Houston Chiropractor Convicted of Health Care Fraud in State and Federal Probe

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HOUSTON, TX – Justina Okehie aka Dr. Tina Collins, 55, of Richmond, Texas, has pleaded guilty to one count of conspiracy to commit health care fraud, United States Attorney Kenneth Magidson announced today.
 
The conspiracy resulted in fraudulent physical therapy and chiropractic claims being paid by the Medicare and the Texas Medicaid programs. From January 2007 through August 2010, Medicare and Medicaid paid approximately $2.1 million to Okehie.
 
Okehie owned and operated Adom Rehabilitation Services and Healthcare and Wellness Medical Center which were both located in southwest side Houston. As part of the conspiracy, Okehie would pay patient recruiters to refer Medicare beneficiaries to her clinics. Okehie also paid the Medicare beneficiaries themselves for just showing up at the clinics. In many instances, the physical therapy and chiropractic services billed to the government health care programs were not performed and were not medically necessary. Some of the Medicare beneficiaries were actually receiving medical services at inpatient hospital facilities at the time Okehie was purportedly providing them physical therapy and chiropractic services in her clinics.
 
Co-defendant Cassandra Tasby Barnes, 48, of Houston, who was employed by Barnes as an office manager, had previously pleaded guilty in this case to one count of conspiracy to violate the anti-kickback statute. Barnes pleaded guilty for her role in paying Medicare beneficiaries and patient recruiters for referring Medicare beneficiaries for physical therapy and chiropractic services. Both Okehie and Barnes are currently on bond and are scheduled to be sentenced on May 21, 2012, before U.S. District Judge Nancy Atlas.
 
The investigation into Adom Rehabilitation and Healthcare and Wellness Medical Center was the result of joint efforts by agents and investigators of the Inspector General’s Office of the U.S. Department of Health and Human Services, the Texas Attorney General’s Medicaid Fraud Control Unit, the Railroad Retirement Board and the FBI. Special Assistant U.S. Attorney Justin Blan and Assistant U.S. Attorney Julie Redlinger are prosecuting this case. 

Source: The U.S. Attorney for the Southern District of Texas 
 

State Accuses Chiropractor Of Unethical Practices; Functional Endocrinologist Accused of Practicing Medicine

aroundtheworldDENVER, CO — The state of Colorado took action against a chiropractor, handing down pages of violations, accusing him of unethical practices, after a television investigation exposed his business practices.  Over the past year, many former patients of chiropractor Brandon Credeur told 7NEWS that they paid thousands of dollars upfront, seeking help for thyroid and diabetes problems from someone they thought was an endocrinologist.

Credeur has been hit with 25 counts including negligent chiropractic practice, false or misleading advertising, unethical advertising, ordering unnecessary tests, failing to make essential entries on patient records, or falsifying them, abandoning a patient, and performing a procedure beyond the scope of authorized services.

CJ Omelian, a former Credeur patient, believes that Credeur’s license should be pulled.
 
“He abused that,” Omelian said.

Until she saw an investigation by CALL7, a local television program, the patient believed Credeur was an endocrinologist.”I hope he has to answer to every charge he has against him,” Omelian said.

“Patients are sometimes not understanding the qualifications of the people they’re dealing with. And we think this is one of those cases,” said Dr. Brent Keeler, president of the Colorado Medical Society. The Colorado Medical Society is calling for more transparency. And it is Credeur’s own words, seen in Web videos posted online, that raises even more questions as he tutors others chiropractors on his business model.

“I would take the spines out of the office or at least hide them,” Credeur instructed in one video.

“These patients are desperate,” Credeur said in another video.

Source: TheDenverChannel.com – CALL7 News

D.C. Loses Insurance Case and Pays Big for Fraud

aroundtheworldBOSTON, MA– For the second time this year, The Norfolk & Dedham Group has won a significant insurance fraud/racketeering case filed against a chiropractor and his treatment facilities. By a Memorandum of Decision issued September 15, 2011, a judge sitting in the Massachusetts Suffolk Superior Court ordered Jason Corbett, and his chiropractic clinics (including Franklin Field, Hyde Park and Union Street Chiropractic) pay Norfolk & Dedham $1,138,453.42 dollars in damages.The litigation began when Jason Corbett’s Clinics filed hundreds of individual lawsuits against Massachusetts automobile insurers, including Norfolk & Dedham, in Courts throughout Massachusetts. In these complaints, Corbett sought payment for treatments allegedly provided to automobile accident victims. Norfolk & Dedham consolidated the Corbett lawsuits and filed a Complaint in Suffolk Superior Court for Fraud, Civil Conspiracy, as well as violations of the Federal Racketeer Influenced Corrupt Organizations (“RICO”) Act, and the Massachusetts’ Unfair Business Practices Statute.

During the discovery phase of the case, Corbett admitted that he violated Massachusetts Chiropractic Regulations by paying individuals, known as referrers or runners, as much as $500.00 dollars per person to solicit patients for his clinics. Moreover, chiropractors employed by Corbett admitted that they knowingly provided excessive and unnecessary services to patients.
 
In reaching its decision, the Court found that, “Jason Corbett, and his clinics, were all responsible for the misrepresentations created by their employees.” The Court concluded that “both as manager at the chiropractic clinics and of the chiropractors themselves, it is factually obvious that [Jason] Corbett had actual knowledge that the reports being prepared by the chiropractors contained false representations that the treatment rendered was reasonable and necessary.” The Judge further observed that, “In addition, it is beyond dispute that Corbett possessed actual knowledge that the false reports would be relied upon by the Insurers’ to their detriment.” For these reasons, the Court awarded Judgment in favor of the insurer on all,”. . . fraud claims stemming from chiropractic patients treated at the Corbett Clinics who were referred to the clinics by runners or who received unnecessary treatment . . .”

Norfolk & Dedham’s $1.1 million dollar award against Jason Corbett follows closely behind another significant victory in its ongoing battle against insurance fraud. On September 9, 2011, in a separate fraud/racketeering lawsuit filed against former Massachusetts chiropractors, Alan Cohen and Marc Cohen, the Suffolk Superior Court entered a Final Judgment ordering the Cohens pay Norfolk & Dedham $693,961.67 dollars.

“These two awards from the Court demonstrate Norfolk & Dedham’s resolve in combatting insurance fraud. Norfolk & Dedham will remain vigilant in rooting out insurance fraud in all forms,” said James T. Harrington, Executive Director of the Massachusetts Insurance Federation. The Massachusetts Insurance Federation is an insurance company trade association comprised of 24 property/casualty insurers and is viewed as the leading advocacy voice of the property/casualty insurance industry in Massachusetts. The Norfolk & Dedham Group is a member of the Federation.
 
Norfolk & Dedham Mutual Fire Insurance Company, Dorchester Mutual Insurance Company, and Fitchburg Mutual Insurance Company, do business as The Norfolk & Dedham Group.

SOURCE: The Norfolk & Dedham Group
 

Atlanta Chiropractor Held for Fondling

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Atlanta, GA: A Sandy Springs chiropractor was behind bars after being accused of fondling a male customer during a massage session. The 28-year-old customer said his chiropractor offered a free massage session after an initial visit to his office. The chiropractor’s office is at the same location as his home address. The chiropractor was taken into custody, and remained at the Fulton County Jail on $5,000 bond for four days.
 
Source: The Atlanta Journal-Constitution

Chiropractor gets year in jail for killing 78-year-old

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STAMFORD, CT — More than 2 1/2 years after killing a 78-year-old resident with a punch in a downtown parking lot, a Florida chiropractor received the maximum one-year jail sentence Friday for criminally negligent homicide.  
 
Judge Gary White, who presided over William Lindemann’s June trial, said the former Greenwich resident acted cruelly, callously and violently toward Herbert Davidson and had no concern for the older man after punching him. 
 
Backing up his words, White said Lindemann left Davidson bleeding on the frozen pavement in January 2009 without calling police or an ambulance and fled Stamford and the state for Florida after throwing the punch. 
 
White went on to say Lindemann did not tell the truth during his trial testimony when he said he did not know how old Davidson was. 
 
He said Lindemann has a history of violence, proven when his wife obtained a protective order against him in Florida while the case was pending in Stamford. Lindemann also has seven felony convictions involving mail fraud on his record. 
 
“His conduct was grossly negligent and cruel,” White said. 

Moments after judicial marshals led Lindemann away, Davidson’s wife of 39 years breathed a sigh of relief outside the courtroom. 

“I just loved it when they put those handcuffs on him,” said Rhea Davidson, a former Stamford teacher for four decades. “But so little time for him. We will never get our Herb back,” she said sadly. 

According to testimony in the case, on Jan. 27, 2009, Lindemann punched Davidson after he began berating the younger man in the parking lot behind Curly’s Diner.
 
Lindemann said defended himself after he saw something in Davidson’s hand and thought the older man had a weapon.

Davidson was going to the diner to attend a poetry circle. 

One witness said Davidson fell like “deadwood” after Lindemann punched him.
 
At the completion of his trial, a jury found Lindemann not guilty of the more serious charges of first-degree manslaughter, first-degree assault of a person over 60 and second-degree manslaughter. 
 
During the sentencing, Davidson’s adopted son Bruce Davidson said he spent weeks by his father’s side in intensive care. Davidson succumbed six weeks after the attack to his injuries sustained during his run-in with Lindemann.
 
Asking White to pronounce the maximum sentence, Bruce Davidson pointed at Lindemann and yelled, “That man took my father’s life and walked away and was tracked down only by his credit card bill left at the scene. That is a responsible person?” 

His brother, Raphael Davidson, also asked White for the maximum sentence. 
 
“What kind of person walks away from an old man dying?” Davidson asked. “Mr. Lindemann has done so much damage to us.” 

When it came time for her to talk to White, Rhea Davidson said Lindemann could have used a lesson that she taught in kindergarten for 40 years. 
 
“Lesson number one. Keep your hands to yourself and use your words,” she said. Davidson said she was worried about what Lindemann will do on the street. 
 
“He will kill again. I want Mr. Lindemann in jail,” she said. 

After the Davidson family had their say, Lindemann said he had come to admire Davidson, and through sobs said he sounded like a “wonderful man” and wished they could have met under different circumstances. 
 
He gave the Davidson family his condolences for Davidson’s death and apologized for the role he played in ending his life. 

He told White he would accept whatever sentence he pronounced.
 
Source: The Connecticut Post 
 

Agents and Governor Accuse, D.C., M.D. of Running a Pill Mill

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fdadrugsDAYTONA BEACH — The Florida Department of Law Enforcement, assisted by the FBI, seized records today from a clinic in North Ridgewood Avenue and others in South Florida linked to a doctor under fire for the way he prescribes medications, officials said.

FBI agents worked all day at Wagner Chiropractic Clinic at 542 N. Ridgewood. The clinic is owned in partnership by several doctors including Joseph Wagner, the father of Volusia County Councilman Josh Wagner, an attorney.

Other search warrants were also served in multiple locations across the state as investigators looked for any records that would link the targets of the searches to West Palm Beach-based Dr. John P. Christensen, according to the FDLE.

The Florida Department of Health ordered an emergency suspension of Christensen’s medical and chiropractic licenses today.

“This emergency suspension order sends a strong message to Floridians that we’re serious about cracking down on pill mills and the illegal distribution of prescription drugs that is killing our friends and family members,” said Gov. Rick Scott. ” It also sends a strong message to the pill mill operators that Florida will not tolerate this type of activity. Through our resources with the Department of Health and the Florida Department of Law Enforcement, we will find you and we will shut you down.”

According to the Emergency Suspension Order of Christensen, investigators say Joseph and John Wagner were in business with Christensen and the doctor allowed his licensing privileges to be used for drugs — including hydrocodone, Xanax and Soma — to be prescribed to the patients of Joseph Wagner without Christensen ever evaluating or seeing the patients. Joseph Wagner also conducted these activities in the South Florida offices, the order said.

The Department of Health also claims in its report Christensen defrauded insurance companies by submitting false paperwork.

FDLE spokeswoman Heather Smith said agents belonging to the South Florida Drug Enforcement Task Force would be at multiple locations serving search warrants at businesses “associated with Dr. Christensen and his practice.”

Smith said no one has been arrested or charged and that the search warrants were served today to obtain records only.

City records show the business license of Wagner Chiropractic is currently in the names of three men: Albert Albatrosov of Hawaii, John Wagner — the county councilman’s brother who lives in Port Orange — and Christensen.

Councilman Josh Wagner has not commented on raids.

Joseph Wagner, a chiropractic physician and licensed acupuncturist, is the owner of the clinic property, according to Volusia County Property Appraiser’s records.

Christensen was the target of a 2010 investigation into the overdose death of a 21-year-old patient who had visited his West Palm Beach office. The state Department of Health officials recommended he be disciplined by the Board of Medicine for prescribing “excessive and/or inappropriate quantities of methadone, and/or oxycodone, and/or alprazolam,” according to state records.

But state records also show that in June an administrative law judge sided with Christensen, saying the state failed to prove the physician prescribed excessive amounts of drugs, or that he committed medical malpractice. The judge recommended that the Board of Medicine enter a final order dismissing the complaint against Christensen.

Albatrosov lists the Daytona Beach clinic as the location of his primary practice with the Health Department, which also indicates he holds medical licenses to practice in Georgia and Hawaii.

Joseph Wagner answered his door this afternoon at his Wilbur-by-the-Sea home, but closed the door before he could be asked any questions.

John Wagner, whose father is Joseph Wagner, was leaving a chiropractic clinic he owns on Mason Avenue today. He said he doesn’t speak to his father and had no idea about the search at the Ridgewood clinic.

A handwritten sign was taped to a window at John Wagner’s office. It said “closed Thursday.”

Dressed in board shorts and no shirt, John Wagner said he was going surfing.

 

Source:  The Daytona Beach News-Journal

Chiropractor Charged with Fraud and Tax-Evasion

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PITTSBURGH — Federal prosecutors on Tuesday filed fraud and tax-evasion charges against a Westmoreland County chiropractor operating two clinics in West Virginia.

Joseph Yurigan, 60, of New Alexandria, operates clinics in Weirton and Wheeling.

Prosecutors allege Mr. Yurigan made money from procedures he didn’t perform, then drew cash from his businesses and hid them in his children’s bank accounts to evade taxes.

He faces 33 charges of healthcare fraud, four tax-evasion charges and one charge of interfering with revenue laws. Prosecutors seek to confiscate some of Mr. Yurigan’s properties, including real estate and two Mercedes-Benz cars.

If convicted, Mr. Yurigan could face up to 10 years in prison and millions of dollars in fines.

 

Source: Pittsburgh Post-Gazette

ERISA Claims Upheld in Aetna Recoupment Case

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TRENTON, N.J., Jun 23, 2011 (GlobeNewswire via COMTEX) — In a decision filed on June 20, 2011, the Honorable Judge Joel A. Pisano of the District of New Jersey sustained the claims brought by a group of individual healthcare providers and state chiropractic associations against Aetna, Inc. and various of its subsidiaries under the Employee Retirement Income Security Act of 1974 (“ERISA”). In the action, the plaintiffs allege that Aetna improperly recouped monies from providers that had previously been paid on behalf of its members, based on retroactive determinations that the services at issue were not covered under the members’ health care plans. Frequently, Aetna determined after-the-fact that the services were excluded from coverage because they were “experimental and investigational” and therefore demanded that the providers return the funds. If the providers did not agree, Aetna placed them into pre-payment review, which in reality meant that Aetna simply withheld payment as a means to punish the provider and save money through undisclosed denials. The entire process, as alleged in the complaint, was in violation of ERISA because Aetna made its retroactive adverse benefit determinations that served as the basis of its repayment demands without providing a “full and fair” review of its decision, as required under the law.

“This decision is very important,” says D. Brian Hufford of Pomerantz Haudek Grossman & Gross LLP (“Pomerantz”), “as now we will be able to proceed to full-scale discovery where we anticipate finding substantial evidence supporting our claims that ERISA has, indeed, been violated as a result of Aetna’s widespread actions.” The case parallels a similar action brought by Pomerantz which is proceeding against a number of Blue Cross Blue Shield licensees in the Northern District of Illinois before the Honorable Matthew E. Kennelly, as well as a recently filed action against United Healthcare in the District of New Jersey before the Honorable Faith Hochberg, both of which allege violations of ERISA for improper repayment demands and recoupments of prior benefit payments.

In addition to the ERISA claims, Judge Pisano also upheld the standing of the association plaintiffs to pursue claims for injunctive relief on behalf of their members, including the Association of New Jersey Chiropractors, the New York Chiropractors Council, the Illinois Chiropractic Society and the International Chiropractors Association.

In addition to the ERISA claims, the plaintiffs also asserted violations of the Racketeer Influenced and Corrupt Organizations Act (“RICO”), which were dismissed. The court further dismissed one individual plaintiff, finding that he had released his claims by entering into an individual settlement prior to the filing of the class action, while granting a motion to compel arbitration against two other plaintiffs, who had arbitration clauses in their in-network provider agreements with Aetna, leaving six remaining individual plaintiffs. According to Robert J. Axelrod of Pomerantz, “while we continue to believe that RICO was violated, ERISA is the heart of our case, and we are very pleased with the result.”

Counsel for plaintiffs are continuing to investigate these claims, and other related claims that may be added to the litigation. If you have any questions, please contact D. Brian Hufford, Esq. of Pomerantz Haudek Grossman & Gross LLP, by phone (212-661-1100) or email ([email protected]), or Vincent N. Buttaci, Esq., of Buttaci & Leardi, LLC, by phone (609-919-6312) or email.

SOURCE: Pomerantz Haudek Grossman & Gross LLP

Chiropractic Patients Sue for Illegal Charges

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MILWAUKEE, WI – Five Wisconsin women are suing their insurance companies for what they claim is an illegal collection of co-payments for chiropractic care.Hansen Riederer Dickinson Cruger LLC says patients’ class-action lawsuit was filed on behalf of state chiropractic patients of five major health insurers.  According to the complaint, the health insurance providers are violating state law by requiring chiropractic patients to pay a co-payment for each visit. Cynthia Larson, one of the plaintiffs, says, “How is it insurance if I have to pay for 100% of my treatment, whether I go once or 50 times? I am actually worse off submitting my chiropractic charges to my insurer than if I paid out-of-pocket because not only do I pay the entire cost through the co-payments but then the insurance company limits the number of times I can receive treatment from my chiropractor.” Larson, along with Kimberly Dehaan, Jeannette Borden, Rebecca Bavinck, and Amy Cloute, filed suit in federal court in the Western District of Wisconsin on Friday, alleging that their insurance companies used co-payments to shift all or nearly all of the cost of chiropractic care to them. They contend that Wisconsin law prohibits these co-payments. Russ Leonard, director of the Wisconsin Chiropractic Association, says “This is a huge step towards ending the systematic and destructive discrimination against Wisconsin chiropractic patients who paid for and have a legal right to an alternative to drugs or surgery.”

 

Source:  WEAU News

OSCA Leads the Nation With ERISA UHC Class Action and PPACA Compliance for Patient Protection

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COLUMBUS, OH–(Marketwire – 03/18/11) – On March 16, 2011, Ohio State Chiropractic Association (OSCA) announced that it was sponsoring the second PPACA Claims Regulations Claims Specialist training in an effort to meet a July 01, 2011 deadline for full enforcement of the Federal Health Reform Law, Patient Protection and Affordability Care Act (PPACA). PPACA is the new Federal Patient’s Bill of Right, for almost all non-Medicare and non-Medicaid health claims and OSCA believes that it is critically important for health care providers as well as their patients to understand what is involved in this important new legislation. Earlier this year, on Jan. 24, 2011, OSCA and Dr. Judson G. Sprandel, II, D.C., past president of OSCA, filed a class action lawsuit against UnitedHealth group for the alleged violation of the Employee Retirement Income Security Act of 1974 (“ERISA”), arising from its post-payment audit and stethoscopeandflagrecoupment practices. The OSCA’s Board of Directors unanimously (19 – 0) voted to file this suit in early January. That decision was driven from a commit to protect the rights of its members and the insured they treat through use of ERISA, the federal statute governing most private employer benefit plans. On Feb. 8, 2011, the Congress of Chiropractic State Associations (“COCSA”) announced that it had voted to join OSCA in pursuing the ERISA Class Action on behalf of providers nationwide. COCSA represents chiropractic member associations in in all 50 states. The American Medical Association described the pending class action in its member publication on March 4, 2011, stating that “the lawsuits could have implications for physicians who are the target of the same kind of collections, even though the plaintiffs are chiropractors.” Through the ERISA class action against United and the PPACA Claims Appeal Compliance training OSCA is leading the nation in advocating for appropriate patient care and against abusive insurance practice.

The Second OSCA PPACA / ERISA Claims Specialists training will be held on April 28, 2011 in Columbus, OH for its PPACA / ERISA Committee Members. Once the eight module trainings are completed the OSCA will begin training all members and providers in the State. OSCA finished its first session in PPACA / ERISA training on March 3, 2011.

The OSCA’s ERISA class action was originally filed on Jan. 24, 2011, in the United States District Court, District of New Jersey, Case 2:11-cv-00425-FSH-PS, by Pomerantz Haudek Grossman & Gross LLP. Pomerantz seeks to represent a nationwide class of all health care providers who have been subjected to improper demands by UnitedHealth Group to repay previously paid health care benefits for services provided to UnitedHealth Group subscribers, only to have such funds forcibly recouped by the withholding of future payments from unrelated claims in alleged violation of ERISA.

PPACA claims regulations will govern all claims processing, reimbursement, denials and appeals for almost all healthcare claims outside Medicare and Medicaid, the most significant reimbursement law changes in 45 years since Medicare was created. The PPACA claims regulations became effective on 09/23/2010 with a deadline on July 01, 2011 as full enforcement grace period.

On July 23, 2010 the United States Department of Labor released a bulletin entitled: Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review Processes Under the Patient Protection and Affordable Care Act; Interim Final Rule. You will find a copy of this bulletin here

These interim final regulations are effective on September 21, 2010.

Information regarding the OSCA and membership benefits can be accessed at http://www.oscachiro.org

 

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For further information, fax 1-305-716-9212. Write us at [email protected] or #CO138, 8619 NW 68th St., Miami, FL 33166.