Friday, September 27, 2019

U.S. Attorney McSwain Announces Charges As Part Of Federal Health Care Fraud Takedown In Northeastern United States

The U.S. Justice Department released the below information:
PHILADELPHIA – United States Attorney William M. McSwain joined fellow Justice Department officials today at a press conference to announce a coordinated health care fraud enforcement action across seven federal districts involving more than $800 million in loss and the distribution of over 3.25 million opioid pills in “pill mill” clinics. The takedown includes new charges against 48 defendants for their roles in submitting over $160 million in fraudulent claims. Of those 48 defendants, 15 are doctors or medical professionals, and at least 24 defendants were charged for their roles in diverting opioids. In the Eastern District of Pennsylvania, 17 defendants (five of whom are doctors or medical professionals) were arrested, and the conduct involved submission of more than $4 million in fraudulent claims and distribution of approximately 738,000 oxycodone pills to the streets of this District.
Today’s announcement comes one year after the Department of Justice announced the formation of the Newark/Philadelphia Regional Medicare Fraud Strike Force, a joint law enforcement effort that brings together the resources and expertise of the Health Care Fraud Unit in the Criminal Division’s Fraud Section, and the U.S. Attorney’s Offices for the Eastern District of Pennsylvania and the District of New Jersey. The Strike Force focuses its efforts on aggressively investigating and prosecuting complex cases involving patient harm, large financial loss, and the illegal prescribing and distribution of opioids and other dangerous narcotics.
“As today’s takedown demonstrates, this Strike Force has produced precisely what we hoped it would – and by that I mean tangible results,” said U.S. Attorney McSwain. “We have brought together a wealth of resources, knowledge, and subject-matter expertise – that of health care fraud prosecutors, civil enforcement attorneys, data analysts, and law enforcement agencies – all working to stop fraud, waste, and abuse within our federal health care programs and to stem the tide of illegal opioid distribution. These are top priorities of the Department of Justice and of my Office, and our focus in this area continues to pay off.”
At the press conference, U.S. Attorney McSwain announced details about the following cases charged in the Eastern District of Pennsylvania:
Timothy F. Shawl, M.D., 60, of Garnet Valley, PA, a medical doctor, was charged with five counts of unlawful distribution of controlled substances. He allegedly wrote prescriptions for controlled substances that were outside the usual course of professional practice and not for a legitimate medical purpose. As alleged in the indictment, Shawl wrote prescriptions for controlled substances for patients without seeing, treating, or examining them. Shawl allegedly prescribed hundreds of prescriptions for oxycodone to approximately 16 patients, amounting to over 29,000 oxycodone tablets. The Federal Bureau of Investigation (FBI) conducted the investigation. The case is being prosecuted by Trial Attorney Debra Jaroslawicz of the DOJ Fraud Section.
The second case involves defendants Neil K. Anand, M.D., 42, of Bensalem, PA, and Asif Kundi, 31, Atif Mahmood Malik, 34, and Viktoriya Makarova, 33, all of Philadelphia, PA. Anand, a medical doctor, Kundi and Malik, unlicensed foreign medical school graduates, and Makarova, a nurse practitioner, were each indicted on one count of health care fraud and one count of conspiracy to distribute controlled substances. The charges stem from the defendants’ alleged submission of false and fraudulent claims to Medicare, health plans provided by the United States Office of Personnel Management (OPM), and Independence Blue Cross (IBC). The claims allegedly were for “Goody Bags,” which were stuffed with medically unnecessary prescription medications that were dispensed by non-pharmacy dispensing sites owned by Anand. In total, Medicare, OPM, and IBC allegedly paid over $4 million for the Goody Bags. Patients were allegedly required to take the Goody Bags in order to receive prescriptions for controlled substances.
According to the indictment, Malik and Kundi wrote prescriptions for controlled substances using blank prescriptions that were pre-signed by Anand or Makarova. Anand and Makarova provided over 10,000 prescriptions for Schedule II controlled substances, of which over 7,000 were for oxycodone, for a staggering total of over 634,000 oxycodone tablets distributed from this scheme. The investigation was conducted by the following agencies: FBI, Department of Health and Human Services – Office of Inspector General (HHS-OIG), United States Postal Service – Office of Inspector General (USPS-OIG), the Office of Personnel Management, the Pennsylvania Office of Attorney General, and the Philadelphia Police Department. The case is being prosecuted by DOJ Trial Attorney Jaroslawicz.
Additionally, 12 indictments were unsealed yesterday involving charges against 12 people for allegedly possessing oxycodone with intent to distribute. The indictments charge that, from September 2016 through June 2019, the 12 defendants all presented forged prescriptions for oxycodone to various pharmacies outside of Philadelphia, in order to obtain oxycodone to distribute to others. The defendants, all from Philadelphia, allegedly drove to Pennsylvania pharmacies in Marcus Hook, Drexel Hill, and Kennett Square, and a New Jersey pharmacy in Mount Laurel, to fill these forged prescriptions. The defendants are charged with at least two, and up to 32, counts of possession with intent to distribute oxycodone. The defendants are charged with having received anywhere from 6,300 milligrams to 135,000 milligrams of oxycodone, which is approximately 75,000 oxycodone pills.
Charged were: Lamar Dillard, 37; Jermaine Grant, 29; Katrina Tucker, 32; Maurice Bertrand, 31; Courtney Brockenborough, 34; Alan Alexander Harrison, 29; Abdullah Howard, 23; Jonathan Metellus, 32; Clinton Monte Bullock, 29; Crystal Coleman, 31; Marques Russell, 35; and Joseph Michael Simmons. One defendant, Metellus, is also charged with one count of health care fraud, for allegedly using his Medicaid card to purchase prescription drugs with a forged prescription. These cases were investigated by the Drug Enforcement Administration, HHS-OIG, the Pennsylvania Department of State’s Bureau of Enforcement and Investigations, the Chester County District Attorney’s Office, and the Easttown Township Police Department. They are being prosecuted by Assistant U.S. Attorneys David E. Troyer, Elizabeth Abrams, Joan Burnes, and Mary Kay Costello, all of the Eastern District of Pennsylvania.
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, as well as the U.S. Attorney’s Offices for the Eastern District of Pennsylvania, District of New Jersey, Western District of Pennsylvania, Eastern District of New York, Western District of New York, District of Connecticut, and District of Columbia.
“Physicians and other medical professionals who fraudulently bill our federal health care programs are stealing from taxpayers and robbing vulnerable patients of necessary medical care. The medical professionals and others engaging in criminal behavior by peddling opioids for profit continue to fuel our nation’s drug crisis,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “The Department of Justice will continue to use every tool at our disposal, including data analytics and traditional law enforcement techniques, to investigate, prosecute, and punish this reprehensible behavior and protect federal programs from abuse.”
“Today's indictments confirm the FBI's commitment to hunting down doctors and other healthcare professionals who act like drug dealers. The opioid crisis is devastating families here in Philadelphia and across the country. The FBI and its law enforcement partners will continue to focus on corrupt physicians and others driving the epidemic,” said Michael T. Harpster, Special Agent in Charge of the Philadelphia Division of the FBI.
“Today’s law enforcement actions show we are holding alleged bad actors accountable and working to prevent further harm to beneficiaries and taxpayers,” said Maureen R. Dixon, Special Agent in Charge, Philadelphia Regional Office of the Inspector General, U.S. Department of Health and Human Services. “HHS-OIG will continue to work with our law enforcement and community partners to combat health care fraud and drug diversion in the Philadelphia Region.”
“The DEA’s Diversion Investigators and Tactical Diversion Squads are missioned with the identification, investigation, and arrest of rogue DEA Registrants and drug trafficking organizations involved in the illegal distribution of controlled substances such as oxycodone and other prescription painkillers,” said Jonathan A. Wilson, Special Agent in Charge of the DEA’s Philadelphia Field Division. “Working with our partner agencies such as the U.S. Department of Health & Human Services, the U.S. Department of Labor, and the Federal Bureau of Investigation, the DEA will continue to pursue federal criminal cases and parallel civil proceedings against the registrants and organizations that seek to divert these powerful painkillers that have contributed to the opioid epidemic.”
U.S. Postal Service Office of Inspector General Special Agent in Charge Kenneth Cleevely, Eastern Area Field Office, stated: “The Postal Service spends billions of dollars per year on health care related costs for postal employees, the majority of which is for legitimate purposes. However, a few medical providers try to take advantage of the system. USPS – OIG special agents will vigorously investigate health care fraud allegations that touch the Postal Service and will work with our law enforcement partners to bring fraudsters to justice.”
“The opioid, heroin, and fentanyl epidemic is devastating Pennsylvania communities, and it is fueled in part by prescription drug abuse,” said Pennsylvania Attorney General Josh Shapiro. “The defendants had a responsibility to help their patients, but instead they are charged with giving them dangerous opioids that they did not need. They also allegedly committed millions of dollars in insurance fraud, which causes rates for all consumers to increase. I’m proud to work with our law enforcement partners to put a stop to this criminal enterprise and protect the people of Pennsylvania.”
A complaint, information or indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

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