The owner of two California-based hospice companies and his biller/consultant have been sentenced to one year and a day in prison each for their roles in a $9 million hospice fraud scheme. In addition, Gayk Akhsharumov, the owner of San Gabriel Hospice and Palliative Care Inc. and Broadway Hospice Inc., was ordered to pay nearly $9.2 million in restitution; Karen Sarkisyan aka Kevin Sarkisyan was ordered to pay nearly $3.7 million in restitution in this hospice fraud scheme. The Healthcare Fraud Scheme According to court documents, Akhsharumov hid his ownership and control of the two hospices ..read more

“If your company has had a recent brush with the law, now is the time to invest — and reinvest — in your compliance programs.” That was one of the messages delivered recently by Deputy Attorney General Lisa Monaco, at the American Bar Association’s 39th National Institute on White Collar Crime. Monaco said that as her agency investigates more complex schemes, they are devoting more resources to cracking down on corporate crime – including healthcare fraud. Whistleblower Program Incentives As part of that crackdown, Monaco announced that the U.S. Department of Justice (DOJ) will be expanding t ..read more

A Missouri laboratory and its three owners have been ordered to pay more than $13.6 million to settle charges they violated the False Claims Act – the federal government’s primary tool for civil enforcement. Jerry, Jerrod and Joel W. Murphy, owners of Gamma Healthcare Inc., were accused of submitting false claims to Medicare for lab tests that were not ordered by healthcare providers and were not medically necessary. In addition to the monetary penalty, Jerry (CEO) and Jerrod (President) are excluded from participating in Medicare, Medicaid, and all other federal healthcare programs for 15 ye ..read more

A former Georgia nurse practitioner, who with her husband owned two telemedicine and two durable medical equipment companies (DME), faces up to 20 years in prison for her role in a Medicare kickback conspiracy that bilked Medicare out of $136 million. Earlier this month, Jean Wilson pleaded guilty to conspiracy to commit healthcare fraud and wire fraud. In addition to the prison sentence, she agreed to pay more than $66 million in restitution to Medicare and the IRS. Sentencing is set for July 18. Husband and Wife Indicted in Illegal Medicare Kickback Scheme According to court documents, Wils ..read more

The former owner of a Fresno, Calif. sleep clinic who faced up to 12 years behind bars for his part in a Medicare fraud scheme has been sentenced to just 19 months in prison following a plea deal. Fraudulent Claims Uncovered: Inside the Medicare Scandal Between March 2018 and September 2021 Travis Gober, owner of the VIP Sleep Clinic, submitted nearly $1 million in fraudulent claims to Medicare for sleep studies that were never performed, according to the original complaint. In some instances, the Medicare beneficiaries were deceased. In other instances, the Medicare recipients who received s ..read more

A New York doctor has been charged in a superseding indictment in connection with an alleged genetic cancer screening and COVID-19 testing scam. Such an indictment adds information or evidence, as well as charges or defendants to an existing case. Alexander Baldonado of Queens was indicted on charges he engaged in a genetic testing and COVID-19 healthcare fraud and illegal kickback scheme involving the submission of more than $20.7 million in fraudulent claims to Medicare for laboratory tests. He originally was charged as part of a coordinated law enforcement action in May 2021 that involved ..read more

The False Claims Act (FCA), the federal government’s primary tool for civil enforcement, is resulting in record returns. The U.S. Department of Justice reported 543 settlements and judgments, recovering $2.68 billion in the fiscal year ending Sept. 30, 2023. Of that, more than $1.8 billion related to matters involving the healthcare industry, including managed care providers, hospitals, pharmacies, laboratories, long-term acute care facilities and physicians. Comparatively speaking, for FY 2022, recoveries surpassed $2.2 billion, with $1.7 billion related to matters involving the healthcare i ..read more

The owner of a home healthcare company who was convicted last September for orchestrating a $2.8 million healthcare fraud and wire fraud conspiracy, and engaging in money laundering, aggravated identity theft, and witness tampering, has been sentenced to nine years in prison. Indian national Yogesh K. Pancholi of Michigan owned and operated Shring Home Care Inc. He purchased the company using the identify of others because in 2017, he had entered into a voluntary settlement agreement which excluded him from billing Medicare and Medicaid. False Claims and Kickbacks According to an investigatio ..read more

A Long Island man who impersonated an NBA player and others to further his complex healthcare insurance fraud scheme has been sentenced to 12 years in prison and ordered to pay restitution of $337 million and forfeit $63 million.  Mathew James engaged in a years-long healthcare and insurance fraud scheme in which he and his co-conspirators, including physicians throughout the country, defrauded multiple health insurance companies out of more than $600 million. He was convicted in July 2022 of conspiracy to commit healthcare fraud, healthcare fraud, three counts of wire fraud, and three c ..read more

A California man with a long history of healthcare fraud was sentenced to 10 years behind bars and ordered to pay millions in restitution as well as forfeit his interest in two residential properties and one business property in Los Angeles. His wife, who will be sentenced later this month. Imran Shams pleaded guilty to conspiracy to commit healthcare fraud and concealment of his exclusion from Medicare. But the charges are just the tip of the iceberg. Serial Healthcare Fraudster According to court documents, Shams was convicted of Medicare and Medicaid fraud in separate 1990 and 2001 cases in ..read more