Florida Health Fraud Uncovered

A federal jury in Miami late yesterday convicted the former medical director of, and three therapists employed by this health care provider of conspiracy to commit health care fraud and related charges for their roles in a scheme to fraudulently bill Medicare and Florida Medicaid more than $63 million.

Roger Rousseau, 73, of Miami; Doris Crabtree, 62, of Miami; Angela Salafia, 68, of Miami Beach, Florida; and Liliana Marks, 48, of Homestead, Florida, were found guilty of conspiracy to commit health care fraud.  In addition, Rousseau was convicted of two counts of health care fraud.  Sentencing is scheduled for Nov. 6, 2015, before U.S. District Judge Robert N. Scola Jr. of the Southern District of Florida.

Rousseau was the former medical director of Health Care Solutions Network Inc. (HCSN), a now-closed partial hospitalization program (PHP) that purported to provide intensive treatment for mental illness.  Crabtree, Salafia and Marks were therapists who worked for HCSN.

According to the evidence presented at trial, from approximately 2004 through 2011, HCSN billed Medicare and Medicaid for mental health services that were not medically necessary or never provided, and that HCSN paid kickbacks to assisted living facility owners and operators in Miami who, in exchange, referred beneficiaries to HCSN.

The trial evidence showed that Rousseau routinely signed what he knew to be fabricated and altered medical records without reviewing the substance of the records and, in most instances, without ever meeting with the patients.  The evidence at trial also demonstrated that Crabtree, Salafia and Marks fabricated medical records to support HCSN’s false and fraudulent claims for reimbursement for PHP services.

In total, HCSN submitted approximately $63.7 million in false and fraudulent claims to Medicare and Medicaid.  Medicare and Medicaid paid approximately $28 million on those claims.

In November 2014, following a jury trial, co-defendants Blanca Ruiz and Alina Fonts were convicted of conspiracy to commit health care fraud, and Fonts also was convicted of health care fraud.  In February 2015, both Ruiz and Fonts were sentenced to serve six years in prison.

This information provided on the US Dept. of Justice website

Adventist Healthcare Admits Guilt For ViolatingFalse Claims Act

Adventist Health System Sunbelt Healthcare Corporation (Adventist) has agreed to pay $5,412,502 to resolve claims that it violated the False Claims Act by providing radiation oncology services to Medicare and TRICARE beneficiaries that were not directly supervised by radiation oncologists or similarly qualified persons, the Department of Justice announced.  Adventist is a non-profit healthcare organization operating a large network of hospitals in the South and the Midwest, and doing business in Florida as Florida Hospital.         

“The settlement demonstrates our continued vigilance to ensure that federal health care beneficiaries receive the highest quality of patient care,” said Acting Assistant Attorney General Benjamin C. Mizer of the Justice Department’s Civil Division.  “It is critical that health care providers adequately supervise the services they provide to their patients.”

Radiation oncology services provided to patients served by Medicare and TRICARE, the Department of Defense’s health care program, must be directly supervised by a radiation oncologist or similarly qualified personnel.  The United States alleged that, from Jan. 1, 2010, through Dec. 31, 2013, Adventist violated this supervision requirement for radiation oncology services provided to federal health care program beneficiaries at several Florida locations, including in Altamonte Springs, Daytona Beach, Deland, Kissimmee, Orange City, Orlando, Palm Coast and Winter Park.  These services included radiation simulation, dosimetry, radiation treatment delivery and devices, and intensity-modulated radiation therapy.

“Medicare and TRICARE patients deserve high quality health care,” said U.S. Attorney A. Lee Bentley III of the Middle District of Florida.  “We will not tolerate providers recklessly cutting corners, particularly when furnishing such critical medical services as radiation oncology.”
The settlement partially resolves allegations made in a qui tam lawsuit under the False Claims Act filed in Tampa, Florida, by Dr. Michael Montejo, a radiation oncologist and former employee of Florida Oncology Network P.A., a radiation oncology group.  The act permits private individuals to sue on behalf of the government for false claims and to share in any recovery.  Dr. Montejo will receive $1,082,500 as his share of the recovery. 

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Eight Car Makers Join in the Recall of Exploding Airbags



When designed correctly, airbags will save lives. According to the National Highway and Traffic Safety Administration, airbags have saved approximately 35,000 lives since 1987. However, when airbags are defectively designed, they create a high risk of severe injury and death. As of 2009, defective airbags were responsible for 296 deaths, 59 life threatening injuries, and countless severe injuries.

Signs that you have  defective airbags are when one of the following occurs:

• The airbag inflates too quickly and aggressively, violently hitting the occupant in the face; or

• The airbag ruptures before inflation, spewing pieces of metal into the occupant’s body.
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NHTSA has opened an investigation into the issue and says that it knows of six incidents of ruptured bags and three injuries in high-humidity Florida and Puerto Rico. As of mid-July, eight car manufacturers including Honda, Mazda, Nissan, Toyota, BMW, Chrysler, Ford, and Subaru had joined in the recall of these defective Takata airbags. In the latest actions:

• Honda recalled 1.02 million vehicles in North America and 2.03 million worldwide. They were built from 2000 through 2005 and include some models of Civic, CR-V, Odyssey and Element. With this expansion, air bag recalls have affected nearly 4 million of the company’s older vehicles in North America.

• Nissan recalled 755,000 vehicles worldwide built from 2001 through 2003, with about a quarter-million Pathfinder, Cube and Infiniti FX35 models in North America.

• Mazda recalled nearly 160,000 vehicles made from 2002 through 2004, with about 15,000 in North America, including RX-8 and early Mazda6 sedans.

• Regional recalls in the U.S. by Honda, Nissan, Mazda, Toyota, BMW, Ford and Chrysler of certain vehicles in humid climates. NHTSA estimates that 1.5 million vehicles could be affected — the totals and lists of vehicles still were being compiled.

• Subaru is recalling nearly 8,600 Subaru Legacy cars, Outback wagons, Baja crossovers, and Impreza cars.

Since 2008, more than 10 million cars containing the defective Takata airbags have been recalled.