative technology, workflow-enhancing clinical applications and sleek-yet-functional ergonomic design. The latest iteration of this premium system provides stellar B-mode imaging and color Doppler for routine examinations, as well as the deep abdominal penetration needed for particularly challenging cases. Covering the entire continuum of care from screening to diagnosis to therapy and follow-up, the new ACUSON S2000 features applications across general imaging, including obstetrics and gynecology, as well as vascular and cardiac imaging.

Women’s Health
On display at RSNA ’11, the MAMMOMAT Inspiration offers digital screening and diagnostic mammography, stereotactic biopsy and upgrade capability to future technologies all in one system. With its unique MoodLight™ LED light panel, the MAMMOMAT Inspiration helps provide a warmer environment by illuminating soft, pastel colors. To match breast density and thickness, the Inspiration offers three anode/filter combinations: Mo/Mo, Mo/Rh and W/Rh. The Inspiration’s Opdose® feature automatically selects the appropriate anode/filter combination and the lowest radiation dose for individual breast characteristics. The Inspiration’s Opcomp® function applies compression only as long as the patient’s breast is soft and pliable – stopping at the point of optimal compression.

(1) syngo.via can be used as a standalone device or together with a variety of syngo.via-based software options, which are medical devices in their own rights.

(2) Prerequisites include: Internet connection to clinical network, DICOM compliance, meeting of minimum hardware requirements, and adherence to local data security regulations.

(3) Apple®, the iPhone®, the iPad®, iPod Touch® are trademarks of Apple Inc., registered in the U.S. and other countries. syngo.via Mobile Applications are not intended for diagnostic use. For iPhone and the iPad country specific laws may apply. Please refer to these laws before using for diagnostic reading / viewing.

(4)syngo.plaza VA20C and Citrix XenApp 6.0 required.

(5)  Data on file; results may vary.

(6)  This product is under development and not commercially available yet. Its future availability cannot be ensured.

(7) At the time of publication, the U.S. Food and Drug Administration has cleared ultrasound contrast agents only for use in LVO. Check current regulations for the country in which you are using this system for contrast agent clearance.

(8) Virtual Touch technology is not commercially available in the U.S.

Launched by Siemens Healthcare Sector in November 2011, Agenda 2013 is a two-year global initiative to further strengthen the Healthcare Sector’s innovative power and competitiveness. Specific measures will be implemented in four fields of action: Innovation, Competitiveness, Regional Footprint, and People Development.

The Siemens Healthcare Sector is one of the world’s largest suppliers to the healthcare industry and a trendsetter in medical imaging, laboratory diagnostics, medical information technology and hearing aids. Siemens offers its customers products and solutions for the entire range of patient care from a single source – from prevention and early detection to diagnosis, and on to treatment and aftercare. By optimizing clinical workflows for the most common diseases, Siemens also makes healthcare faster, better and more cost-effective. Siemens Healthcare employs some 51,000 employees worldwide and operates around the world. In fiscal year 2011 (to September 30), the Sector posted revenue of 12.5 billion euros and profit of around 1.3 billion euros. For further information please visit: www.siemens.com/healthcare.

SOURCE Siemens Healthcare

Siemens Offers Imaging Innovation and Affordable High-end Performance at RSNA 2011 | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

The five-year, $1.5 million grant from the U.S. Department of Health and Human Services expands on previous funding from HHS’s Office of Women’s Health to address health disparities in the counties of Alexander, Hardin, Johnson, Massac, Pope, Pulaski, and Union in rural Illinois.

UIC and Southern Seven Health Department completed a regional health assessment of the area earlier this year and concluded that women in this southernmost region face significant health disparities compared to women in the rest of the state.

Women in this region report higher rates of high blood pressure, high cholesterol, diabetes, and obesity when compared to Illinois women overall.

In order to address the multiple factors that affect women’s health in this region — access to health care, lifestyle choices, attitudes and beliefs about health, and community resources — the project will implement Heart Smart for Women, an evidence-based lifestyle intervention to increase physical activity and improve nutrition among women, at 12 local churches.

Heart Start for Women classes will be offered for 12 weeks. The classes will be followed by monthly maintenance programs for women, as well as men, to sustain behavior change in the long term. Cooking demonstrations and walking groups will be part of ongoing maintenance activities.

“This grant provides an opportunity for the Center for Research on Women and Gender to collaborate with our partners in southern Illinois, a traditionally under-resourced area of the state, to improve the health of rural women,” said Stacie Geller, director of the UIC center and professor of obstetrics and gynecology.

When compared to Illinois women overall, a higher percentage of women in this region do not meet the recommended standard of five or more servings of fruits and vegetables per day, report less physical activity, and have almost double the state’s adult female smoking rate.

“We are extremely pleased to continue our partnership with UIC for five more years,” said Patricia Moehring, community health education director for Southern Seven Health Department. “I am really excited for the women we serve in our region to have the opportunity to move themselves to healthier lifestyles.”

The HHS funding is part of a national initiative entitled the Coalition for a Healthier Community. The Office on Women’s Health awarded grants in 2010 (phase I) and 2011 (phase II) to improve community health policies and programs for women and girls. UIC and Southern Seven Health Department have partnered on health promotion initiatives since 2007.

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Initial employer findings expose opportunities to reduce health cost risk, maximizing dollars

CHICAGO, Nov. 14, 2011 /CHICAGOPRESSRELEASE.COM/ — The nonprofit Center for Health Value Innovation (CHVI) released the initial results of employers completing the Health Value Accelerator finding that over 20 cents out of every dollar of revenue are going toward health care costs that are under managed. This is an investment which CHVI argues could produce better results by focusing on outcomes, which is missing from most benefit programs. The Accelerator is an online tool that allows employers to create a recipe for value-based benefit design focused on engagement and accountability for first-year results.

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“We weren’t surprised by the results that show not only an overall lack of engagement from employees, but a need for more attention from employers as well,” said Cyndy Nayer, CHVI president and CEO. “Employers are spending billions of dollars, often without holding their plans and providers accountable. The Accelerator is the first employer engagement tool that shows these disconnects.”

To date the tool has been used by more than 50 fully- and self-funded employers ranging in size from three to 100,000 employees, representing 600,000 covered lives, annual revenues of more than $215 billion and $2.8 billion worth of health care costs.

Key findings from initial participating employers include:

• Employers offer tools that should support workforce engagement, but they are not tracking the use or the outcomes, such as behavior change or risk reduction.  
• Incentives do not guarantee engagement or better outcomes; in fact, some companies showed better outcomes without incentives for prevention and wellness screenings.
• Most employers do not know how their employees manage their health, or which programs work, until there is a care claim, often for use of the emergency room.
• When asked about the engagement level of senior management, there is more engagement in companies under 5,000 covered lives.
• Few employers can relate the size of the diagnosed chronic care population (i.e. diabetes, hypertension, depression, high cholesterol) to the success in managing these diseases. Few employers know the adherence rates of their populations, but they know the total costs of the drugs. In value-based design for chronic disease, the lack of adherence is a key indicator of waste.

“Vendor contracting has not evolved at the same rate as our benefits or even patient care,” said Michael Jacobs, National Clinical Practice Leader for Buck Consultants and co-author (with Nayer) of the annual CHVI employer survey in value-based design. “In order to ensure we get what we pay for, we need to establish contracting for outcomes as the industry standard, which requires cooperation, transparency, accountability and value for all involved.”

What this means for employers

As a result of these findings, CHVI recommends that employers begin to take a more active and disciplined risk management approach for health benefits, making screening and follow-through their first step; offer guidance to employees on the goal-setting and tracking of prescribed treatment; build accountability through Outcomes-Based Contracting (aligning incentives across all stakeholders) by creating a prototype contract for services, data and measures; and identify and implement best practices that improve accountability for outcomes.

“It’s important to treat employee benefits and health care expenses like other business practices,” said Gregg Kamas, Vice President, Health Risk Management Practice Leader, IMA of Colorado, CHVI Board Director and advisor for the Accelerator. “Aligning responsibilities for all parts of the puzzle is a necessary step in taming health care and absence costs in a way that encourages good performance and good health.”

About the Health Value Accelerator™

CHVI’s Health Value Accelerator, is an easy-to-use online tool that prioritizes the redistribution of benefits and resources for better engagement and accountability in care. The Accelerator addresses key health care issues that drive higher health cost and allows health care purchasers to create personalized, actionable reports founded on value-based benefit design, changing the contracting mechanisms focused on the end goal of improved health.

Available free to CHVI members, the Accelerator and can be purchased by non-members and consultants and brokers on behalf of their clients.

About the Center for Health Value Innovation (CHVI)

CHVI (501c3) is focused on the relentless pursuit of innovation in benefit designs that improve engagement, accelerate accountability and create a predictable health cost trend. CHVI members represent over 60 million lives from all market segments in the health value supply chain, sharing the evidence of improved health and economic outcomes through value-based designs, including the Outcomes-Based Contracting™ platform for accelerating meaningful change. The Center for Health Value Innovation’s goal is to improve the health of people, organizations and communities throughout the U.S.  www.vbhealth.org

Available Topic Expert: For information on the listed expert, click appropriate link.

Cyndy Nayer

http://www.profnetconnect.com/cyndy.nayer

SOURCE Center for Health Value Innovation

http://www.vbhealth.org

CHVI Releases Health Value Accelerator™ Results Showing Health Care Costs Can Exceed 20 Cents of Every Revenue Dollar | Chicago Press Release Services - Chicago's leading press release newswire service; professional press release services, press release distribution and newswire services.

The two managers and operators of a Fort Lauderdale, Fla.-area halfway house company pleaded guilty today for their role in a Medicare fraud kickback scheme that funneled patients through a fraudulent mental health company, American Therapeutic Corporation (ATC), announced the Department of Justice, FBI and Department of Health and Human Services (HHS).

Robert Jenkins, 36, and Nikki Jenkins, 36, each pleaded guilty before Chief U.S. District Judge Federico A. Moreno in the Southern District of Florida to one count of conspiracy to solicit and receive health care kickbacks. Robert and Nikki Jenkins, who are married, were the managers and operators of Life 4 Life Inc., which operated several halfway houses in Fort Lauderdale.

According to court documents, Robert and Nikki Jenkins agreed to refer Medicare beneficiaries who resided at Life 4 Life halfway houses to ATC for partial hospitalization program (PHP) services. A PHP is a form of intensive treatment for severe mental illness. ATC purported to operate PHPs in seven different locations throughout south Florida and Orlando. The Jenkins admitted that they recruited Medicare beneficiaries for their halfway houses whom they could refer to ATC in exchange for health care kickbacks. The Jenkins knew that ATC would bill the Medicare program for PHP services provided to the beneficiaries they referred to ATC, and they knew receiving such kickbacks was illegal.

According to court filings, ATC’s owners and operators paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and its related company, the American Sleep Institute (ASI). In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for PHP services. The ineligible beneficiaries attended treatment programs that were not legitimate so that ATC and ASI could bill Medicare more than $200 million in medically unnecessary services.

According to the plea agreement, the Jenkins’s participation in the fraud resulted in more than $157,980 in fraudulent payments from the Medicare program. At sentencing, scheduled for Dec. 19, 2011, Robert and Nikki Jenkins each face a maximum of five years in prison and a $250,000 fine.

ATC, its management company Medlink Professional Management Group Inc., and various owners, managers, doctors, therapists, patient brokers and marketers of ATC, Medlink and ASI, were charged with various health care fraud, kickback, money laundering and other offenses in two indictments unsealed on Feb. 15, 2011. ATC, Medlink and nine of the individual defendants have pleaded guilty or have been convicted at trial. Other defendants are scheduled to begin trial on April 9, 2012, before U.S. District Judge Patricia A. Seitz.

Today’s guilty plea 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 B. Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

The case is being prosecuted by Trial Attorneys Steven Kim and Jennifer L. Saulino of the Criminal Division’s Fraud Section. 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 1,140 defendants that collectively have billed the Medicare program for more than $2.9 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.

A copy of this press release may be found on the website of the United States Attorney’s Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.

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