United States Attorney A. Lee Bentley, III, Attorney General Loretta E. Lynch, and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced Wednesday an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings.
Twenty-three state Medicaid Fraud Control Units also participated in Wednesday’s arrests. In addition, the HHS Centers for Medicare & Medicaid Services (CMS) is suspending payment to a number of providers using its suspension authority provided in the Affordable Care Act. This coordinated takedown is the largest in history, both in terms of the number of defendants charged and loss amount.
“As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime,” said Attorney General Loretta Lynch. “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people – many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends. The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.”
“Protecting our nation’s health care programs is a top priority of our Office,” said U.S. Attorney Bentley. “We are committed to prosecuting all those who submit false claims to these important programs, whether they be health care providers or dishonest individuals seeking benefits to which they are not entitled. Every tax dollar appropriated by Congress for health care should be spent on deserving patients in need.”
In the Middle District of Florida, 15 individuals were charged with participating in a variety of schemes, including compound pharmacy fraud and intravenous prescription drug fraud involving millions in fraudulent billing. Among those charged are business owners, a registered nurse, a pharmacist, and a physician’s assistant.
“Health care providers and patients are key to protecting the Medicare and Medicaid programs, but when they instead choose to commit fraud or to lie in order to obtain government benefits they are not entitled to, they steal precious tax dollars and corrupt the integrity of our health care system,” said Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health & Human Services Office of Inspector General (HHS OIG). "This takedown reflects the dedication of OIG and our law enforcement partners to bring such fraudsters to justice."
“The Social Security Office of the Inspector General is committed to pursuing those who violate the public’s trust by stealing SSA benefits. We are pleased with the aggressive action by the U.S. Attorney’s Office and our law enforcement partners’ joint efforts in identifying and prosecuting those who commit fraud, as one of our many efforts to protect the integrity of Social Security and Medicare programs for those who rely on them now and into the future,” stated Special Agent-in-Charge Margaret Moore-Jackson, SSA/Office of the Inspector General.
"These arrests highlight the commitment of the Defense Criminal Investigative Service (DCIS) and its law enforcement partners to protect the integrity of the Department of Defense (DoD) health care program-Tricare," said Special Agent in Charge John F. Khin, Southeast Field Office. "DCIS aggressively investigates health care providers that defraud the DoD, to preserve American taxpayer dollars intended to care for our Warfighters, their family members, and military retirees."
“Despite recent challenging events occurring in our territory, FBI Tampa remained devoted to dedicate resources to the National Health Care Fraud initiative,” stated FBI Special Agent in Charge Paul Wysopal. “Agents will continue to identify and investigate individuals who seek to personally benefit from the medical needs of a very vulnerable population.”
The Medicare Fraud Strike Force operations are part 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 efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations and since its inception in March 2007 has charged over 2,900 defendants who collectively have falsely billed the Medicare program for over $8.9 billion.
Including today’s enforcement actions, nearly 1,200 individuals have been charged in national takedown operations, which have involved more than $3.4 billion in fraudulent billings. Today’s announcement marks the second time that districts outside of Strike Force locations participated in a national takedown, and they accounted for 82 defendants charged in this takedown.
The cases announced today are being prosecuted and investigated by U.S. Attorney’s Offices nationwide, along with Medicare Fraud Strike Force teams from the Criminal Division’s Fraud Section, and agents from the FBI, HHS-OIG, Drug Enforcement Administration, DCIS, SSA-OIG, and state Medicaid Fraud Control Units.
A complaint or indictment is merely a charge, and all defendants are presumed innocent unless and until proven guilty.
Middle District of Florida Cases
Yosbel Marimon (39, Winter Park), owner of several Orlando-area infusion clinics, was indicted on one charge of conspiracy to commit health care fraud and wire fraud, six counts of health care fraud, and one count of conspiracy to commit money laundering. The charges stem from her role in a scheme to defraud Medicare by billing for more than $11.1 million in expensive intravenous prescription drugs that the clinics never purchased, never administered, and were not medically necessary. As a result of the scheme, Medicare paid over $8.6 million in fraudulent claims.
Greggory Jackson (40, Eagle Lake), Dustin “Drey” Chennells (40. Mount Dora), Michael Ayotunde (53, Ocala), Tashima Kenny (32, Davenport), Iris Ayala (54, Clermont), and Nalita Rajkumar (28, Lake Park) were indicted on a charge of conspiracy to commit health care fraud and wire fraud. Jackson also was indicted on two charges of receiving illegal kickbacks, two charges of paying illegal kickbacks, and two counts of money laundering. Kenny was also indicted on one count of money laundering. Jackson, Chennells, Kenny, and others managed and operated a telemarketing call center known as DMA Logistics d/b/a Nation Wide Meds located inside Life Worth Living Pharmacy. Ayotunde, a licensed pharmacist, is the owner and operator of Life Worth Living Pharmacy. Ayala is a licensed physician, and Rajkumar is a licensed physician assistant. The charges stem from these individuals’ roles in a compounding pharmacy fraud scheme that victimized the TRICARE program. Based on false and fraudulent claims, TRICARE made more than $5.7 million in reimbursement payments to Life Worth Living Pharmacy.
Belinda Jalloh (60, New Port Richey), a registered nurse, has been charged with one count of theft of government services stemming from her violation of an order from the Department of Health and Human Services excluding her from participating in the Medicare program. The order prohibited her from treating Medicare beneficiaries. Despite the exclusion, she applied for, and obtained, employment at a facility that billed Medicare for her treatment of Medicare beneficiaries.
Robert Lee Lanier (57, Jacksonville) has been charged with one count of theft of government property and one count of making a false statement. Lanier provided false information regarding his employment to the Social Security Administration. Between 2007 and January 2016, Lanier collected more than $236,682 in Social Security and Medicare benefits to which he was not entitled.
Maria Lugo (65, Marion County) was indicted for theft of government funds stemming from her concealment of her living arrangements while simultaneously collecting disability benefit payments from the Social Security Administration. Lugo falsely claimed a separation from her husband, whose income rendered her ineligible to receive disability benefits and Medicaid. From June 2000 through May 2016, Lugo obtained $118,346.12 in SSA benefit payments and $99,483.62 in Medicaid utilization that she was not entitled to receive.
Janice and Thurman Hammock (66 and 62, Citrus County) were indicted for theft of government funds stemming from their concealment of their living arrangements while Janice Hammock collected disability benefit payments from the Social Security Administration. Both spouses falsely claimed to be separated from one another, causing the wife to receive substantially more federal benefits than otherwise permitted. She illegally obtained $75,048.89 in SSA benefit payments and $101,465.07 in Medicaid utilization from January 2004 through May 2016.
Louis William Rimondi, IV (47, Marco Island) was indicted on two charges of theft of government money stemming from his alleged concealment from the Social Security Administration and Medicare of his return to gainful employment while continuing to collect disability benefits and Medicare benefits. From January 2010 through February 2016, Rimondi fraudulently collected $101,466 in SSA disability benefits to which he was not entitled. From January 2011 through February 2016, he also fraudulently received $20,467 in Medicare benefits to which he was not entitled.
Douglas Thompson (51, Jacksonville) was indicted on one count of theft of government property, one count of making a false statement, and three counts of wire fraud stemming from his role in a scheme to fraudulently receive approximately $108,834 in benefits under the Federal Medicaid Health Care Benefit Program and the Supplemental Security Income Program. For more than five years, Thompson collected benefits by falsely claiming he was unemployed and had no income when, in fact, he operated a business, Douglas Thompson Industries Inc. (or DTI Inc.), which brokered the sale of trucking equipment. When questioned about DTI Inc., Thompson provided a written statement to the Social Security Administration that falsely stated that he had never heard of DTI Inc. and was not working.
Craig DeMange, Sr. (62, Oviedo) was indicted on one count of making a false statement to the Social Security Administration concerning his employment, which hindered the agency’s efforts to determine his continued eligibility for disability benefits. As a result of DeMange’s false statement, he defrauded the SSA and the United States Department of Health and Human Services of approximately $25,000 in disability and Medicare benefits.
These cases will be prosecuted by Middle District of Florida Assistant United States Attorneys Yolande G. Viacava, Emily C.L. Chang, William S. Hamilton, Michael J. Coolican, Mac Heavener, and Department of Justice Trial Attorneys Timothy Loper and Christopher Hunter of the Criminal Division’s Fraud Section.
Maximum Penalties per charge
Theft of Government Money: 10 years in federal prison.
Conspiracy to Commit Healthcare Fraud and Fraud: 20 years in federal prison.
Healthcare Fraud: 10 years in federal prison.
Conspiracy to Commit Money Laundering: 20 years in federal prison.
Money Laundering: 10 years in federal prison.
False Statement: 5 years in federal prison.
Wire Fraud: 20 years in federal prison.