New Orleans, Louisiana - Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division announced Wednesday an expansive health care fraud enforcement operation across the Gulf Coast, involving charges against a total of 11 individuals across four federal districts for their alleged involvement in various schemes to defraud Medicare, Medicaid and TRICARE and to obtain oxycodone and other controlled substances by fraud.
The conduct allegedly resulted in more than $515 million in fraudulent billings. Those charged included physicians, licensed social workers, as well as other medical and business professionals. In addition, in the state of Louisiana, 22 defendants, including 19 certified mental and home health professionals, have been charged with defrauding Medicaid out of approximately $300,000. These cases were investigated by Louisiana’s Medicaid Fraud Control Unit (MFCU).
Today’s enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section in conjunction with its Medicare Fraud Strike Force (MFSF) partners, a partnership among the Criminal Division, U.S. Attorney’s Offices, the FBI, the Drug Enforcement Administration (DEA), and U.S. Health and Human Services-Office of Inspector General (HHS-OIG). In addition, the operation includes the participation of IRS-Criminal Investigations (IRS-CI), Mississippi Bureau of Narcotics (MBN) and various other federal law enforcement agencies and state MFCUs.
The charges announced today aggressively target alleged schemes billing Medicare, Medicaid, TRICARE (a health insurance program for members and veterans of the armed forces and their families) and private insurance companies for medically unnecessary services, such as psychotherapy and other behavioral health services, and items, including durable medical equipment and compounded medications.
“Fraud against our nation’s vital federal health care programs amounts to theft from American taxpayers,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “The Department of Justice, together with our law enforcement partners, will continue to investigate and prosecute aggressively those who bill these programs for medically unnecessary services, whether in the Gulf Coast or elsewhere in the United States.”
“Health care fraud steals valuable resources from those truly in need and tarnishes the hard-earned respect of honest health care providers who deliver legitimate health care for their fellow Americans every day,” said U.S. Attorney Brandon J. Fremin of the Middle District of Louisiana. “It is especially egregious when carried out by health care professionals who are betraying the trust given them by the community. As demonstrated by this takedown, this office remains committed to working with our outstanding partners in the Strike Force including federal, state, and local law enforcement and prosecutors in Louisiana and throughout the country to aggressively pursue those who defraud our health care systems. Our message is consistent: we will bring every available resource to bear in seeking justice through investigations and convictions of those who commit health care fraud. I want to commend the hard work of all who have been instrumental in this nationwide effort.”
“The charges announced today reinforce The U.S. Department of Justice’s mission to aggressively pursue those individuals and medical providers who attempt to prey on our most vulnerable citizens,” said U.S. Attorney Peter G. Strasser of the Eastern District of Louisiana. “Our office, along with our law enforcement partners, will continue to seek justice for those impacted by Health Care Fraud schemes.”
“Law enforcement works tirelessly to detect health care fraud, and we will continue to use every lawful tool at our disposal to prosecute those who defraud public programs of their limited funds,” said U.S. Attorney Lawrence Keefe of the Northern District of Florida. “This indictment is the next step in holding these two defendants accountable for their actions.”
“Healthcare fraud harms us all," said U.S. Attorney Mike Hurst of the Southern District of Mississippi. "When individuals put their greed above the interests and well-being of our men and women in uniform and our veterans, this office will be there to swiftly bring them to justice.”
“Medicaid welfare fraud not only jeopardizes resources from our most needy but it also steals from our taxpayers,” said Louisiana Attorney General Jeff Landry. “So I applaud my Medicaid Fraud Control Unit and our law enforcement partners for their efforts to find, arrest and prosecute Medicaid welfare fraudsters.”
“Healthcare Fraud continues to impact the cost of healthcare in America and is amplified when trusted professionals abandon their ethical code in the name of greed. These unethical practices are damaging the lives of individuals and families throughout this country,” said Special Agent in Charge Thomas J. Holloman for the IRS-CI Atlanta Field Office. “Medical professionals who illegally dispense prescription narcotics are no better than street level drug dealers and must be held accountable for their actions, therefore IRS-CI
will continue to work with our law enforcement partners and the US Attorney's Office to address these public challenges.”
“Healthcare fraud harms patients and diverts taxpayer funds from vitally important federal healthcare programs that exist for the sole purpose of providing care to beneficiaries with medical needs,” said Special Agent in Charge C.J. Porter of the HHS-OIG Dallas Region. “As this takedown demonstrates, we will continue to work with our law enforcement partners to crack down on and bring to justice those who disregard the medical needs of patients and betray the public’s trust for their own personal enrichment.”
“Along with our partners, the FBI has dedicated significant time, manpower, and resources toward investigating criminal enterprises engaged in defrauding Medicare, Medicaid, private insurance companies and prescription drug schemes,” said Special Agent in Charge Bryan Vorndran of the FBI’s New Orleans Field Office. “Organizations or individuals providing dangerous and unnecessary medical services to any citizen and billing fraudulently is unacceptable and will continue to be high priority investigations of the FBI. The illegal prescribing and dispensing of oxycodone and other controlled substances for distribution to citizens who battle addiction will not be tolerated and adds to the escalating opioid epidemic in this country.”
“The Defense Criminal Investigative Service, with our investigative partners, is committed to thoroughly investigate and bring to justice anyone who defrauds TRICARE or endangers our nation's brave soldiers, sailors, airmen, marines, retirees and military families,” said Special Agent in Charge Cynthia Bruce of the DCIS Southeast Field Office. “Our agency is stepping up our efforts to combat the opioid problem facing our nation. These complex and expansive fraud schemes diverted significant taxpayer funds that should be spent on critical medical care.”
Among those charged in partnership between Strike Force attorneys and U.S. Attorney’s Offices are the following:
In the Southern District of Mississippi, three defendants have been charged.
Wade Ashley Walters, 52, of Hattiesburg, Mississippi, a co-owner of numerous compounding pharmacies and pharmaceutical marketing companies, was charged for his alleged role in a scheme to defraud TRICARE and other private health insurance companies by paying kickbacks to practitioners and marketers for the prescribing and referring of fraudulent prescriptions for medically unnecessary compounded medications that were ultimately dispensed by his pharmacies, as well as for his alleged role in a scheme to launder the proceeds of the fraud scheme. The indictment alleges that, based on these fraudulent prescriptions, Walters caused TRICARE and other health care benefit programs to reimburse his and other compounding pharmacies more than $510 million. The case is being prosecuted by Assistant Deputy Chief Dustin Davis and Trial Attorney Sara Porter of the Fraud Section, Trial Attorneys Amanda Wick and Stephanie Williamson of the Criminal Division’s Money Laundering and Asset Recovery Section and Assistant U.S. Attorney Mary Helen Wall of the Southern District of Mississippi.
Gregory Auzenne, M.D., 49, of Meridian, Mississippi, and Tiffany Clark, 45, of Meridian, Mississippi, were charged for their alleged participation in a scheme to defraud TRICARE and other private health insurance companies by prescribing medically unnecessary compounded medications in exchange for kickbacks and bribes. The indictment alleges that Auzenne and Clark caused the submission of over $1.6 million in fraudulent claims to TRICARE. The case is being prosecuted by Trial Attorneys Jared Hasten and Sara Porter of the Fraud Section and Assistant U.S. Attorney Mary Helen Wall.
In the Middle District of Louisiana, four defendants have been charged.
J. Foster Chapman, D.O., 40, of Alexandria, Louisiana, was charged for his alleged participation in a scheme to prescribe medically unnecessary durable medical equipment, namely orthotics, to Medicare beneficiaries whom he never examined and in the absence of any doctor-patient relationship. According to the indictment, Chapman concealed the fraud with falsified orders that stated, among other things, that he consulted with the beneficiaries and conducted diagnostic tests, which were not conducted. The indictment alleges that Chapman caused the submission of over $4.8 million in fraudulent claims to Medicare. The case is being prosecuted by Trial Attorney Justin M. Woodard of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Kristen L. Craig of the Middle District of Louisiana.
Victor Clark Kirk, 70, of Baton Rouge, Louisiana, and Marilyn Brown Antwine, 51, of Baton Rouge, Louisiana, the former CEO and COO, respectively, of a federally qualified health center, were charged for their alleged roles in a scheme to defraud Medicaid. Specifically, the indictment alleges that Kirk and Antwine directed employees to falsely diagnose students with significant mental health disorders and subsequently submit false claims to Medicaid falsely claiming that psychotherapy services were provided, when in fact they were not. According to the indictment, during the relevant time period, the health center’s claims for purported group psychotherapy services totaled more than $1.8 million. The case is being prosecuted by Trial Attorney Justin M. Woodard and Assistant U.S. Attorney Jessica M.P. Thornhill of the Middle District of Louisiana.
In the Eastern District of Louisiana, three defendants have been charged.
Aaron Denn, 34, of Metairie, Louisiana, was charged for his alleged role in a scheme to obtain and divert oxycodone pills to the black market. The case is being prosecuted by Trial Attorney Jared Hasten.
Christie Lynn Browning, 40, of Metairie, Louisiana, was charged for her alleged role in a conspiracy to obtain oxycodone by fraud and to then distribute those oxycodone pills. The case is being prosecuted by Trial Attorney Jared Hasten and Assistant U.S. Attorney Myles Ranier of the Eastern District of Louisiana.
In the Northern District of Florida, two defendants have been charged.
Helen Elizabeth Storey, 37, of Tallahassee, Florida, and Stephanie Lynn Fleming, 42, of Tallahassee, Florida, the owner of, and a licensed mental health counselor at, a Tallahassee-based counseling center, were charged for their alleged participation in a scheme to defraud Medicaid by submitting false and fraudulent claims for purported behavioral health services, including psychotherapy, that were not provided. According to the indictment, Fleming and Storey submitted approximately $250,000 in false and fraudulent claims to Medicaid. The case is being prosecuted by Assistant U.S. Attorney Justin Keen of the Northern District of Florida.
The charges and allegations contained in the indictments are merely accusations. The defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
The Fraud Section leads the Medicare Fraud Strike Force (MFSF), 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. Since its inception in March 2007, MFSF maintains 15 strike forces operating in 24 districts and has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion. In addition, HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.