Ex-assembly member charged for pill mill participation

From CBS 2:

More than a dozen people have been arrested and charged in a prescription drug ring in Brooklyn, and a doctor is the alleged ringleader.

As CBS2’s Dave Carlin reported, nurses and even a former New York state assemblyman were also caught up in the bust, dubbed “Operation Avalanche.”

Allegedly, the multimillion-dollar scheme involved thousands of medically unnecessary prescriptions, and shady patient tests and treatments to defrauded Medicare and Medicaid.

Also charged is former Coney Island, Brooklyn Assemblyman Alec Brook-Krasny, 59. He is in Israel and has not surrendered.

Investigators said he allegedly directed a lab he is now affiliated with to alter drug test results.

Ambulette service ripped off Medicaid

From the Daily News:

A QUEENS-BASED transportation company will pay the state back $300,000 in a settlement related to Medicaid overcharges, Attorney General Eric Schneiderman said Monday.

Apple Transportation of New York, Inc. “frequently” billed Medicaid for ambulette services to transport mental health patients instead of for livery services, which has a lower reimbursement rate, Schneiderman’s office said.

The pricier ambulette services provide personal assistance to the patient, whereas livery service does not.

The improper billings took place between 2004 and 2008, officials said.

Taxpayer-funded Lexus?

From the NY Post:

A Queens nursing-home director billed taxpayer-funded Medicaid for his . . . Lexus!

The 240-bed Elmhurst Care Center overcharged Medicaid by some $1.65 million — including more than $105,000 in expenses for a Lexus used by Executive Director Mark Persaud and another vehicle assigned to the marketing executive, Gov. Cuomo’s Medicaid probers claim.

The six-year audit, conducted by state Office of Medicaid Inspector General James Cox, concluded that expensing the program for the hospital administrator’s luxury vehicle was beyond the pale.

“Costs pertaining to luxury automobiles are not related to patient care. Consequently, disallowances were necessary,” said the OMIG audit, which examined billings from 2000 to 2006.

Elmhurst Care insisted the expenses were aboveboard.

An old, familiar problem

From NBC:

The operator of a Queens medical practice specializing in radiological exams was arrested by FBI and Secret Service agents early Thursday on charges of filing more than $30 million in false Medicare and Medicaid billings, prosecutors tell NBC 4 New York.

Ting Huan Tai, 34, was taken into custody from his apartment on the 58th floor of a luxury high-rise building in Lower Manhattan. Agents executed a search warrant at Tai’s apartment and seized his 2008 Lamborghini and several bank accounts containing millions of dollars, law enforcement sources said.

According to court papers, Tai became the operator of United Medical Diagnosis (UMD), based in Flushing, in May 2010 after the departure of the former owner. Between May 2010 and May 2012, Tai and his employees submitted bills to Medicare and Medicaid for more than $30 million for radiological services never performed. The bills used the identity of the radiologist and former owner of UMD without his knowledge or consent, sources said.

Prosecutors say Tai used money from the scheme to pay personal expenses, including credit card bills and rent.

Medicaid fraud rampant in Rego Park

From NBC:

Medicaid is a health care program reserved, primarily, for the poor. Benefits are based on federal poverty guidelines. To be eligible in New York State, a single person must earn less than $17,000 a year.

With that in mind, you might expect the most impoverished neighborhoods would be the ones that generate the most Medicaid bills.

Not so.

It turns out, the state’s highest Medicaid billing total can be found within a relatively affluent community: Rego Park, Queens.

With the help of the New York Office of the Medicaid Inspector General, NBC New York examined Medicaid data from all of the state’s nearly 15,000 zip codes.

The analysis found Rego Park -- a neighborhood with a median income above $50,000 -- generated more than $1.5 billion in Medicaid reimbursements in 2010. Because the health care program is aimed at helping poor people, the findings had even regulators scratching their heads.

By running data queries, Little discovered one of the state’s largest Medicaid managed care contractors uses a Rego Park address to process bills -- a clear reason for the high billing volume.

That doesn’t mean investigators won’t continue to have their eyes on the Queens neighborhood.

In his data query, Little also discovered pharmacy reimbursements make up the second largest share of Medicaid bills in Rego Park. That is significant because Rego Park pharmacists have been snared for fraud in the past. Most recently, federal prosecutors busted Rego Park’s ASA Pharmacy for taking part in a $2.5 million kickback scheme.

Currently there are thirteen Rego Park medical service providers who have been banned from participating in Medicaid.

Welfare cheats busted

From the NY Post:

Five former Brooklyn residents were charged with welfare fraud and grand larceny after falsely claiming they still lived in the borough so that they could collect city Medicaid benefits for years, authorities said yesterday.

The two couples and one woman -- who collected a total of $114,000 in Medicaid benefits -- also hid ownership of homes and other assets on applications for Medicaid, which is earmarked for poor people, the Brooklyn District Attorney's Office said.

They face up to seven years in prison if convicted.

One couple, Fouad Fouad, 47, and his wife Nevertity Ibrahim, 39, previously lived in a Dyker Heights apartment, Hynes' office said. But in late 2005, the couple bought a home in Milltown, NJ, for $273,000 and moved there.

Despite that, after receiving a recertification form from the city Human Resources Administration that had been mailed to their old address, the couple claimed they still lived in Brooklyn, and that their only income was the $300 per week Fouad said he earned as a taxi driver, the DA said.

In reality, the couple also had income from two rental properties they owned in South Amboy, NJ, the DA said.

Prosecutors said the couple would travel to a Staten Island hospital for treatments that included a broken rib by Fouad, and a high fever by their child. Between early 2006 and late 2010, the couple claimed $71,704 in Medicaid benefits to which they were not entitled, an indictment charges.

The other married couple, Tau Sing Chow, 47, and Yue Hao Zhou, 37, allegedly collected $26,449 in Medicaid benefits for themselves and their two kids from 2006 until 2010 by falsely claiming they still lived in Bensonhurst after moving into a $120,000 home in Philadelphia in 2006, authorities said. Chow had also applied for welfare benefits in Philadelphia but was turned down because of his $30,000 in income as a supermarket chef, prosecutors said.

Clamping down on Medicaid fraud

From the NY Post:

The number of suspected Medicaid-fraud cases handled by state investigators -- ranging from dirty dentists and druggists to millionaires illegally on the dole -- more than doubled last year, according to an explosive new report.

The state Office of Medicaid Inspector General referred 208 cases to Attorney General Andrew Cuomo's office for potential criminal prosecution of health-care providers -- a 136 percent increase from 2008.

Meanwhile, the number of suspected cases of Medicaid-patient fraud referred to local prosecutors also skyrocketed.

For example, the number of suspected forgeries tied to the diversion of prescription drugs jumped from 304 to 683.

Overall, the number of substantiated fraud cases involving Medicaid patients increased 50 percent, the report said. A total of 552 cases were referred to New York City investigators for potential prosecution, the report said.

$40M in dental Medicaid fraud

From the Daily News:

New Yorkers are taking it on the chin for bad dental bills.

The state's Medicaid program paid out $40 million for excessive dental cleanings and examinations over five years, according to an audit out today from state Controller Thomas DiNapoli.

One dental clinic got paid for 79 exams given to one patient over four years, according to the audit, a copy of which was obtained by the Daily News.

The law allows only eight exams over four years.

Other findings included a dentist who billed taxpayers for 18 cleanings for one patient over five years and a patient who received 32 cleanings from 19 separate dentists over three years.

The latest crooked pol roundup: Espada, Smith, Parker & the Boylands

From the Daily News:

Senate President Malcolm Smith ripped off an elderly Queens couple he'd promised to build a dream house for in a land deal under scrutiny by the FBI, the Daily News has learned.

Cora Wheeling, 70, and her husband, Eddie, 71, wound up with no home to show for the $88,200 they put down toward a split-level Smith claimed he'd build them.

They sued in 1998; Smith still owes them more than $60,000.

"I didn't know he's a rat," an irate Cora Wheeling said. "I should have known better."

The house was supposed to be part of a subdivision Smith was trying to build on 230th St. in Cambria Heights. That deal is at the center of an expanding federal probe, sources said.

The FBI is also looking at why Smith got a steep discount from an architect hired for a job at that same address. The architect then got work at nonprofits Smith has funded with taxpayer dollars.

Investigators want to know if Smith used his influence as an elected official to benefit himself financially, a possibly criminal conflict of interest.

From the NY Post:

A do-nothing Brooklyn charity created with the help of state Sen. Kevin Parker used most of the $18,750 in taxpayer funds he steered to it to hire the brother of his chief-of-staff as a "planning consultant."

The only community program the Building Blocks Local Development Corp. managed to implement since it was created in 2004 was a part-time vegetable stand staffed by local teens at a farmers market on Nostrand Avenue in Brooklyn.

Parker has been uncharacteristically mum on Building Blocks, which has no office or discernible staff and only sporadically filed IRS forms designed to provide accountability of its spending.

That didn't stop Parker from trying to fund the organization -- authorizing $75,000 in pork-barrel money in five separate member-item grants since 2004.

From the NY Post:

A hospital group linked to an influence-peddling scandal in Albany put three members of a prominent family of Brooklyn politicians on its payroll, records and e-mails obtained by The Post show.

Prosecutors say MediSys Health Network, which runs Jamaica, Flushing and Brookdale hospitals and other ventures, gave $390,000 in "corrupt payments" to crooked ex-Assemblyman Anthony Seminerio's bogus consulting firm for help with government funding and acquisition of hospitals.

It also paid three members of the Boyland family, a force in central Brooklyn politics for decades:

* Assemblyman William F. Boyland Jr., a Democrat who represents Brownsville, was a "patient recruiter" for the MediSys-managed Brookdale Medical Center for years while helping the hospitals get state grants and lobbying for the network.

* His father, former Assemblyman William F. Boyland Sr., spent years on Brookdale's payroll, doing "public outreach."

"I improved the image of the hospital and tried to get patients to go there," he told The Post. He said he "retired" last June, the same month Seminerio pleaded guilty to fraud.

* Boyland Jr.'s sister, former City Councilwoman Tracy Boyland, helped Brookdale get $2.6 million in grants when she represented Brownsville. After leaving office in 2005, she was hired by Neighborhood Health Providers, a MediSys health-insurance company. She did not return calls.

The US Attorney's Office said only that its probe stemming from the Seminerio case is ongoing.

From the NY Post:

State Senate Majority Leader Pedro Espada Jr., already slapped with two lawsuits over alleged corruption at his Bronx health centers, may still be on the hot seat for Medicaid fraud.

State Attorney General Andrew Cuomo's Medicaid Fraud Control Unit asked for patient records from the Bronx Democrat's Soundview HealthCare Network, according to an October letter sent to Espada and included in court records.

The letter requests the "entire treatment history" and original charts for 259 patients.

One of those patients, Alfreda Alston, 54, of The Bronx, made repeated trips to the Soundview dental clinic over a year -- all paid for through Medicaid. Despite X-rays and exams, the staff could find nothing wrong with Alston's aching tooth, according to her daughter, Alfreda Jones.

Alston finally went to another dentist who fixed the ailment with a simple extraction.

LI developer defrauded Medicaid

Prosecutor: Wealthy LI couple stole $33G from Medicaid
AP

MINEOLA, N.Y. — Prosecutors have charged a wealthy Long Island couple with stealing more than $33,000 in Medicaid benefits while living in luxury.

Nassau County District Attorney Kathleen Rice says the Old Westbury couple owned their own real estate development company and lived in million-dollar homes.

Daniel and Dalia Mairzadeh were facing arraignment Wednesday on grand larceny, welfare fraud and other charges. Their attorney did not immediately respond to a call for comment.

Rice says the couple intentionally underreported their personal income to Social Services so that they would qualify for Medicaid benefits.

She adds that in 2006, the couple sold their home for over $1 million and bought a new one for over $2 million. They could face seven years in prison if convicted.

Bums' free rides costing us big time

From the NY Post:

These bums are costing you a fortune.

Ricky Alardo, a homeless alcoholic nicknamed Ricky Ricardo, swigs cheap vodka by day at his favorite corner in Washington Heights, then calls an ambulance to chauffeur him to the hospital for a free meal and a warm place to sleep, courtesy of taxpayers who fund his Medicaid benefits.

For a chronic caller like Alardo -- who phones 911 four or five times a week -- the annual medical bill can be as high as $300,000. Over 13 years, the length of time he has been abusing the emergency room, he has cost the medical system an estimated $3.9 million.

In Midtown, another bum, Robert, has faked emergencies to get food and shelter in ERs about 40 or 50 times in the past three years -- and taxpayers pick up his tab, too.

Ricky and Robert are among the dozens of "frequent fliers" who clog the 911 system, tie up city ambulances, crowd emergency rooms and burn through Medicaid money.

Living the good life while on welfare

From the NY Post:

The number of people caught as welfare and Medicaid cheats in New York City skyrocketed by 45 percent last year, potentially costing taxpayers millions in fraudulent claims, figures obtained by The Post show.

Individuals nailed for gaming the system surged to 28,335 in 2008 from 19,476 the year before, according to the city Human Resources Administration.

A new Medicaid-fraud unit alone nabbed 10,379 cheaters.

Rita Mitilis, 37, was one of the scammers arrested earlier this month. She lived in a home worth more than $1 million and owned several luxury cars while receiving thousands in Medicaid benefits, Brooklyn prosecutors said.

Mitilis hid a bank account balance of $400,000 while she claimed more than $60,000 in Medicaid benefits for medical care for herself, her husband and her four children, according to investigators.

In addition to her home, she owns two rental properties in Brooklyn and two vacant lots in Florida as well as a commercial glass distribution business, Odyssey Glass and Storefront Inc., authorities said.