MILKING THE SYSTEM: WELFARE FRAUD

DOJ PRESS RELEASE: Houston Physician Convicted of Conspiracy in $1.5 Million Medicare Fraud Scheme
PRESS RELEASE ISSUED 7/ 21/ 17

A federal jury convicted a Houston physician today for his role in a scheme involving approximately $1.5 million in fraudulent Medicare claims for home health care services and various medical testing and services.
Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Abe Martinez of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services-Office of Inspector General’s (HHS-OIG) Dallas Region and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.
After a four-day trial, Ronald F. Kahn, M.D., 62, of Harris County, Texas, was convicted of one count of conspiracy to commit health care fraud and one count of conspiracy to pay and receive illegal kickbacks. Sentencing has been scheduled for September 25, before U.S. District Judge Kenneth M. Hoyt, who presided over the trial.
According to evidence presented at trial, from approximately 2006 until 2013, Kahn and others engaged in a scheme to defraud Medicare out of approximately $1.5 million in fraudulent claims for home heath care services in connection with Allied Covenant Home Health, Inc., a Houston home healthcare agency (Allied).  Kahn fraudulently admitted patients for home health care with Allied when they did not qualify for such services, the evidence showed. To make it appear that these patients did qualify, Kahn falsified medical records and signed false documents purporting to show that patients admitted to Allied’s home health program satisfied Medicare’s requirements for admission, the evidence showed.
The evidence also showed that Kahn paid illegal kickbacks for patients from Harris Health Care Group, a Houston medical clinic (Harris). Kahn paid illegal kickbacks to the owner of Harris in order to bill Medicare for facet injections that were medically unnecessary, not provided or both, the evidence showed.
The case was investigated by the FBI, HHS-OIG and Texas MFCU, and was brought as part of the Medicare 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 Chief Ashlee McFarlane and Trial Attorney Scott Armstrong of the Fraud Section.
 The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative 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 nationwide.  Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion.

 DOJ PRESS RELEASE: Social Security Disability Lawyer Sentenced to 12 Years in Prison for Role in More Than $550 Million Social Security Fraud Scheme
PRESS RELEASE ISSUED 7/ 14/ 17

A social security disability lawyer was sentenced today in federal court for his role in a scheme to fraudulently obtain more than $550 million in federal disability payments from the Social Security Administration (SSA) for thousands of claimants.

Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division; Special Agent in Charge Michael McGill of the Social Security Administration-Office of Inspector General’s (SSA-OIG) Philadelphia Field Division; Special Agent in Charge Amy S. Hess of the FBI’s Louisville, Kentucky Field Division; Special Agent in Charge Tracey D. Montaño of the Internal Revenue Service Criminal Investigation (IRS-CI) Nashville, Tennessee, Field Office; and Special Agent in Charge Derrick L. Jackson of the U.S. Department of Health and Human Services-Office of the Inspector General (HHS-OIG) Atlanta Regional Office made the announcement.
Eric Christopher Conn, 56, of Pikeville, Kentucky, was sentenced by U.S. District Judge Danny C. Reeves of the Eastern District of Kentucky to 12 years in prison, and to pay restitution in an amount in excess of $106 million to the SSA and HHS. Conn pleaded guilty to one count of theft of government money and one count of payment of gratuities. On June 2, Conn fled from federal custody and remains a fugitive. He was not present for his sentencing hearing.
According to the plea, from October 2004 to April 6, 2016, Conn participated in a scheme with former SSA administrative law judge David B. Daugherty and multiple doctors that involved the submission of thousands of falsified medical documents to the SSA. As a result of the scheme, Conn and his co-conspirators obligated the SSA to pay more than $550 million in lifetime benefits to claimants for these fraudulent submissions.
According to the plea, Conn is an attorney whose firm in Floyd County, Kentucky, focused for more than 20 years primarily on representing individuals seeking Social Security disability benefits throughout Kentucky and elsewhere. According to documents filed in connection with the guilty plea, Conn admitted that from December 2004 through April 2011, he paid Daugherty approximately $10,000 a month to award disability benefits to claimants for whom Conn submitted falsified medical documents.
As part of his plea, Conn admitted that he submitted the falsified medical documents, and Daugherty authored decisions granting disability benefits, in well over 1,700 claimants’ cases. Conn admitted that he paid medical professionals to sign medical forms that he fabricated before evaluations of claimants took place. According to the plea, Conn routinely prepared and medical professionals, such as clinical psychologist Alfred Bradley Adkins, signed evaluation reports indicating that claimants had limitations considered disabling by the SSA, irrespective of the claimants’ actual physical or mental conditions. Conn admitted that he received more than $5.7 million in representative fees from the SSA based upon these fraudulent claims.
Conn was indicted last year, along with Daugherty and Adkins. They were charged with conspiracy, fraud, false statements, money laundering and other related offenses in connection with the scheme, and that indictment remains pending. An indictment is merely an allegation and all defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.
Daugherty pleaded guilty on May 12 to a two-count information charging him with receipt of illegal gratuities. On June 12, Adkins was convicted after a jury trial of one count of conspiracy to commit mail fraud and wire fraud, one count of mail fraud, one count of wire fraud and one count of making false statements. Both Daugherty and Adkins are awaiting sentencing.
The SSA-OIG, FBI, IRS-CI and HHS-OIG are investigating the case. Trial Attorney Dustin M. Davis of the Criminal Division’s Fraud Section and Trial Attorney Elizabeth G. Wright of the Criminal Division’s Money Laundering and Asset Recovery Section are prosecuting the case, with previous co-counsel including Assistant U.S. Attorney Trey Alford of the Western District of Missouri and Investigative Counsel Kristen M. Warden of the Justice Department’s Office of the Inspector General. ( our focus report on welfare fraud continues on page 2)