Posted on Leave a comment

Texas clinic owner heading to prison for illegally prescribing meds

BY KRISTEN HARRISON-ONEAL DECEMBER 10, 2020DECEMBER 10, 2020  POLICE BLOTTER/TEXAS NEWS 
Source: Shore News Network

Source: Shore News Network
Shidonna Raven Garden and Cook

HOUSTON, TEXAS – A Houston-area pain clinic owner and a clinic employee who posed as a physician were sentenced to 240 months and 96 months in prison, respectively, today for their roles at a “pill mill” where they and their co-conspirator illegally prescribed hundreds of thousands of doses of opioids and other controlled substances.

Acting Assistant Attorney General Brian C. Rabbit of the Justice Department’s Criminal Division, U.S. Attorney Ryan K. Patrick of the Southern District of Texas and Special Agent in Charge Steven S. Whipple of the Drug Enforcement Administration’s (DEA) Houston Division made the announcement.

Baker Niazi, 49, of Sugarland, Texas, and Muhammad Arif, 62, of Katy, Texas, were sentenced by U.S. District Judge Alfred H. Bennett of the Southern District of Texas. Judge Bennett ordered that Niazi pay a fine of $500,000, and also ordered that Niazi forfeit $493,000 and that Arif forfeit $11,423.11.  Niazi pleaded guilty in April 2018 to one count of conspiracy to unlawfully distribute and dispense controlled substances, and Arif was convicted at trial in August 2019 of one count of conspiracy to unlawfully distribute and dispense controlled substances and three counts of unlawfully distributing and dispensing controlled substances.

According to the evidence presented at the trial of Arif, from September 2015 through February 2016, Niazi owned and operated Aster Medical Clinic in Rosenberg, Texas, which he operated as an illegal pill mill.  Arif was an employee at Aster Medical Clinic who conspired with Niazi and a Dallas-based physician to unlawfully prescribe controlled substances to individuals posing as patients.  The evidence showed that Niazi hired Arif, who was not licensed to practice medicine in the United States, to pose as a physician at Aster Medical Clinic, where he saw the clinic’s customers as if he were a physician, and wrote prescriptions for them on prescription pads that had often been pre-signed by the physician, Arif’s co-conspirator.

Through this scheme, Aster Medical Clinic dispensed prescriptions for over 200,000 dosage units of hydrocodone, a Schedule II controlled substance, and over 145,000 dosage units of carisoprodol, a Schedule IV controlled substance.  The combination of hydrocodone and carisoprodol is a dangerous drug cocktail with no known medical benefit, the evidence showed.

Trial evidence showed that Aster Medical Clinic issued unlawful prescriptions for controlled substances to over 40 people on its busiest days.  “Runners” brought numerous people to pose as patients at Aster Medical Clinic and paid for their visits in order to obtain prescriptions for controlled substances that the crew leaders then diverted onto the black market.  Aster Medical Clinic charged approximately $250 for each patient visit, and required payment in cash, the evidence showed.

One other co-conspirator has pleaded guilty based on his role in the unlawful prescription scheme at Aster Medical Clinic and is currently awaiting sentencing before U.S. District Judge Alfred H. Bennett of the Southern District of Texas.

The case was investigated by the DEA, and was brought as part of the Health Care Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Texas.  The case is being prosecuted by Assistant Deputy Chief Aleza Remis and Trial Attorney Alexis Gregorian of the Fraud Section.

The Fraud Section leads the Health Care Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

What are the medicinal benefits of the medicines you take? How do these medicines support your diet and sustain your life? Do these medicines make you better?

Share your comments with the community by posting them below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

If these articles have been helpful to you and yours, give a donation to Shidonna Raven Garden and Cook Ezine today.

Posted on Leave a comment

GlaxoSmithKline Most Heavily Fined Drug Company


Source: Pain News Network
By Pat Anson, PNN Editor

The pharmaceutical industry has long been criticized for engaging in illegal or unethical activities, such as fraud, kickbacks and price gouging. A new study published in JAMA shines a light on the scale of the problem, finding that Big Pharma paid over $30 billion in financial penalties for illegal activities in the United States.

Researchers looked at state and federal settlements from 2003 to 2016 and found that almost every large pharmaceutical company had paid a fine for illegal activity. The biggest transgressor was GlaxoSmithKline (GSK), which paid nearly $9.8 billion to settle 27 cases brought against it for bribery, corruption, improper marketing, pricing violations and selling adulterated drugs. In one settlement alone, GSK was fined $3 billion for encouraging doctors to prescribe its antidepressants to children.  

The fines paid by GSK were over three times higher than the amounts paid by Pfizer ($2.9 billion) and Johnson & Johnson ($2.6 billion) during the study period. Researchers say only four of the 26 drug companies they analyzed were not assessed a penalty.

TOP 10 MOST HEAVILY FINED DRUG COMPANIES

  1. GlaxoSmithKline $9.8 billion
  2. Pfizer $2.9 billion
  3. Johnson & Johnson $2.6 billion
  4. Abbott Laboratories $2.5 billion
  5. Merck $2.1 billion
  6. Eli Lilly $1.8 billion
  7. Schering-Plough $1.6 billion
  8. Wyeth $1.6 billion
  9. Bristol Myers Squibb $1.4 billion
  10. Novartis $1.2 billion
bigstock-Caduceus-Medical-Symbol-Chrome-7762432.jpg
Source: Pain News Network
Shidonna Raven Garden and Cook

“Among the large pharmaceutical companies included in this study, 85% had evidence of financial penalties for illegal activities. Given the scope and nature of the illegal activities involving financial penalties, physicians and regulators should exhibit vigilance over the activities of large pharmaceutical firms,” wrote lead author Denis Arnold, PhD, a professor of business ethics at Belk College of Business, University of North Caroline at Charlotte.

“Four firms were not found to have penalties for illegal activities during the sample period. This may indicate an ability for illegal activity to be undetected, although these firms may instead have effective ethics and compliance programs.”

Because the study period ended in 2016, it did not include any recent settlements with drug companies involving opioid litigation. Nor did it cover fines paid outside the U.S., such as the $490 million fine that GSK paid for bribing Chinese doctors to prescribe its medications.

“This has been a deeply disappointing matter for GSK,” chief executive Sir Andrew Witty said in a formal apology to the Chinese government in 2014.

Not much has changed at GSK over the years. This year the company agreed to pay $4.5 million in fines in Australia for marketing and price violations involving the pain relief gel Voltaren.  The British pharmaceutical giant was also recently fined $2.8 million by Romania for failing to supply the country with asthma medication.

Drug company executives rarely serve prison time for illegal activities and the large fines do not appear to be much of a deterrent against unethical behavior. The nearly $9.8 billion paid by GSK amounts to less than 2 percent of its total revenues during the study period. On average, GSK’s illegal activities went on for over seven years before the company stopped them, according to the JAMA study.

GSK did not respond to a request for comment for this story.    

Fraud Alert for Speaker Programs

In recent years, federal watchdogs have become increasingly concerned about the use of speaker fees, free meals, entertainment and other kickbacks paid by healthcare companies to promote their drugs and medical devices. In the last three years, companies paid nearly $2 billion to healthcare providers for speaker-related services.

In a special fraud alert released this week, the Office of Inspector General (OIG) for the Department of Health and Human Services warned against the practice, saying high-priced speaker programs “may be subject to increased scrutiny.” The OIG cited cases where speaker programs were held at wineries, stadiums and restaurants where expensive meals and alcohol were served at no charge to attendees.

“OIG is skeptical about the educational value of such programs. Our investigations have revealed that, often, HCPs (healthcare providers) receive generous compensation to speak at programs offered under circumstances that are not conducive to learning or to speak to audience members who have no legitimate reason to attend,” the report warns.

“Furthermore, studies have shown that HCPs who receive remuneration from a company are more likely to prescribe or order that company’s products. This remuneration to HCPs may skew their clinical decision making in favor of their own and the company’s financial interests, rather than the patient’s best interests.”

Why do you think these companies were fined? Do you take any medications from these companies? Why? Why not?

Share your comments with the community by posting them below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

If these articles have been helpful to you and yours, give a donation to Shidonna Raven Garden and Cook Ezine today.

Posted on Leave a comment

Medical Fraud in our backyard

fake shidonna raven garden and cook

Fraud seems to have become so prevalent and clandestine one rarely notices it when they first see the signs of it. In fact we have been subject to medical fraud ourselves. Since the beginning of the fraud, in 2012, our health has declined to its worst state ever due to what we believe have been a host of subsequent misdiagnosis and treatments. Typically fraud involves some type of financial gain through over billing, billing for unnecessary treatments and procedures. The fraud can also include submitting false claims and attempting to defraud Medicaid and Medicare through billing. Medical professionals have also used their activities to cover other crimes such as sex crimes. These criminals are often looking for a means to get paid through billing some type of insurance company or government agency.

In fact we have documented a major hospital in Norfolk, VA, USA who used Chamberlin and Edmonds to falsify patients signatures in an attempt to bill fraudulent Medicaid claims to social security. We have documented that these same group of individuals have submitted multiple fraudulent applications and claims since 2012 in attempt to get paid through billing. They submitted so many fraudulent claims it sparked an internal investigation into their activities. These groups and organizations will sometimes use third party companies and organizations to force fraudulent claims through. These groups will often misinform or misguide patients in hopes of deceiving them for a pay day.

We have heard the reports of health care fraud and never thought we would see such atrocities first hand. What have you learned from these articles? How can these articles help you, your family and friends? Do you report fraud when you see it? Share your comments below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

If these articles have been helpful to you and yours, give a donation to Shidonna Raven Garden and Cook Ezine today.

Posted on Leave a comment

Massive Fraud: Psychiatry’s Corrupt Industry

medical fraud shidonna raven garden and cook

Click to watch the short Video: Massive Fraud: Psychiatry’s Corrupt Industry

Source: Citizens Commission on Human Rights

Click the link for this short but highly informative documentary. Many people seek hospitals for solutions to health problems never expecting to be subject to fraud and criminals. Why do you think such behavior is so prevalent in society today? What do you think the government should do regarding reducing such fraud and criminal offenses? Do you know of anyone who has been subject to fraud, abuse or criminal activity? Do you think they should be allowed to keep their activities behind close doors or should there be public access permitted? How could COVID 19 cases be subject to fraud and criminal activity? Share your comments below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

If these articles have been helpful to you and yours, give a donation to Shidonna Raven Garden and Cook Ezine today.

Posted on Leave a comment

Health Care Fraud

health care reform shidonna raven garden and cook

The National Heath Care Anti-Fraud Association estimates conservatively that health care fraud costs the nation about $68 billion annually — about 3 percent of the nation’s $2.26 trillion in health care spending. Other estimates range as high as 10 percent of annual health care expenditure, or $230 billion.

Source: Blue Cross Blue Shield

The Challenge of Health Care Fraud

Everyone Shares the Burden of Health Care Fraud

In 2018, $3.6 trillion was spent on health care in the United States, representing billions health insurance claims. It is an undisputed reality that some of these claims are fraudulent. Although they constitute only a small fraction, those fraudulent claims carry a very high price tag, both financially and in how they impact our perception of the integrity and value of our health care system.

The National Health Care Anti-Fraud Association (NHCAA) estimates that the financial losses due to health care fraud are in the tens of billions of dollars each year. A conservative estimate is 3% of total health care expenditures, while some government and law enforcement agencies place the loss as high as 10% of our annual health outlay, which could mean more than $300 billion.

Whether you have employer-sponsored health insurance or you purchase your own insurance policy through HealthCare.gov, a state marketplace or the individual market, health care fraud inevitably translates into higher premiums and out-of-pocket expenses for consumers, as well as reduced benefits or coverage. For employers—private and government alike—health care fraud increases the cost of providing insurance benefits to employees which, in turn, increases the overall cost of doing business. For many Americans, the increased expense resulting from fraud could mean the difference between making health insurance a reality or not.

However, financial losses caused by health care fraud are only part of the story. Health care fraud has a human face too. Individual victims of health care fraud are sadly easy to find. These are people who are exploited and subjected to unnecessary or unsafe medical procedures. Or whose medical records are compromised or whose legitimate insurance information is used to submit falsified claims.

Don’t be fooled into thinking that health care fraud is a victimless crime. There is no doubt that health care fraud can have devastating effects.

What Does Health Care Fraud Look Like?

The majority of health care fraud is committed by a small number of dishonest health care providers, and in some particularly distressing cases, by individuals only posing as legitimate health care providers. Sadly, the actions of these deceitful few ultimately serve to sully the reputation of perhaps the most trusted and respected members of our society—our doctors.

Unfortunately, the stock in trade of fraud-doers is to take advantage of the confidence that has been entrusted to them in order to commit ongoing fraud on a very broad scale. And in conceiving fraud schemes, this group has the luxury of being creative because it has access to a vast range of variables with which to formulate all sorts of wrongdoing:

  • The entire population of our nation’s patients (sometimes, incredulously, even patients that are deceased);
  • The entire range of potential medical conditions and treatments on which to base false claims; and
  • The ability to spread false billings among many payers and insurers simultaneously, including public programs such as Medicare and Medicaid, thus increasing fraud proceeds while lessening their chances of being detected by any a single insurer.

Some of the more common types of fraud committed by dishonest providers include:

  • Billing for services that were never rendered—by using genuine patient information, sometimes obtained through identity theft, to fabricate entire claims or by padding otherwise legitimate claims with charges for procedures or services that did not take place.
  • Billing for more expensive services or procedures than were actually provided or performed, commonly known as “upcoding”—i.e., falsely billing for a higher-priced treatment than was actually provided (which often requires the accompanying “inflation” of the patient’s diagnosis code to a more serious condition consistent with the false procedure code).
  • Performing medically unnecessary services solely for the purpose of generating insurance payments—this is seen very often in diagnostic-testing schemes such as nerve-conduction and genetic testing.
  • Misrepresenting non-covered treatments as medically necessary covered treatments for purposes of obtaining insurance payments—this is widely seen in cosmetic-surgery schemes, in which non-covered cosmetic procedures such as “nose jobs” are billed to patients’ insurers as deviated-septum repairs.
  • Falsifying a patient’s diagnosis and medical record to justify tests, surgeries or other procedures that aren’t medically necessary.
  • Unbundling—billing for each step of a procedure as if they are separate procedures.
  • Billing a patient more than the required co-pay amount for services that were prepaid or paid-in-full by the benefit plan under the terms of a managed care contract.
  • Accepting kickbacks for patient referrals.
  • Waiving patient co-pays or deductibles for medical or dental care and over-billing the insurance carrier or benefit plan (insurers often set the policy with regard to the waiver of co-pays through its provider contracting process; while, under Medicare, routinely waiving co-pays is prohibited and may only be waived due to “financial hardship”).

Consider Some Risks of Health Care Fraud to You

False Patient Diagnoses, Treatment and Medical Histories

Health care fraud, like any fraud, demands that false information be represented as truth. An all too common health care fraud scheme involves perpetrators who exploit patients by entering into their medical records false diagnoses of medical conditions they do not have, or of more severe conditions than they actually do have. This is done so that bogus insurance claims can be submitted for payment.

Unless and until this discovery is made (and inevitably this occurs when circumstances are particularly challenging for a patient) these phony or inflated diagnoses become part of the patient’s documented medical history, at least in the health insurer’s records.

A Miami-Dade psychiatrist, for example, pleaded guilty in 2016 to several fraud-related counts of conspiracy, was ordered to pay $50 million in restitution and was sentenced to more than twelve years in federal prison for his role in a fraud scheme that regularly involved entering false psychiatric diagnoses into the medical records of patients. For instance, the physician documented false information such as auditory hallucinations, bipolar disorder, and depression with psychosis in the medical record of an FBI informant’s medical file.  According to a signed statement by the defendant as part of his guilty plea, the psychiatrist’s false diagnoses resulted in more than $20 million in undeserved disability payments to various “patients” between 2002 and January 2016.

Medical Identity Theft

As a consumer, you are surely aware of the perils of identity theft and the devastating affects it can have on your financial health—jeopardizing bank accounts, credit ratings and your ability to borrow. But are you as familiar with the risks posed by medical identity theft? You should be, considering that more than 2 million Americans have been victims of this escalating crime, according to the Medical Identity Theft Alliance (MIFA).

When a person’s name or other identifying information is used without that person’s knowledge or consent to obtain medical services or goods, or to submit false insurance claims for payment, that’s medical identity theft. Medical identity theft frequently results in erroneous information being added to a person’s medical record, or even the creation of an entirely fictitious medical record in the victim’s name.

Victims of medical identity theft may receive the wrong medical treatment, could become uninsurable for life insurance coverage, and may find that their medical record shows diagnoses they don’t actually have. A medical identity theft victim may unexpectedly fail a physical exam for employment because a disease or condition for which he’s never been diagnosed or received treatment has been unknowingly documented in his health record.

Untangling the web of deceit spun by perpetrators of medical identity theft can be a grueling and stressful endeavor. The effects of this crime can plague a victim’s medical and financial status for years to come.

Physical Risk to Patients

Shockingly, the perpetrators of some types of health care fraud schemes deliberately and callously place trusting patients at significant risk of injury or even death. It’s distressing to imagine, but there have been many cases where patients have been subjected to unnecessary or dangerous medical procedures simply because of greed. Unnecessary procedures can result in countless irreversible outcomes such as patients losing their ability to have children or losing full physical mobility.

In December, 2015, an Ohio cardiologist was sentenced to 20 years in federal prison for performing unnecessary catheterizations, tests, stent insertions and causing unnecessary coronary artery bypass surgeries as part of a scheme to overbill Medicare and other insurers by $29 million.

In an ongoing 2019 case, a Virginia OB/GYN was arrested and accused of performing unnecessary surgeries on female patients to collect insurance payments. So many concerned former patients have contacted federal authorities that a hotline for potential victims has been established. Some of the medically unnecessary surgical procedures alleged to have been performed include hysterectomies, dilation and curettages, and the removal of ovaries and fallopian tubes.

Health Care Fraud and Organized Criminal Groups

Health care fraud is not just committed by dishonest health care providers. So enticing an invitation is our nation’s pool of health care money, that in some geographic areas, law enforcement agencies and health insurers have witnessed the migration of criminals from illegal drug trafficking into the safer and far more lucrative business of perpetrating fraud schemes against Medicare, Medicaid and private health insurance companies.

Enterprise crime, as it’s often called, can be far reaching and move quickly from place to place. In 2007, Medicare Fraud Strike Force Teams began to be established in various locations across the nation considered to be hotbeds of fraud activity with the goal of harnessing the collective resources of Federal, State, and local law enforcement entities to prevent and combat health care fraud, waste, and abuse. Strike Force “takedowns” often involve dozens of defendants involved in elaborate enterprise-wide fraud schemes. Strike Force Teams currently operate in Miami; Los Angeles; Detroit; Houston; Brooklyn; Baton Rouge and New Orleans; Tampa and Orlando; Chicago; Dallas; Washington, D.C.; Newark and Philadelphia; and the Appalachian Region.

In FY 2018 alone, investigative efforts of the FBI resulted in over 812 operational disruptions of criminal fraud organizations and the dismantlement of the criminal hierarchy of more than 207 health care fraud criminal enterprises.

A Federal Crime with Stiff Penalties

In response to these realities, Congress—through the Health Insurance Portability and Accountability Act of 1996 (HIPAA)—specifically established health care fraud as a federal criminal offense, with the basic crime carrying a federal prison term of up to 10 years in addition to significant financial penalties. [United States Code, Title 18, Section 1347.]

The federal law also provides that should a perpetrator’s fraud result in the injury of a patient, the prison term can double, to 20 years; and should it result in a patient’s death, a perpetrator can be sentenced to life in federal prison.

HIPAA also established a comprehensive program to combat fraud committed against health plans, private as well as public. It mandated the establishment of a national Health Care Fraud and Abuse Control Program (HCFAC), under the joint direction of the Attorney General and the Secretary of the Department of Health and Human Services (HHS) acting through the Department’s Inspector General (HHS/OIG). HCFAC coordinates federal, state and local law enforcement efforts against health care fraud and abuse. Since 1997, the Department of Justice (DOJ) and HHS have produced an Annual Report detailing the Control Program’s activities and outcomes.

Many states also have responded vigorously to the threat of health care fraud, not only by strengthening their insurance fraud laws and penalties, but also by requiring health insurers to meet certain standards of fraud detection, investigation and referral as a condition of maintaining their licenses in the state.

Private-Public Cooperation Against Fraud is Essential

Founded in 1985 by a handful of private insurers and law enforcement personnel, the National Health Care Anti-Fraud Association is a private-public non-profit organization focused solely on improving the private and public sectors’ ability to detect, investigate, prosecute and, ultimately, prevent fraud and abuse committed against our private and public health insurance programs.

Today, NHCAA represents the combined efforts of the anti-fraud units of the vast majority of our country’s private health payers and the entire spectrum of federal and state law enforcement and regulatory agencies that have jurisdiction over the crime of health care fraud, along with hundreds of individual members from the private health insurance sector as well as from federal, state and local law enforcement.

The NHCAA pursues its mission by fostering private-public cooperation against health care fraud at both the case and policymaking levels, by facilitating the sharing of investigative information among health insurers and government agencies and by providing information about health care fraud to all interested parties.

The NHCAA Institute for Health Care Fraud Prevention, a non-profit educational foundation, provides unmatched professional education and training to industry and government anti-fraud investigators and other personnel.

What Can You Do to Avoid or Prevent Health Care Fraud?

Here are some simple ways you can protect yourself from health care fraud, and keep health care costs down for everyone:

  • Protect your health insurance ID card like you would a credit card. In the wrong hands, a health insurance card is a license to steal. Don’t give out policy numbers to door-to-door salespeople, telephone solicitors or over the Internet. Be careful about disclosing your insurance information and if you lose your insurance ID card, report it to your insurance company immediately.
  • Report fraud. Call your insurance company immediately if you suspect you may be a victim of health insurance fraud. Most insurers now offer the ability to report suspected fraud online through their Website.
  • Be informed. Be knowledgeable about and aware of the health care services you receive, keep good records of your medical care, and closely review all medical bills you receive.
  • Read your policy and benefits statements. Read your policy, Explanation of Benefits (EOB) statements and any paperwork you receive from your insurance company. Make sure you actually received the treatments for which your insurance was charged, and question suspicious expenses. Are the dates of service documented on the forms correct? Were the services identified and billed for performed?
  • Beware of “free” offers. Is it too good to be true? Offers of free health care services, tests or treatments are often fraud schemes designed to bill you and your insurance company illegally for thousands of dollars of treatments you never received.

Health care fraud is a serious crime that affects everyone and should concern everyone—government officials and taxpayers, insurers and premium-payers, health care providers and patients—and it is a costly reality that none of us can afford to overlook. By taking steps to protect yourself from health care fraud, you are helping protect the integrity of our nation’s health care system and enormous, yet finite, resources we devote to it.

Source: National Health Care Anti-Fraud Association

Health care fraud is a serious offense which can have a lasting impact on one’s health and taxes. Have you been a victim of health care fraud? Do you know someone who has? Do you know if you (a friend or family member) were a victim of health care fraud? Post your comments below. Share the wealth of health with your friends and family by sharing this article with 3 people today. As always you are the best part of what we do. Keep sharing!

If these articles have been helpful to you and yours, give a donation to Shidonna Raven Garden and Cook Ezine today.