Fraud Recoveries Come from Pharmaceutical Giants

In 2009, the Department of Health and Human Services and Department of Justice jointly created the Health Care Fraud Prevention & Enforcement Action Team (“HEAT”). The goal of the venture was and remains the prevention of waste, fraud, and abuse in programs such as Medicare and Medicaid. The program utilized task forces throughout the country […]

Former Professional Baseball Player Pleads Guilty to Medicare Fraud Charges

Ihosvany Marquez, a former pitcher in the Baltimore Orioles and Boston Red Sox organizations, pleaded guilty on Monday, April 12, 2010, in federal court in Miami to health care fraud charges. The government charged that Marquez and his partners submitted more than $55 million in false claims to Medicare for HIV and cancer therapy and […]

Pfizer Found Liable in Civil RICO Case

Yesterday was quite newsworthy the U.S. District Court in Boston. (See blog entry below about the identity theft sentencing.) In a case before the court a jury found Pfizer, Inc., liable for the violation of federal racketeering law by improperly marketing its epilepsy drug Neurontin for off-label uses. The jury awarded the plaintiffs, Kaiser Foundation […]

Detroit Area Physician Convicted of Healthcare Fraud and Jailed

A jury in U.S. District Court in Detroit has returned verdicts of guilty in the prosecution of a physician charged in an $18 million healthcare fraud. Jose Castro-Ramirez, M.D., was convicted of 13 counts of Medicare fraud and money laundering. The court remanded Ramirez into custody pending his sentencing. Ramirez and others took part in […]

DOJ Seeks Funding to Expand Strike Forces

Officials from the U.S. Department of Justice are asking Congress to significantly enhance funding for health care investigation and prosecution in the fiscal 2011 budget. Acting Deputy Attorney General Gary Grindler and acting Deputy Assistant Attorney General for the Criminal Division Greg Andres appeared before a House Appropriations subcommittee. The officials are seeking an increase […]

RACs Unlikely to Report Fraud

Recovery audit contractors or “RACs” are private companies that Medicare hires to identify improper payments. When a RAC identifies an improper payment to a physician or medical facility, the RAC receives a “bounty” of between 9% and 12% of the monies recovered for the government. In a three year pilot program in six states, the […]

Big Tobacco Seeks Supreme Court Review of RICO Finding

Three of the nations largest companies are seeking Supreme Court review of the determination that they had engaged in racketeering acts in violation of the federal RICO statute. The appeal is of the decision of a three judge panel of the United States Court of Appeals for the District of Columbia. That court upheld the […]

Feds Indict Two Doctors for Medicare Fraud

The United States Attorney in Seattle has obtained grand jury indictments of two Seattle area physicians on charges of defrauding the Medicare program. While the indictments do not allege a relationship between the defendants, the two schemes were allegedly identical. The grand jury charged Dr. Garnik Karapetyan with bilking Medicare of $1.9 million and attempting […]

Pennsylvania Physician Pleads Guilty to Fraud Charges

A Lancaster County physician, Saroj K. Parida, has pleaded guilty in the U.S. District Court for the Middle District of Pennsylvania, located in Harrisburg, to bilking public and private health insurers out of $8 million. Parida pleaded guilty to health care fraud and mail fraud charges. He is awaiting sentencing. Parida and the federal prosecutors […]

US Settles Qui Tam Suit

The federal government has settled a qui tam or whistle blower action against a medical device manufacturer. Atricure, Inc., a Ohio based company, will pay $3,760,000 to settle the lawsuit. The action alleged that Atricure engaged in prohibited conduct in the marketing of its surgical ablation devices. Such devices use focused energy to create scar […]