Texas and the Department of Justice are expanding Medicare Fraud Crackdowns, Texas Medicare Fraud Crackdowns, and Texas Medicaid Fraud Crackdowns to expose and prosecute criminals that have been committing Texas Medicare Fraud, Texas Medicaid Fraud, and other Medicare Fraud & Medicaid Fraud.  As such, it is very important for those that are aware of Texas Medicare Fraud, Texas Medicaid Fraud, and other Medicare Fraud Schemes to come forward before the Medicare Fraud Schemes are exposed and Health Care Executives start blaming each other and turning on each other to reduce their own potential criminal liability.

MEDICARE FRAUD STRIKE FORCE OPERATIONS EXPAND TO DALLAS AND CHARGE SEVEN IN NORTH TEXAS AREA WITH SCHEMES TO DEFRAUD MEDICARE OF $2.8 MILLION

North Texas Arrests Part of National Strike Force Takedown; 111 Defendant Charged with Submitting $225 Million in Fraudulent Claims

DALLAS — Seven North Texas-Dallas/Fort Worth, Texas-area residents, including the owners and operators of two health care companies, were arrested today on charges outlined in two indictments returned by a grand jury in Dallas last week and unsealed today, that they participated in a series of separate schemes in the North Texas area to defraud the Medicare program of more than $2.8 million, announced U.S. Attorney James T. Jacks of the Northern District of Texas, at a press conference in Dallas today. Mike Fields, Special Agent in Charge of the Dallas Regional Office of the Inspector General (OIG) for the Department of Health & Human Services (HHS), Robert E. Casey Jr., Special Agent in Charge, Dallas FBI Field Office, and the Texas Attorney General’s Medicaid Fraud Control Unit joined in making the announcement.

These indictments are part of a nationwide takedown by the Departments of Justice (DOJ) and HHS Medicare Fraud Strike Force, a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. These Medicare Fraud Strike Force operations have led to charges against 111 defendants for their alleged participation in Medicare fraud schemes involving more than $225 million in false billing. DOJ and HHS today announced that the Medicare Fraud Strike Force, previously operating in seven locations across the country (Miami, Los Angeles, Detroit, Houston, Brooklyn, Tampa and Baton Rouge), has expanded operations to Dallas and Chicago.

“With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country. We have safeguarded precious taxpayer dollars. And we have helped to protect our nation’s most essential health care programs, Medicare and Medicaid,” said Attorney General Eric Holder. “As today’s arrests prove, we are waging an aggressive fight against health care fraud.”

U.S. Attorney Jacks said, “Health care fraud has infiltrated almost every layer of the health care industry and the addition of a Health Care Fraud Prevention & Enforcement Action Team (HEAT) Strike Force in Dallas greatly expands law enforcement’s combined efforts in this area to root out this fraud that costs taxpayers, patients and private insurers millions of dollars, and prosecute those responsible. Today’s arrests in our area are merely the beginninf of the Strike Force’s efforts.”

Since their inception in March 2007, Strike Force operations in nine districts, have indicted 1000 defendants who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

“Financial kickbacks and fraudulent medical billing – as alleged here today – subvert the nation’s Medicare program by steering tax dollars into provider pockets, rather than sound patient care,” said Special Agent in Charge Mike Fields. “Today’s actions are part of a coordinated, nationwide sweep in the OIG’s continuing battle against the very real threat that health care fraud poses to the viability of the Medicare program.”

Special Agent in Charge Casey stated, “Medicare fraud is a significant problem in north Texas, taking taxpayers’ dollars and putting them in the pockets of criminals. The FBI and its partners, through the HEAT Strike Force, have concentrated extensive resources toward combating health care fraud. We have made the commitment to investigate and criminally prosecute such fraud to the fullest extent of the law.”

Texas Attorney General Greg Abbott said, “Thanks to an outstanding effort by state and federal law enforcement officers, 15 suspects have been arrested in this takedown in Dallas and Houston for defrauding the taxpayer-funded Medicaid program. The Texas Attorney General's Office is committed to working with federal law enforcement authorities to reduce Medicaid fraud. Today's arrests demonstrate the importance - and effectiveness - of collaborative law enforcement.”

U.S. v. Sylvia Jean Willett, et al.

In this indictment, Sylvia Jean Willett, 60, the owner and operator of JS&H Orthopedic, Inc., a DME supplier on Vickery Blvd., in Fort Worth, Texas, and her husband, Hugh Willett, 67, are each charged with one count of conspiracy to commit health care fraud and five substantive counts of health care fraud. The indictment alleges that from September 2008 through December 2010, the Willetts conspired to defraud Medicare by submitting at least $1.8 million in claims to Medicare for DME that JS&H purportedly provided, when in fact, JS&H did not provide the DME for which Medicare was billed. After the Medicare payments were deposited into JS&H bank accounts, the Willetts would transfer the proceeds of the fraud to themselves and co-conspirators.

The conspiracy to commit health care fraud count and the five substantive counts of conspiracy to commit health care fraud each carry a maximum statutory sentence of 10 years in prison and a $250,000 fine, upon conviction.

U.S. v. Ernest Amadi, et al.

This indictment charges Ernest Amadi, 53, the CEO and Administrator of Alliance Healthcare Services, L.P., located on Estate Lane in Dallas, and four co-defendants, George Opurum, 60, Agatha Opurum, 53, Edith Amadi, 49, and Ollie Futrell, 55, each with one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the U.S. and to receive and pay health care kickbacks. Defendant Futrell, who was a patient recruiter for Alliance, is also charged with three counts of payment and receipt of health care kickbacks.

According to the indictment, Ernest Amadi and his wife, Edith Amadi, both of Wylie, Texas, as well as George Opurum and his wife, Agatha Opurum, both of Richardson, Texas, paid kickbacks to Ollie Futrell, of Garland, Texas, for referring Medicare patients to Alliance. Edith Amadi and Agatha Opurum were nurses at Alliance. George Opurum was the CFO and Alternate Administrator of Alliance. From November 2008 through November 2010, Alliance billed Medicare approximately $1,031,758 on behalf of Medicare beneficiaries to whom it purportedly provided home health care services.

Each of the conspiracy to defraud the U.S. and to receive and pay health care kickbacks counts and each of the substantive counts of payment and receipt of health care kickbacks carries a maximum statutory sentence of five years in prison and a $250,000 fine, upon conviction.

An indictment is an accusation by a federal grand jury, and a defendant is entitled to the presumption of innocence unless proven guilty.

These cases are being prosecuted by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Northern District of Texas.

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Houston Federal Jury Convicts Patient Recruiter of Medicare Fraud Involving Claims of Hurricane Damage to Power Wheelchairs To Date, Six Individuals Guilty of Federal Crimes for Roles in Scheme

WASHINGTON – Marion Beverly Metoyer, a patient recruiter for a Houston durable medical equipment (DME) company, was convicted today by a Houston federal jury of health care fraud related to a power wheelchair fraud scheme, the Departments of Justice, Health and Human Services (HHS) and the FBI announced.

After a four-day trial, Metoyer, 57, of Dayton, Texas, was convicted on one count of conspiracy to commit health care fraud, three counts of health care fraud, one count of conspiring to receive illegal kickbacks for referring Medicare beneficiaries, and two counts of receiving illegal kickbacks for referring Medicare beneficiaries.

According to evidence presented at trial, Helen Etinfoh was the owner and operator of Luant & Odera Inc., a Houston-area DME company doing business as Tonni Medical Equipment & Supplies. Metoyer was a recruiter for Luant who was paid kickbacks in exchange for providing the company with beneficiaries in whose names bills could be submitted to Medicare. Etinfoh and other co-conspirators submitted false and fraudulent claims to Medicare for medically unnecessary DME, including power wheelchairs, wheelchair accessories and motorized scooters.

Evidence at trial showed that, based on representations from Metoyer and other recruiters, Luant would bill Medicare under a special code that designated the power wheelchairs as replacements for wheelchairs lost during hurricanes that hit the Houston area in fall 2008. In fact, the hurricanes did not damage the wheelchairs. Certain beneficiaries testified that they did not even have a power wheelchair before receiving the ones provided to them by Luant. Luant used the hurricane code because it allowed the company to submit claims to Medicare without a doctor’s order.

At trial, beneficiaries in whose names claims were submitted to Medicare testified that recruiters whom they had never met, including Metoyer, came to their homes and offered them free power wheelchairs in exchange for their Medicare information. The power wheelchairs were often billed to Medicare at more than $6,000 per chair.

Etinfoh was previously convicted by a federal jury of health care fraud in April 2010, and was sentenced to 41 months in prison. Paula Whitfield, a patient recruiter for Luant, was also convicted by a federal jury in April 2010, and was sentenced to 21 months in prison. Melvin Barnes, Johnnie Lee Andrews and Monica Rene Perry, each a patient recruiter for Luant, pleaded guilty to conspiracy to commit health care fraud and await sentencing.

At sentencing, Metoyer faces maximum penalties of 10 years in prison for the health care fraud conspiracy; 10 years in prison for committing health care fraud; five years in prison for conspiring to receive illegal kickbacks for referring Medicare beneficiaries; and five years in prison for receiving an illegal kickback for referring a Medicare beneficiary. A sentencing date has not been set.

Today’s guilty jury verdict was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney José Angel Moreno of the Southern District of Texas; Acting Special Agent-In-Charge Russell D. Robinson of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General (HHS-OIG), Office of Investigations; and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU).

The case was tried by Trial Attorney Laura Cordova and Assistant Chief Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.

Since their inception in March 2007, Strike Force operations in nine locations have obtained indictments of 1,000 individuals who collectively have falsely billed the Medicare program for more than $2.3 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.

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Medicare Fraud Strike Force Operations Lead to Charges Against 32 Doctors and Health Care Executives for More Than $16 Million in Alleged False Billing in Houston Early Morning Takedown Leads to Arrests in Houston, New York, Boston and Louisiana

WASHINGTON – Thirty-two people have been indicted for schemes to submit more than $16 million in false Medicare claims in the continuing operation of the Medicare Fraud Strike Force in Houston, Deputy Attorney General David W. Ogden and Deputy Secretary Bill Corr of the Department of Health and Human Services (HHS) announced today. The Strike Force in Houston is the fourth phase of a targeted criminal, civil and administrative effort against individuals and health care companies that fraudulently bill the Medicare program.

While the indictments were returned by a grand jury in Houston, individuals were arrested today in Houston, New York, Boston and Louisiana. In addition, Strike Force agents executed 12 search warrants at health care businesses and homes across the Houston area.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. The fourth phase was announced in May 2009, with agents from FBI, HHS Office of the Inspector General (HHS-OIG), the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU), the Drug Enforcement Administration (DEA), Office of Personnel Management, Office of the Inspector General (OPM-OIG) and the Office of the Inspector General at the Railroad Retirement Board (RRB-OIG).

"Our Medicare Strike Force is striking back against health care fraud in all its forms and wherever it occurs. We will stop fraud as its happening, using real-time data analysis of Medicare billing records," said Deputy Attorney General David W. Ogden. "Those who commit health care fraud will not be allowed to steal money from American taxpayers. Anyone operating or considering operating a health care fraud scheme around the country should take notice that they will be held accountable."

"When criminals rip off Medicare beneficiaries, we all pay the price. These false Medicare schemes and scams are costing the taxpayers millions of dollars, harming Medicare beneficiaries and driving up the cost of health care, but thanks to this new innovative partnership and the hard work of our staff on the ground, we are starting to fight back against fraud in a big way. The Administration’s HEAT initiative and our Strike Forces are making a big difference in a very short amount of time, returning millions back to the Medicare Trust in just a few months," said Bill Corr, Deputy Secretary of Health and Human Services and the top HHS official on the HEAT Team. "We are also working together across the federal government on important new innovations in the way we do business on the front end, to try and prevent crime like this from happening in the first place."

The Strike Force operations in Houston are another important step 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 joint efforts to reduce and prevent Medicare and Medicaid fraud through enhanced cooperation. The HEAT taskforce, co-chaired by Deputy Attorney Ogden and Deputy Secretary Corr, is made up of top-level law enforcement agents, prosecutors and staff from both Departments and their operating divisions. In the May 2009 announcement, Attorney General Eric Holder and Secretary Kathleen Sebelius announced the expansion of the Strike Force into Detroit and Houston to build upon existing partnerships between the agencies in a heightened effort to reduce fraud and recover taxpayer dollars.

Charges were unsealed today against 32 individuals who are accused of various Medicare fraud offenses, including conspiracy to defraud the Medicare program, and criminal false claims. The Strike Force operations in Houston have identified the primary fraud schemes as those related to false billing for "arthritis kits," power wheelchairs and enteral feeding supplies.

According to the indictments, the defendants charged today participated in schemes to submit claims to Medicare for products that were in fact medically unnecessary and oftentimes, never provided. In some cases, indictments allege that beneficiaries were deceased at the time they allegedly received the items. Collectively, the physicians, company owners and executives charged in the indictments are accused of conspiring to submit more than $16 million in false claims to the Medicare program.

"Americans deserve quality healthcare and have the right to expect that money expended on Medicare is not wasted," said U.S. Attorney Tim Johnson. "We will prosecute anyone who fraudulently obtains Medicare benefits at the expense of the truly needy."

"We will protect the Medicare program and its beneficiaries by stopping those who falsely bill for power wheelchairs, orthotic devices and other supplies that are not needed," said Daniel R. Levinson, Inspector General of the Department of Health & Human Services. "Today’s arrests demonstrate the significant impact of the new HEAT strike force on combating fraud and abuse in the Houston area."

"We will continue to work together to combat those who corrupt the system and wish to line their pockets with taxpayer dollars," said Special Agent in Charge Richard C. Powers, FBI Houston Field Office. "Healthcare fraud strikes at the heart of our health care system and our economy."

Texas Attorney General Greg Abbott added: "Today’s arrests reflect a concerted effort to crack down on those who defraud Texas taxpayers. We will continue working with our federal partners to uncover waste, fraud, and abuse in the Medicare and Medicaid systems."

Since the inception of Strike Force operations in March 2007 with phase one in South Florida, phase two in Los Angeles in May 2008, and phase three in Detroit in March 2009, the Strike Force has obtained indictments of more than 293 individuals and organizations that collectively have billed the Medicare program for more than $674 million. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Each of the three Houston Strike Force teams is led by a federal prosecutor from the U.S. Attorney’s Office in Houston or the Criminal Division’s Fraud Section. Each team has an agent from the FBI, HHS-OIG and the Texas Attorney General’s MFCU. DEA, OPM-OIG and RRB-OIG also have agents on the teams.

The cases are being prosecuted by attorneys from the U.S. Attorney’s Office, including Assistant U.S. Attorney Jennifer Lowery and Special Assistant U.S. Attorney Justin Blan, on detail from HHS-OIG, as well as from the Criminal Division’s Fraud Section, including Assistant Chief John S. (Jay) Darden and Trial Attorneys Charles Reed, Katherine Houston, Anthony Burba and John Cunningham.

An indictment is merely an allegation, and defendants are presumed innocent until and unless proven guilty.

Remember Medicare Billing Fraud Whistleblowers and Medicare Payment Fraud Whistleblowers not only can avoid potential criminal liability if they expose Medicare Billing Fraud Schemes, but can get an economic incentive for exposing Medicare Billing Fraud, if they are an original source with special knowledge of fraud and are the first to file, they receive a portion of the money that the government recovers.  Depending on the extent of the fraud, qui tam recoveries for the government can be in the billions of dollars and whistleblower recoveries can be in the hundreds of millions of dollars.

There are several keys to a successful Texas Medicare Fraud Lawsuit, Federal False Claims Act Qui Tam Medicare Fraud Whistleblower Lawsuit, or a Texas Medicaid Fraud Lawsuit including 1) obtaining original and specialized information of the fraud, 2) being the first to file regarding the specific fraud, and 3) protecting the whistleblower for retaliation. 

Medicare Payment Fraud Whistleblower Lawyer, Texas Medicare Payment Fraud Lawyer, Texas Medicare Fraud Whistleblower Lawyer, Texas Medicaid Fraud Lawyer, and Medicare Payment Fraud Whistleblower Lawyer

Being the First to File on the Medicare Billing Fraud Scheme is Essential for Recovery Under the False Claims Act and can Prevent Potential Criminal Liability (Importance of Being the First to File on Texas Medicare Fraud)

It is also essential to not delay in coming forward with a False Claim Act Qui Tam Action as the first whistleblower to file is eligible to be a relator and make a large recovery for exposing the fraud.  Additionally, when the fraudulent scheme is exposed, the people that kept the fraud secret can sometimes be found liable for criminal activity for not exposing the fraud that was being committed and further be held liable for continuing criminal activity.

Health Care Medicare Billing Fraud Whistleblower Protection, Medicare Payment Fraud Whistleblower Protection, and other Medicare Fraud False Claims Act Whistleblower Protections

Medicaid is a public health care problem in the United States that provides health care, medical care, dental care, and orthodontic care for eligible individuals and families with low incomes and resources. The Medicaid Program is jointly funded by state and federal governments, but is managed by the states.  Medicaid is the largest source of funding for medical and health-related services for people with limited income in the United States.  The Medicaid program has been growing and is expected to continue to grow in expand in the future.  The fastest growing aspect of Medicaid is nursing home coverage and this is expected to continue as the Baby Boomer generation begins to reach nursing home age. 

The State of Texas has enacted the Texas False Claims Act which is designed to prevent Texas Medicaid Fraud including false Texas Medicaid billing, Texas fraudulent Medicaid billing, Texas Medicaid kickbacks, Texas billing Medicaid for patients that have died, Texas phantom Medicaid billing, and other forms of Medicaid fraud.  This Act offers large financial rewards to whistleblowers that properly report instances of significant Medicaid fraud.  For more information on Texas Medicaid Fraud Lawsuits and Texas Medicaid Fraud Whistleblower Lawsuits, please go to the following webpage, CHIP Fraud Whistleblower Lawsuit and Medicaid Billing Fraud Whistleblower Lawsuit Information and Texas False Claims Act and Medicaid Fraud Prevention Act Information.

Texas False Claims Act Lawsuit, Texas Medicare Fraud Whistleblower Recovery Lawsuit, Texas Medicare False Billing Whistleblower Award Lawsuit, Texas Medicare Double Billing Fraud Lawsuit, Texas Medicare Fraud False Billing Lawsuit, Texas Unnecessary Medical Treatment Relator Lawsuit, and Texas Medicare Fraud Whistleblower Lawsuit Information

Texas Medicare Fraud Whistleblowers and Texas Medicaid Whistleblowers that provide original source information of schemes to fraudulently bill Medicare or Medicaid may recover a portion of the proceeds recovered on the government's behalf.  These fraudulent schemes regarding medical services or medical products to fraudulently take Medicare payments and Medicaid payments include upcoding, double billing, bill padding, unbundling, and charging for services never provided  Below are some additional types of Medicare fraud and Medicaid fraud:

• billing Medicare for X-rays, blood tests and other procedures that were never performed

• falsifying a patient’s diagnosis to justify unnecessary tests;

• giving a patient a generic drug and billing for the name-brand version of the medication;

• giving a recipient a motorized scooter and billing for an electric wheelchair, which can cost three times more;

• billing Medicare for care not given;

• billing Medicare for patients who have died or who are no longer eligible for Medicare;

• billing Medicare for care given to patients who have transferred to another facility;

• transporting Medicare patients by ambulance when it is not medically necessary;

• requiring vendors to “kick back” part of the money they receive for rendering services to Medicare patients (kickbacks may also include vacations, merchandise, etc.);

• billing patients for services already paid for by Medicare;

• billing Medicare for phantom patients;

• double billing Medicare for services;

• upcoding services for increased Medicare payments.

Texas Medicare Fraud Lawyers, Medicare Payment Fraud Whistleblower Lawyers, Texas Medicare Payment Fraud Lawyers, Texas Medicare Fraud Whistleblower Lawyers, Texas Medicaid Fraud Lawyers, Medicare Payment Fraud Whistleblower Lawyers, Texas Medicare Payment Fraud Lawyers, and Federal Qui Tam Medicare Billing Fraud Whistleblower Lawyers

If you are aware of a large health care company or individual that is defrauding the United States Government out of millions or billions of dollars, contact Texas Medicare Fraud lawyer Jason Coomer.  As a Texas Medicare Fraud Lawyer, he works with other powerful qui tam lawyers that handle large Medicare Payment Fraud cases.  He works with San Antonio Medicare Fraud Lawyers, Dallas Medicare Fraud Lawyers, Houston Medicare Fraud Lawyers, and other Texas Medicare Fraud Lawyers as well as with Medicare Fraud Whistleblower Lawyers and Medicaid Fraud Whistleblower Lawyers throughout the nation to blow the whistle on fraud that hurts the United States. 

For more information on Medicare Fraud, Tricare Fraud, Medicaid Fraud, Defense Contractor Fraud, Off Label Fraud, Road Construction Fraud, and other types of False Claims Act Whistleblower Claims, please go to the Qui Tam, Whistleblower, and Federal Federal False Claims Act Information Center.

It is also important to understand that many potential whistleblower are medical professionals and employees that may often need whistleblower protections when reporting Texas Medicare Fraud, Texas Medicaid Fraud, or other Medicaid/Medicare Fraud under the False Claims Act.  As such, it can be very useful for these medical professionals to discuss potential whistleblower protections with an attorney including how to prepare for potential retaliation or aggressive attacks by the employer or contractor.  For more information on this topic please go to the following web page on False Claims Act Lawsuit Whistleblower Protections. 

Texas Medicare Fraud Lawyer, Medicare Payment Fraud Whistleblower Lawyer, Texas Medicare Payment Fraud Lawyer, Texas Medicare Fraud Whistleblower Lawyer, Texas Medicaid Fraud Lawyer, and Medicare Payment Fraud Whistleblower Lawyer

If you are a health care executive, hospital administrator, hospital compliance officer, coder, benefit coordinator, health care administrator, medical doctor, other health care professional, family of a Medicare or Medicaid recipient, or Medicare recipient with original source knowledge of Texas Medicare Fraud, Texas Medicaid Fraud, or other Medicare/Medicaid fraud, it is important that you are the first to step forward to blow the whistle on the Medicare fraud or Medicaid fraud.  If you are aware of Medicare Fraud or Medicaid fraud, feel free to contact Texas Medicare Fraud Whistleblower Lawyer Jason Coomer via e-mail message or our submission form.