September 26, 2019 by WorkCompWire

Houston, TX – The Justice Department recently announced a coordinated health care fraud enforcement operation across the state of Texas involving charges against a total of 58 individuals, several of which are charged in Houston. They were allegedly involved in Medicare fraud schemes and networks of “pill mill” clinics resulting in $66 million in loss and 6.2 million pills. Of those charged, 16 were doctors or medical professionals, while 20 were charged for their role in diverting opioids.

The Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force (MFSF) partners led the enforcement actions. The MFSF is a partnership among the Criminal Division, U.S. Attorney’s Offices, FBI, Department of Health and Human Services – Office of Inspector General (HHS-OIG) and Drug Enforcement Administration. In addition, the operation includes the participation of the Veterans Affairs – OIG and the Department of Labor (DOL), various other federal law enforcement agencies and Texas State Medicaid Fraud Control Units.

The charges announced aggressively target schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families), DOL – Office of Worker’s Compensation Programs and private insurance companies for medically unnecessary prescription drugs and compounded medications that often were never even purchased and/or distributed to beneficiaries. The charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals allegedly involved in the unlawful distribution of opioids and other prescription narcotics, a particular focus for the Department.

According to the Centers for Disease Control, approximately 115 Americans die every day of an opioid-related overdose.

The arrests come three weeks after the Department announced that the Health Care Fraud Unit’s Houston Strike Force coordinated the filing of charges against dozens in a trafficking network responsible for diverting over 23 million oxycodone, hydrocodone and carisoprodol pills.

“Sadly, opioid proliferation is nothing new to Americans,” said U.S. Attorney Ryan K. Patrick of the Southern District of Texas. “What is new, is the reinforced fight being taken to dirty doctors and shady pharmacists. Texas may have four U.S. Attorneys, but we are focused on one health care mission: shutting down pills mills and rooting out corruption in health care. From Lufkin to Laredo and Dallas to Del Rio, one of us will shut these operations down.”

“Today’s charges highlight the amazing work being done by the Department’s Medicare Fraud Strike Force and our partners in Texas,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “As we continue to dedicate resources to battle healthcare and opioid fraud schemes in Texas and elsewhere, we are shining an inescapable light on dirty doctors, clinic owners, pharmacists and others who may have long believed they could perpetrate their frauds behind closed doors.”

“These arrests across multiple investigations and jurisdictions is further proof that successful teamwork exemplifies Texas law enforcement,” said DEA Houston Special Agent in Charge Will R. Glaspy. “Today’s operation affirms both our commitment to targeting those individuals who illegally divert opioids in our communities, and our collective will to bring those individuals to justice.”

“Health care fraud undermines our country by driving up medical costs, wasting taxpayer dollars, and often harming patients,” said Special Agent in Charge C.J. Porter of HHS-OIG. “Today’s takedown shows that we are fighting hard to protect Medicare and Medicaid and the patients served by those programs. Working closely with our law enforcement partners, our agents are determined to ensure fraudsters pay for their crimes.”

“Today’s announcement demonstrates the close collaboration between the FBI and its law enforcement partners in North Texas,” said Special Agent in Charge Matthew J. DeSarno of the FBI’s Dallas Field Office. “The enormous economic damage caused by those who defraud crucial public health programs, as well as the ever-increasing loss of life caused by illicit and illegitimate pill schemes cannot be overstated. The public can rest assured the FBI will continue to make these investigations a top priority moving forward.”

Among those charged in the Southern District of Texas are:

Diana Hernandez, Kathy Hernandez, Hieu Troung R.P.H., Clint Randall, Prince White, Charles Walton and Cedric Milbrurn were charged for their alleged participation in a scheme to unlawfully distribute and dispense controlled substance without a legitimate medical purpose through S&S Pharmacy of Houston.

Franklin Nwabugwu R.P.H. was charged for their alleged participation in a scheme to unlawfully distribute and dispense controlled substance without a legitimate medical purpose through Golden Pharmacy of Houston.

Steven Inbody M.D. and Hoai-Huong Truong were charged for their alleged participation in a scheme to unlawfully distribute and dispense controlled substance without a legitimate medical purpose.

Ashley McCain, John Sims, Gregory Comer, Kesia Banks and Jacqueline Hill were charged for their alleged participation in a scheme to unlawfully distribute and dispense a controlled substance without a legitimate medical purpose through Continuous Medical Care and Rehabilitation.

Trial Attorneys Devon Helfmeyer and Catherine Wagner and Assistant Deputy Chief Aleza Remi, all of the Fraud Section, are prosecuting the respective cases.

Several others were also charged in the Northern District of Texas (NDTX), Eastern District of Texas (EDTX) and Eastern District of Texas (EDTX).

“Healthcare should revolve around patients’ well-being – not providers’ personal interests,” said NDTX U.S. Attorney Erin Nealy Cox. “When medical professionals line their own pockets by submitting false insurance claims or prescribing unnecessary medications, equipment or treatments, it not only drains taxpayer coffers – but it makes healthcare more expensive for everyone else. We cannot allow the healthcare industry to become bloated by fraud.”

“Every dollar stolen from Medicare through fraud comes out of the pocket of taxpayers,” said EDTXU.S. Attorney Joseph D. Brown of the “These are real costs that help drive up the cost of medical services for everyone. It is important that there be real consequences for those who cheat the system.”

“I am proud to fight healthcare fraud in Texas alongside Ryan Patrick, Erin Nealy Cox and Joe Brown,” said WDTX U.S. Attorney John Bash. “These crimes drive up the cost of health insurance, waste tax revenue and threaten the well-being of Texans.”

The Fraud Section leads the MFSF, which is part of a joint initiative 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. MFSF maintains 15 strike forces operating in 24 districts. Since its inception in March 2007, MFSF has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion. In addition, HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless convicted through due process of law.

Source: US Attorney’s Office