Category Archives: Conspiracy

Florida physician pleads guilty to $29M fraud

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https://www.beckershospitalreview.com/legal-regulatory-issues/florida-physician-pleads-guilty-to-29m-fraud.html?origin=BHRE&utm_source=BHRE&utm_medium=email&utm_content=newsletter&oly_enc_id=2893H2397267F7G
Ugly Case of Health Care Fraud - Pondera Solutions

Moses D. deGraft-Johnson, MD, pleaded guilty Dec. 18 to 56 counts of healthcare fraud, conspiracy to commit healthcare fraud and aggravated identity theft, according to the Department of Justice. 

Between late 2015 and his arrest in February of this year, Dr. deGraft-Johnson, who owned and operated the Heart and Vascular Institute of North Florida in Tallahassee, performed invasive surgical procedures on patients who didn’t need them or altered patients’ medical records to reflect procedures he didn’t perform. 

As part of his plea deal, Dr. deGraft-Johnson acknowledged consistently performing two invasive diagnostic angiography procedures on hundreds of patients, whether medically necessary or not. When the patients returned for follow-up office visits, Dr. deGraft-Johnson submitted fraudulent claims to their insurance companies stating he performed atherectomies during the appointments. Using this scheme, the physician admitted he claimed to have performed more than 3,000 of these surgical procedures to clear blockages in arteries in as many as 845 of his patients’ legs. 

In court documents released in February, prosecutors provided several examples of Dr. deGraft-Johnson’s fraud. In one case, he claimed to have done 14 procedures during a seven-hour period. Prosecutors said the procedures would have taken roughly 28 hours, according to The New York Times. In another example, he allegedly claimed to have performed 13 atherectomies on patients in Florida when he was traveling abroad.

Dr. deGraft-Johnson submitted false claims to insurers for the surgeries he didn’t perform and for the unnecessary procedures. As of Dec. 18, the investigation revealed he received at least $29 million through the fraud scheme. 

California surgeon gets prison time for role in $580M billing fraud scheme

Posted on by • Posted in Conspiracy, Dept of Justice (DOJ), Fraud, Fraud and Abuse, Hospital, Hospital Industry, Kickbacks, Patient Referrals, Physician, Physician Practice Management, Prison Sentence, Rev Cycle Management, Workers Compensation • Leave a comment

https://www.beckershospitalreview.com/legal-regulatory-issues/california-surgeon-gets-prison-time-for-role-in-580m-billing-fraud-scheme.html?origin=cfoe&utm_source=cfoe

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An orthopedic surgeon was sentenced to 30 months in federal prison Nov. 22 for his role in a healthcare fraud scheme that resulted in the submission of more than $580 million in fraudulent claims, mostly to California’s worker compensation system, according to the Department of Justice.

Daniel Capen, MD, was sentenced more than a year after pleading guilty to conspiracy to commit honest services fraud and soliciting and receiving kickbacks for healthcare referrals. He was one of 17 defendants charged in relation to the government’s investigation into kickbacks physicians received for patient referrals for spinal surgeries performed at Pacific Hospital in Long Beach, Calif.

Dr. Capen received at least $5 million in kickbacks for referring surgeries to Pacific Hospital and for referring services to organizations affiliated with the hospital. He allegedly accounted for $142 million of Pacific Hospital’s claims to insurers between 1998 and 2013, according to the Justice Department.

In addition to the prison term, Dr. Capen was ordered to forfeit $5 million to the federal government and pay a $500,000 fine.

 

 

 

 

Former UMMS board member indicted in fraud scheme

Posted on by • Posted in Board, Conspiracy, Fraud, Fraud and Abuse, Health System, Hospital, Indictment, Leadership, Tax Evasion • Leave a comment

https://www.beckershospitalreview.com/legal-regulatory-issues/former-umms-board-member-indicted-on-11-counts-of-fraud-tax-evasion.html

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Former Baltimore Mayor Catherine Pugh, who served on the board of University of Maryland Medical System for 18 years, was indicted on charges of wire fraud and tax evasion related to a children’s book scandal that involved the Baltimore-based health system and Oakland, Calif.-based Kaiser Permanente, a local CBS affiliate reports.

The indictment was unsealed Nov. 20, ahead of Ms. Pugh’s scheduled hearing on Nov. 21. If convicted, Ms. Pugh could face up to 100 years in prison and be required to forfeit her home and repay more than $769,000 allegedly obtained through the scheme.

The indictment alleges Ms. Pugh conspired with city employees to defraud buyers of her Healthy Holly children’s books, according to CBS, which published the indictment in full. It alleges Ms. Pugh arranged five $100,000 deals with UMMS to donate a total of 100,000 books to Baltimore public schools. The books were allegedly never delivered, and instead rerouted to alternate storage facilities around the city, distributed at campaign events and double-sold to other customers.

The indictment also alleges Ms. Pugh used Healthy Holly profits to fund straw donations to her mayoral campaign and to buy a house in Baltimore. She also faces allegations of tax evasion related to Healthy Holly sales, according to the report.

CBS notes Kaiser Permanente also disclosed buying $114,000 of the books at a time that overlaps with winning a $48 million contract from the city, according to the report.

The two city officials connected to the scheme pleaded guilty to conspiracy and tax evasion, according to the report.

Read the full story and access the full indictment here.