Two Pennsylvania judges ordered to pay $200m to kids-for-cash scandal victims

Mark Ciavarella and Michael Conahan accepted $2.8m in illegal payments to send children to for-profit jails

Former judges Michael Conahan, front left, and Mark Ciavarella, front right, leave the US district courthouse in Scranton, Pennsylvania, in 2009. Photograph: Mark Moran/AP

Two Pennsylvania judges who orchestrated a scheme to send children to for-profit jails in exchange for kickbacks were ordered to pay more than $200m to hundreds who fell victim to their crimes.

US district judge Christopher Conner awarded $106m in compensatory damages and $100m in punitive damages to nearly 300 people in a long-running civil suit against the judges, writing the plaintiffs are “the tragic human casualties of a scandal of epic proportions”.

In what came to be known as the kids-for-cash scandal, Mark Ciavarella and another judge, Michael Conahan, shut down a county-run juvenile detention center and accepted $2.8m in illegal payments from the builder and co-owner of two for-profit lockups.

Ciavarella, who presided over juvenile court, pushed a zero-tolerance policy that guaranteed large numbers of children would be sent to PA Child Care and its sister facility, Western PA Child Care.

Ciavarella ordered children as young as eight to detention, many of them first-time offenders convicted of petty theft and other minor crimes. The judge often ordered youths he had found legally delinquent to be immediately shackled, handcuffed and taken away without giving them a chance to say goodbye to their families.

“Ciavarella and Conahan abandoned their oath and breached the public trust,” Conner wrote on Tuesday in his explanation of the judgment.

“Their cruel and despicable actions victimized a vulnerable population of young people, many of whom were suffering from emotional issues and mental health concerns.”

The Pennsylvania state supreme court threw out some 4,000 juvenile convictions after the scheme was uncovered.

Ciavarella is serving a 28-year prison sentence. Conahan, who was sentenced to more than 17 years in prison, was released to home confinement in 2020, with six years left on his sentence, because of the coronavirus pandemic.

It is not clear whether the plaintiffs, now well into adulthood, will see any of the substantial damages award.

Marsha Levick, co-founder and chief counsel of the Philadelphia-based Juvenile Law Center and a lawyer for the plaintiffs, said on Wednesday she “can’t imagine there is any money out there”.

 

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Two Pennsylvania judges ordered to pay $200m to kids-for-cash scandal victims

After lying about thousands of patients’ life expectancy, hospice care owner sentenced to prison, $120M fine

by Kate Winkle

AUSTIN (KXAN) — A hospice care owner told thousands of people they had less than six months to live, enrolled them in hospice programs and even sent chaplains to some of them to receive last rites. He lied, a federal jury in McAllen determined in November 2019. He was sentenced to 20 years in prison and ordered to pay $120 million in restitution on Wednesday.

The people Rodney Mesquias, 48, of San Antonio, defrauded included patients with Alzheimer’s and dementia, according to a release from the Department of Justice. Mesquias was CEO of the Merida Group, a health care company that had dozens of locations throughout Texas.

“Mesquias funded his lavish lifestyle by exploiting patients with long-term, incurable diseases by enrolling them in expensive but unnecessary hospice services,” said Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division. According to a DOJ release, he used the money to buy a Porsche, expensive jewelry and luxury clothing, real estate and tickets for sporting events. It said he held “lavish parties” at Las Vegas night clubs and invited doctors who later gave him “medically unnecessary patient referrals.”

Mesquias was convicted of one count of conspiracy to commit health care fraud, conspiracy to commit money laundering, conspiracy to obstruct justice, six counts of health care fraud and one count of conspiracy to pay and receive kickbacks. A man officials describe as a “co-conspirator,” Henry McInnis, 48, was convicted on all but the kickbacks charges.

According to Special Agent in Charge Miranda L. Bennett, Mesquias paid kickbacks to physicians, falsified medical records and enrolled patients in “hospice care that prevented them from accessing curative care.” Bennett works for the U.S. Department of Health and Human Services Office of Inspector General’s Dallas Region.

Officials say the scheme involved $150 million in false claims between 2009 and 2018.

“Hospice services require patients to be suffering from a terminal illness expected to result in death within six months. Not only were patients not in such circumstances, they were walking, driving, working and even coaching athletic sporting events in some instances,” a DOJ release said. “However, Mesquias and others kept patients on services for multiple years in order to increase revenue.”

The DOJ says his case was one of the first criminal hospice fraud prosecutions it had brought to a federal jury. McInnis will be sentenced at a later date, according to a release, and two other co-conspirators have pleaded guilty and are waiting to be sentenced. Francisco Peña, 82, of Laredo, acted as a medical director for Merida Group and was mayor of Rio Bravo when he also pleaded guilty to charges, according to KXAN sister station KVEO. He died in November 2019.

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After lying about thousands of patients’ life expectancy, hospice care owner sentenced to prison, $120M fine

Nursing home companies accused of misusing federal money received hundreds of millions of dollars in pandemic relief

Nursing home companies sued for Medicare fraud in recent years received more than $300 million in coronavirus relief payments. The allegations include putting elderly residents into unnecessary therapy services and delaying patients' release to reap higher Medicare payments. (N/A/Getty Images)

By Debbie Cenziper

For-profit nursing home providers that have faced accusations of Medicare fraud and kickbacks, labor violations or widespread failures in patient care received hundreds of millions of dollars in “no strings attached” coronavirus relief aid meant to cover shortfalls and expenses during the pandemic, a Washington Post analysis of federal spending found.

More than a dozen companies that received federal funding have settled civil lawsuits in recent years with the Justice Department, which alleged improper Medicare billing, forged documents, substandard care and other abuses.

The companies repaid the government a total of more than $260 million and nearly all are under active corporate integrity agreements with the inspector general of the U.S. Department of Health and Human Services — the same department that distributed the payments under the Coronavirus Aid, Relief, and Economic Security Act, or Cares Act. The five-year agreements require independent audits, employee training and other enhanced reporting protocols.

One nursing home provider is still embroiled in active litigation with the government, which has accused the company in federal court in Tennessee of putting elderly residents into unnecessary therapy services and delaying the release of patients to reap higher Medicare payments. SavaSeniorCare, whose homes received more than $65 million in pandemic relief aid, has denied wrongdoing.

All told, nursing home companies sued for Medicare fraud in recent years received more than $300 million in relief payments.

Millions more went to nursing homes with widely publicized breakdowns during the pandemic. Among them: a facility in Pennsylvania cited by the state for giving more than 200 residents the experimental anti-malarial drug touted by President Trump and a home in New Jersey under investigation by the state attorney general for lapses in infection control and patient care during a lethal coronavirus outbreak earlier this spring. After an anonymous tip, police found the bodies of 17 residents in a makeshift morgue; another had been stored in a shed.

The money was distributed through the $175 billion Provider Relief Fund, which since April has directed federal stimulus payments to hospitals, nursing homes and other health-care providers. In May, HHS announced a targeted nursing home distribution of $4.9 billion.

The payments, for expenses or lost revenue related to covid-19 — the disease caused by the novel coronavirus — came with few spending restrictions. Agreements between the providers and HHS include language prohibiting nursing homes from using the federal money for abortions, gun-control lobbying and the purchase of chimpanzees, but do not require homes to spend on such things as personal protective equipment or hazard pay for nurses and aides caring for covid-19 patients.

Seema Verma, administrator of the Centers for Medicare and Medicaid Services, told nursing home companies and other health-care providers in April that coronavirus relief payments came with “no strings attached.” (Drew Angerer/Getty Images)

“The president wants us to accelerate getting those dollars out,” Seema Verma, administrator for the Centers for Medicare and Medicaid Services (CMS), announced in April during a news briefing with the White House coronavirus task force. “There are no strings attached, so the health-care providers that are receiving these dollars can essentially spend that in any way they see fit.”

Watchdog groups and some independent experts say the government should have assessed the financial needs of the nursing home industry, scrutinized the track records of providers and attached some spending restrictions before distributing the payments. They say they are most concerned about for-profit companies, some owned by private equity and other investment firms, that in the past have slashed costs and cut staff to boost profit.

Two publicly traded nursing home companies that regularly pay dividends to shareholders announced they continued to do so in the first two quarters of this year, The Post found.

Rep. James E. Clyburn (D-S.C.), who chairs the House select subcommittee on the coronavirus crisis, launched a congressional investigation in June focused in part on grant spending by five nursing home chains.

Rep. James E. Clyburn (D-S.C.), chairman of the
House select subcommittee on the coronavirus
 crisis, said that the panel will conduct oversight
 to make sure nursing home companies are spending
 funds as Congress intended. (Salwan Georges/The
Washington Post)

“Our committee intends to conduct rigorous oversight to ensure that nursing home companies that received funds in order to deal with the crisis spend those funds as Congress intended,” he said in a statement to The Post. “Nursing home companies that received funds after committing fraud warrant particularly close scrutiny.”

HHS said that providers will be required to undergo audits and submit spending documents, and those unable to show that money went to expenses or lost revenue attributed to the coronavirus could be forced to return some or all of the funds.

“HHS will have significant anti-fraud monitoring of the funds distributed, and the Office of Inspector General will provide oversight as required in the CARES Act to ensure that federal dollars are used appropriately,” according to HHS.

The American Health Care Association (AHCA) and National Center for Assisted Living, which represents 14,000 long-term-care providers, said the federal money was badly needed. The group has reported that both nonprofit and for-profit nursing homes had been “on the verge of collapse” during a deepening health crisis, faced with the increasing costs of supplies and personnel expenses and the loss of existing and potential residents.

The industry group said it expects reporting and tracking protocols.

“For several months, all health care providers have been waiting for guidance on reporting and HHS’ approach to auditing and are anticipating significant oversight in the coming months,” Mike Cheek, AHCA senior vice president of reimbursement policy, said in a statement to The Post. “We support reasonable efforts to ensure this federal aid has been properly directed to providers to cover costs associated with addressing COVID-19 and potential losses."

Whether that oversight prompts the government to flag irregular spending — or demand the return of stimulus money — is not yet known.

As the money became available, LeadingAge, an industry group that represents nonprofit providers, put out a primer for providers with detailed instructions about how to access and use the payments.

“HHS or Congress could clawback some portion of the relief funds from non-COVID areas,” the document says. “But in an election year, there is low probability of this occurring.”

Those familiar with the industry say they fear some companies will simply absorb the money without investing in patient care or compensation for front-line workers.

“This has been one of my concerns from the moment the government passed the Cares Act — the money is not ending up where it needs to be,” said Michael Wasserman, medical director of a Los Angeles nursing home and president of the California Association of Long Term Care Medicine. “The help has to go specifically to the front line.”

To better understand where stimulus money was distributed, The Post used public records and provider websites to untangle the ownership structure of individual homes and then determine the total funding for homes within the same parent company. The calculations may be low. In some cases, The Post was unable to link the names of individual nursing homes with ownership records maintained by HHS or CMS.

The analysis captured more than 2,000 homes within some of the largest chains in the United States. The Post also looked at several publicly traded nursing home companies as well as smaller companies and individual facilities scrutinized for improper business practices or patient care before or during the pandemic. The Post could not independently verify how the relief payments, only recently distributed, were spent.

More than $35 million went to homes operated by the for-profit Brius, with dozens of nursing homes in California, federal data shows.

In 2016, officials at four Brius homes acknowledged in federal court that employees used corporate credit cards to buy massages, tickets to sporting events and excursions on the 222-foot mega yacht Inspiration Hornblower for hospital planners who provided patient referrals. The officials, who struck deferred prosecution agreements with the government, said at the time that Brius management was unaware of the scheme to maximize Medicare revenue.

The four homes repaid $6.9 million through a settlement.

Last year, the state threatened to fine one Brius home $156,000 after inspectors noted that a resident who had trouble swallowing choked on a honey bun and died, and another resident needed two surgeries after she fell out of her wheelchair while unattended. The home’s administration withheld records and instructed staff not to cooperate, according to the state inspection report.

In 2014, then-California Attorney General Kamala D. Harris called the company’s owner, Shlomo Rechnitz, a “serial violator of rules within the skilled nursing industry” in an emergency court motion to stop Brius from buying homes through a bankruptcy sale.

Shlomo Rechnitz, right, with Steve Rechnitz and their wives at a 2012 event in Beverly Hills, Calif., is the owner of Brius Healthcare, the largest nursing home provider in California. In 2014, then-California Attorney General Kamala D. Harris called Shlomo Rechnitz a “serial violator of rules within the skilled nursing industry.” (David Livingston/Getty Images)

Speaking for Rechnitz, company attorney Mark Johnson said Rechnitz does not have any role in the day-to-day operations of Brius homes. Johnson said the Justice Department settlement stemmed from allegations from 2006 to 2012 and “clearly has nothing to do with the CARES Act or the current pandemic.” The company, he said, cooperated with investigators and terminated the individuals involved.

Johnson denied allegations that facility employees failed to cooperate last year with state inspectors and said the company appealed the state’s findings. He added that Brius has faced rising expenses from increased wages, the cost of supplies and other needs during the coronavirus crisis.

“While we certainly cannot project the end of this pandemic, at present it seems unlikely that the relief funding will be sufficient to meet the increased expenses related to this pandemic,” Johnson said in an email.

In New York, two homes that are part of the for-profit SentosaCare received more than $2 million in pandemic relief payments, federal records show. In October, a federal judge ruled that the owners of the company were liable for violations of human-trafficking laws after Filipino nurses brought to the United States to work in the two homes said they were overworked, improperly paid and threatened with $25,000 fines if they quit before their contracts ended.

Elliot Hahn, a lawyer for SentosaCare, said nurses were not threatened and were paid an hourly rate of $29 or more. The company has appealed the ruling.

“This is not a case where employees were mistreated or ‘trafficked’ in any sense of the word,” Hahn said in an email.

Nursing homes that have drawn significant scrutiny during the pandemic also received relief payments, The Post found.

The Life Care Center of Kirkland in Washington state, the site of the country’s first known coronavirus outbreak, received nearly $320,000 in pandemic relief. After the outbreak, CMS inspectors found the home did not properly care for sick residents or alert authorities to the spread of illness. The state banned the home, linked to more than 40 deaths, from accepting new residents until changes were made.

The Life Care Center of Nashoba Valley outside of Boston drew $300,000 in federal funds. After 17 people died of covid-19, including a nurse at the home, Sens. Elizabeth Warren (D-Mass) and Edward J. Markey (D-Mass.) and Rep. Lori Trahan (D-Mass.) appealed to CMS to provide more oversight of Life Care and other for-profit chains. The Massachusetts Attorney General is investigating the home.

Tim Killian, public information liaison for the Tennessee-based chain, said the company continues to work with government regulators to “provide the best care and to safeguard both residents and staff.”

“We have lost both residents and staff members to this horrible contagion,” he said in an email. “Our staff members engaged in heroic efforts to provide the best care possible at great risk to their own health and well-being."

Life Care, with more than 200 nursing homes, is being monitored by federal authorities for financial compliance with Medicare rules. In 2016, Life Care, without admitting liability and arguing the government did not prove its case, agreed to the oversight and to a $145 million settlement to resolve allegations by the government that the chain and its billionaire owner had engaged in “a systematic scheme” to maximize Medicare billing.

Homes within the Life Care network received more than $48 million in pandemic relief payments, federal data shows.

“I asked Seema Verma to increase oversight of these for-profit chains, not hand out hundreds of millions of dollars with no strings attached,” Warren said in a statement to The Post. “CMS needs to make sure this money goes to responding to the virus and protecting vulnerable residents and staff, not padding profits and bottom lines.”

Billions distributed with few restrictions

The nursing home industry has pressed for financial relief since the start of the pandemic, when hundreds and then thousands of elderly residents fell ill during coronavirus outbreaks that swept homes from New York to California. More than 45,000 residents have died since March, along with several hundred nurses and other caregivers.

For months, the industry has asked Congress and the Trump administration to provide testing supplies, protective gear and money to cover expenses as well as lost revenue from beds left empty by patients who died of covid-19 or potential residents who decided to live elsewhere. Congress complied, allowing nursing homes to use stimulus money to cover shortfalls in revenue or expenses attributed to covid-19.

In May, Health and Human Services Secretary Alex Azar, talking with President Trump, announced $4.9 billion in targeted pandemic relief to nursing homes. Homes were given broad flexibility on use of the money. (Jabin Botsford/The Washington Post)

Nursing homes received about $2.7 million in initial, general distribution payments for hospitals and health-care providers. In May, HHS Secretary Alex Azar announced a targeted $4.9 billion distribution to nursing homes.

“This funding secured by President Trump will help nursing homes keep the seniors they care for safe during the COVID-19 pandemic,” Azar said at the time.

HHS opted for a simple distribution formula: Nursing homes would receive a $50,000 lump-sum payment, along with an additional allocation of $2,500 per bed. The average distribution was $315,000, with some larger facilities receiving $3 million or more, according to HHS.

The money, HHS said in guidance to the industry, did “not need to be specific to providing care for possible or actual coronavirus patients.” Providers could use the grants for a range of expenses, including health insurance, rent or mortgage payments, and equipment lease payments. Providers would have to comply with unspecified future audits and reporting requirements.

“They should have specified that the money couldn’t just be used for administrative costs and profits,” said Charlene Harrington, a nursing home researcher and professor at the University of California at San Francisco. “There was no reason that CMS couldn’t have put more restrictions on the money."

Some say the government also should have assessed the finances of nursing homes and their parent companies before distributing the payments.

In 2018, nursing homes in the United States received $28.5 billion from Medicare, which covers short-term stays and pays a far higher rate for services than Medicaid.

As the coronavirus crisis spiraled, CMS waived a rule that required patients to spend three consecutive days in a hospital before becoming eligible for skilled nursing care funded by Medicare. The idea was to free up hospital beds for covid-19 patients — and protect the elderly from exposure. But the change also allowed nursing homes to convert existing, long-term-care patients on Medicaid to higher-paying Medicare as long as the homes determined the residents needed skilled care under CMS guidelines.

David Grabowski, a professor of health-care policy at Harvard Medical School, called the change a “huge revenue bump.”

“That’s where all of the high margins are associated with nursing home care,” Grabowski said. “You can quadruple your revenue overnight for those residents.”

CMS also extended the time that patients were eligible for Medicare-funded skilled nursing, doubling the pre-pandemic 100-day limit if patients affected by covid-19 needed more care. At the same time, states including Massachusetts and Connecticut have directed aid to nursing home providers.

Then came the stimulus money.

Homes within the publicly traded Genesis HealthCare, which reported $33 million in net income in the first quarter of this year, received about $180 million in pandemic payments. States provided an additional $27 million.

“It goes back to this issue of whether or not there were shortfalls,” Grabowksi said. “You would want them to be able to make payroll, to buy all the supplies. … But I think there are a lot of concerns, especially with private equity and others, are you making the payments to a private-equity group or are you paying your staff? Greater accountability here on the financial side would be a good thing.”

The American Health Care Association said the money came at a critical time: Medicaid for years has covered only 70 or 80 percent of the cost of care in nursing homes, leaving some companies even before the pandemic with razor-thin margins. Struck by higher costs and lower occupancy rates during the crisis, the industry faced the loss of billions of dollars in revenue, the group has reported.

Money flows to troubled chains

On the front lines of nursing homes, the needs are clear. Last month nearly 3,000 reported shortages of nurses, aides or both, according to CMS data. More than 1,700 reported that they lacked a week’s supply of N95 masks; 1,500 said they lacked surgical gowns.

Hundreds of nursing homes ran short on staff, protective gear as more than 30,000 residents died during pandemic

But lawmakers and watchdog groups worry that with few safeguards, nursing home companies will seek to grow profit rather than direct money to patients and caregivers. Some providers have affiliated entities, such as medical supply companies, that could charge related nursing homes above-market rates for goods and services to justify expenses.

“There are owners in the industry who have related parties,” said Wasserman, the California doctor and industry representative. “Now the facility is paying five to 10 times the amount for PPE. That is not how Cares Act money should be spent.”

Watchdog groups say they are particularly concerned about companies that have faced allegations of Medicare abuse.

Nursing homes within Ohio-based Saber Healthcare, with facilities in seven states, received more than $45 million in pandemic funding only weeks after the company and related entities settled a 2016 government lawsuit, agreeing to five years of compliance monitoring and repaying $10 million to the government, court records show.

Government lawyers alleged in federal court in Virginia that nine of Saber’s homes submitted false claims to Medicare in recent years for rehabilitation therapy services for residents that were not reasonable, necessary or skilled.

“Our office is committed to investigating and stopping health-care fraud,” U.S. Attorney G. Zachary Terwilliger, of the Eastern District of Virginia, said in April. “Billing Medicare for higher-than-necessary levels of care exploits our senior citizens and undermines trust in the health-care system.”

Saber did not admit liability when settling the case.

“Saber disputes the allegations and has the utmost confidence that its facilities have acted in compliance with applicable laws and regulations in providing the best possible care to each and every patient,” the company said in a statement to The Post. “During this critical time for healthcare providers, our resources are better spent in serving our patients’ needs and supporting our employees rather than continuing to litigate these issues.”

In federal court in Tennessee, the Justice Department is currently pursuing a case against SavaSeniorCare, arguing that the nursing home company, among the largest in the U.S., pressured its homes to meet “unrealistic” financial goals by submitting false claims to Medicare for rehabilitation therapy.

Homes within the Sava network received more than $65 million in pandemic relief, federal spending data shows.

Patte Packey, whose 83-year-old father died of covid-19 at a Sava nursing home in Bethesda, Md., said she worries the money will not be spent on patient care.

“Who’s responsible for the oversight?” she said.

A spokesperson for Sava declined to comment on the government’s case, saying the litigation is ongoing. In court records, the company disputed the allegations, arguing the government failed to prove its case.

“The government hinges its entire case on five patient examples that demonstrate, at most, the government’s subjective clinical disagreement — and even then, a disagreement that wholly ignores the high standard to which [skilled nursing facilities] are held in the delivery of therapy services,” the company said.

Nursing homes flagged by government inspectors for lapses in care during the pandemic also drew millions of dollars, including Andover Subacute and Rehabilitation Center in New Jersey, where 17 bodies were found in a makeshift morgue.

Hundreds of nursing homes with cases of coronavirus have violated federal infection-control rules in recent years

The facility, which along with a sister property received about $3 million, failed to follow infection-control standards or properly screen visitors, according to a state inspection in April. Inspectors also found staff members who did not use proper protective equipment, wash their hands or separate sick patients from healthy ones.

The home, under investigation by the New Jersey attorney general, said every effort was made to keep residents safe.

“Despite all our efforts, the virus made its way into our facility, as it did in the majority of long-term care facilities across New Jersey,” owner Chaim “Mutty” Scheinbaum said in a statement. “We took every possible step to handle this crisis internally while simultaneously making dozens of outreaches to local, state, and federal agencies for help. … The facility has made a strong recovery since the height of the pandemic.”

Industry appeals for more

In recent weeks, state and federal lawmakers have ramped up calls to track the money. Clyburn is investigating Sava, Genesis and Life Care, among other nursing home chains, to determine how the stimulus money was spent.

In Pennsylvania, state Sen. Katie Muth (D) is pushing a measure that would require providers to track and report their spending.

“All these things that we hoped the feds would do, they haven’t,” Muth said.

The nursing home industry, meanwhile, is lobbying for more money. Last month, the Trump administration announced an additional $5 billion in funding for nursing homes and state veterans homes.

The American Health Care Association is asking for $100 billion, much of it directed at nursing homes. In early June, the group announced a $15 million fundraising effort to launch a public awareness campaign.

“Our profession faces its greatest challenge in history,” Mark Parkinson, the former governor of Kansas and AHCA’s president, wrote in a letter to the industry. “This isn’t like the usual fight we have in D.C. over a two percent increase or cut, or over some crazy regulation. Instead, this is a battle for the lives of our residents, our staff, and the very survival of our sector.”

Jacobs and Mulcahy are graduate students in journalism at Northwestern University’s Medill Investigative Lab. Post researcher Alice Crites and staff writer Douglas MacMillan contributed to this report, along with Michael Korsh, Ellie Eimer, Chloe Hilles, Cadence Quaranta, Catherine Buchaniec, Daniel Rosenzweig-Ziff and Alexa Mikhail with the Medill Investigative Lab.

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Nursing home companies accused of misusing federal money received hundreds of millions of dollars in pandemic relief

Indictment charges Decatur doctor, Ed Henry with kickbacks and bribery

Rep. Ed Henry

Doctors in Decatur and Huntsville were charged with participating in a bribery and kickback scheme, and additional charges were filed against state Rep. Ed Henry in a federal indictment filed last week.

The Hartselle lawmaker was originally indicted May 31 for allegedly engaging in a conspiracy with a Montgomery doctor, Gilberto Sanchez, to defraud Medicare. The superseding indictment filed last week alleges he engaged in similar conspiracies with Dr. Punuru Reddy of Decatur and Dr. Nicole Scruggs of Huntsville.

Henry’s lawyer said prosecutors filed the new indictment to put pressure on his client.

“By adding the two new defendants into Ed’s case, they hope that one or both will succumb to the pressure and then become witnesses for the prosecution,” Birmingham lawyer Max Pulliam said.

Reddy and Scruggs, who did not return calls Tuesday, have not filed responses to the superseding indictment. Henry pleaded not guilty to the original indictment and has filed motions seeking to dismiss it.

Sanchez, who pleaded guilty to drug distribution, health care fraud and money laundering charges in November, is not named as a defendant in the indictment.

“In an effort to apply additional pressure to Ed Henry, the government has charged two additional citizens with being partners in crime with Ed,” Pulliam said. “These citizens practice medicine in Decatur and Huntsville, and neither has any relationship with Sanchez, the real criminal. Like Ed, these citizens helped people get the health care they needed and saved the taxpayers money.”

Henry's business, MyPractice24 Inc., provided chronic care management for the patients of doctors who contracted with the company. Chronic care management involves coordinating medical care and billing issues for Medicare patients with two or more serious health conditions.

Henry entered into an agreement to provide chronic care management services to Reddy’s Medicare patients at a rate of $22.65 per month in August 2015, according to the indictment. Consistent with Medicare regulations, the doctor would bill Medicare for the services, and Henry’s company would invoice the doctor.

Because chronic care management involves no face-to-face time with a doctor, and is handled primarily by telephone calls between the patient and a non-physician, the indictment indicates many patients would reject the service if they were required to pay their own money, either through the 20 percent co-pay amount or if their deductible had not been met.

“Henry assured Reddy that a physician could ‘write off’ a co-pay obligation if a patient refused to pay,” according to the indictment. “Henry said that to do so, all that Reddy would need to do would be to write ‘financial distress’ on the patient’s bill.”

Henry instructed Reddy that he should refrain from submitting reimbursement claims to Medicare until well after the beginning of the year “so as to allow patients to pay their annual deductibles on other services,” according to the indictment. To facilitate this, the indictment alleges, Henry agreed to delay invoicing Reddy until after the doctor had received reimbursement from Medicare.

Reddy began sending bills for the co-pay amounts on the chronic care management services soon after entering into the agreement with Henry, but patients resisted. “The patients stated that they did not wish to pay out-of-pocket for a service that did not include seeing or speaking to a physician,” according to the indictment.

Reddy instructed his front desk staff to waive the co-pay amount, typically $8, on services provided by Henry’s company anytime a patient complained about the charge, according to the indictment. He initially signed each waiver. He eventually “grew tired of signing co-pay waiver documentation forms,” according to the indictment, and had his staff use his signature stamp to waive the co-pays of patients who complained.

Non-routine waivers of Medicare co-pays are not considered kickbacks, according to the U.S. Department of Health and Human Services guidelines, but doctors who routinely waive co-pays with the intent of attracting patients violate the federal anti-kickback law.

Pursuant to Henry’s instructions, Reddy also refrained from submitting claims to Medicare for chronic care management services provided from January 2017 until May of that year, according to the indictment, thus increasing the likelihood the patients’ deductibles already had been met. Henry’s company delayed submitting invoices to Reddy for those months until June 2017, when he sent combined invoices for $31,137, the indictment claims.

The allegations concerning Henry’s interactions with Scruggs are similar, although in Scruggs' case the indictment claims Henry bribed her by hiring an employee to work in her office at no cost to the doctor.

“MyPractice24 would pay the entirety of the employee’s salary,” according to the indictment. “Nevertheless, Henry advised Scruggs that Scruggs would be permitted to use the MyPractice24 employee to perform clinical work not related to chronic care management.”

The employee “spent significant amounts of time doing work at Scruggs’ direction that was unrelated to chronic care management,” the indictment alleges. “Henry knew that the employee was doing so.”

Henry also paid an employee at Sanchez’s office, according to the original and superseding indictments. In that case, Henry initially paid the employee $1 per referral, leading to monthly kickback payments of hundreds of dollars, according to the indictment. He later hired her and had her provide chronic care management services for Sanchez’s patients while also providing services for Sanchez, according to the indictment.

According to Alabama Secretary of State records, Henry incorporated MyPractice24 in July 2015, shortly after Medicare guidelines were changed to allow reimbursement of chronic care management services. The indictment alleges his partner in the venture was a Decatur resident identified only as “G.C.” According to Secretary of State records, Greg Cheatham is a director of MyPractice24. A call to Cheatham’s office was not returned.

A call to Reddy’s practice was not returned Tuesday. A voicemail option for patients calling his office for chronic care management was not operational. His lawyer, Anthony Joseph of Birmingham, did not return a call late Tuesday.

Scruggs did not return a call to her practice, Legacy Medical Care LLC.

The Alabama Board of Medical Examiners database shows no restrictions on either Reddy’s or Scrugg’s medical licenses and reflects no public reprimands or disciplinary actions.

“Ed paid no kickbacks to anyone and like Ed, these citizens are guilty of no crimes,” Pulliam said.

Sanchez’s medical license was surrendered Dec. 31, 2017, while he was under investigation by the board, according to the database.

Henry’s arraignment on the superseding indictment is scheduled in Montgomery for Aug. 8 before U.S. District Judge Wallace Capel Jr. A pretrial conference in Henry’s case is scheduled the following day.

Henry announced early in 2017 he would not seek a third term this year. He is still the state representative, earning $1,927 every two weeks.

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Indictment charges Decatur doctor, Ed Henry with kickbacks and bribery

Local nursing homes agree to pay up to $6.9 million to settle kickback and fraud allegations

A room at Brighton Place in San Diego

Four San Diego nursing homes have agreed to pay up to $6.9 million to settle civil allegations that employees paid kickbacks for referrals and submitted fraudulent bills to government healthcare programs, the U.S. Attorney’s Office announced Thursday.

The nursing homes, all owned by Los Angeles-based Brius Management Co., were accused of paying kickbacks to hospital staffers in violation of anti-kickback laws, the U.S. Attorney’s Office said in a news release.

The four nursing homes were Point Loma Convalescent Hospital, Brighton Place in San Diego, Brighton Place in Spring Valley and Amaya Springs Health Care Center in Spring Valley, according to the news release. Brius Management could not be reached for comment.

The settlement resolves a lawsuit brought by a former employee of one of the nursing homes under federal whistleblower laws, the statement said. The employee, Viki Bell-Manako, will receive 20 percent of each settlement payment.

In a deferred prosecution agreement with the U.S. Attorney’s Office last year, the four nursing homes admitted employees conspired to pay kickbacks, and did so without the owner’s knowledge, the statement said.

The nursing homes also admitted employees used corporate credit cards to buy gift cards, massages, tickets to sporting events and a cruise for hospital staffers in exchange for referrals, according to the statement.

The settlement announced Thursday calls for Brius Management Co. to pay $1,785,967 to the United States over three years, and a single payment of $240,950 to California, the statement said.

It also agreed to pay $4.9 million to the U.S. government if certain “operational contingencies” are met and to enter into a corporate integrity agreement with the U.S. Department of Health and Human Services, the statement said.

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Local nursing homes agree to pay up to $6.9 million to settle kickback and fraud allegations

10 ALF owners sentenced for accepting kickbacks

Ten Miami-Dade County assisted living facility owners have received sentences of federal prison time or home confinement for accepting healthcare kickbacks, the Justice Department announced Wednesday.According to court documents, the operators conspired with the former owner of Florida Pharmacy to receive kickbacks and bribes in exchange for referring residents for prescription medication and durable medical equipment paid for by Medicare and Medicaid. The scheme violated their Medicaid provider agreements as well as federal and state anti-kickback rules and regulations the Justice Department said.Nine of the owners were sentenced to federal prison terms ranging from eight months to one year and one day, and an additional owner was sentenced to home confinement. All 10 defendants also were ordered to serve three years of supervised release, pay restitution and be subject to forfeiture judgments.

Sentenced to home confinement was Blanca Orozco, 69. Sentenced to prison:

• Alicia Almeida, 56;
• Norma Casanova, 67;
• Yeny De Erbiti, 51;
• Maribel Galvan, 43;
• Marlene Marrero, 60;
• Dianelys Perez, 34;
• Jorge Rodriguez, 57;
• Rene Vega, 57; and
• Osniel Vera, 47

The sentences came in the U.S. District Court for the Southern District of Florida. Indictments against the defendants were announced in October. All 10 subsequently pleaded guilty to receiving kickbacks in connection with a federal healthcare program.

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10 ALF owners sentenced for accepting kickbacks

Texas Senator Judith Zaffirini Voices Concerns

Following the indictment of local Judge Jesus “Chuy” Garza, state Sen. Judith Zaffirini called his court “the absolute worst in the state” and a “textbook on cronyism”

“Frankly, it was a category of its own,” Zaffirini wrote in an email to the Webb County Commissioners Court.

Zaffirini, D-Laredo, is requesting the Commissioners Court appoint a successor to Garza, Webb County Court at Law II judge. Garza was suspended without pay Jan. 13 by the State Commission on Judicial Conduct, three days after a grand jury indicted him in the 111th District Court on a misdemeanor influence-peddling charge.

In an email Zaffirini sent Jan. 13 to Webb County Judge Tano Tijerina and county commissioners, she calls for a successor who has the “ability, interest, energy, time and commitment to clean up this dire situation regarding guardianship in that court and who will commit to accountability and transparency in doing so.”

She suggests this successor should preclude anyone who has ties to Garza and who might become involved in a coverup.

Jesus M. Dominguez, one of Garza’s attorneys, declined to comment on Zaffirini’s email.

Reports indicate Garza appointed four local attorneys to the resounding majority of cases, paying them an overwhelming percentage and the highest average of fees paid in his court, according to Zaffirini.

Judith Zaffirini

“I hope you will take steps to ensure that governmental records in (Garza’s) court are not destroyed,” Zaffirini says in her email.

Zaffirini further alleges Garza’s court is what motivated her to pass laws requiring the rotation system for making appointments and monthly reports regarding appointments made and fees paid.

Senate Bill 1876 — authored by Zaffirini and passed in 2015 — directed state courts to use a rotation system for most appointments of attorneys and guardians ad litem, guardians and mediators, while preserving judicial discretion. Ad litem refers to the appointment by a court of an attorney to act in a lawsuit on behalf of another party, such as a child or an incapacitated adult.

All appointments and related payments for attorney ad litem, guardian ad litem, guardian, mediator and competency evaluator are now reported to the Office of Court Administration.

“As your state senator I am keenly interested in helping you address this important and timely issue,” the email states.

In response to her correspondence to commissioners, Tijerina requested Webb County Attorney Marco A. Montemayor take immediate action in addressing Garza’s suspension.

“I strongly feel that removal of office should be considered and would be essential in restoring the trust and integrity in the County Court at Law 2,” said Tijerina in an email obtained by LMT.

Garza, who has served as Webb County Court at Law 2 judge since 1993, was arrested and charged Jan. 12 with one count of gift to a public servant by a person subject to his jurisdiction, a Class A misdemeanor.

The indictment alleges that in January 2015, Garza asked local attorney Shirley Mathis for a $3,000 loan in exchange for appointing her to represent the wealthy Carlos Y. Benavides Jr. estate in a civil dispute. The loan was intended for Christopher Casarez, one of Garza’s court coordinators, the indictment states. Casarez died by suicide Dec. 11 in his home in the Lakeside Subdivision, according to Laredo police.

Zaffirini’s husband, Carlos M. Zaffirini Sr., represents Leticia Benavides, wife of Carlos Y. Benavides Jr., in multiple civil cases involving Carlos Y. Benavides Jr.’s estate, according to court records.

Oscar O. Peña, an attorney for Garza, said in a statement following his arrest that his client maintains his innocence.

“He intends to investigate the state’s claim and he looks forward to defending himself and putting this matter behind him,” the statement reads. “This is a difficult time for the judge, his family and his friends, but he has faced many challenges in his life and he intends to face this one too.”

Guardianship reports
Zaffirini said in her email that as a member of the Texas Judicial Council and Senate State Affairs Committee, she “received reports and heard extensive testimony that 90 percent … of the guardianship cases in Chuy’s court were not in compliance with state law.”

She wrote that “deficiencies include waived bonds for guardians (though there is no legal authority for waivers), no initial inventory, no annual report and missing assets (including an airplane).”

A 2016 report from the Texas Office of Court Administration indicates Webb County has the highest reporting deficiencies in guardianship cases when compared to the counties of Anderson, Bexar, Comal, Guadalupe, Hays, Lubbock, Montgomery, Orange, Tom Green and Tyler.

Reporting deficiencies included 79 percent of cases missing annual reports of person, 77 percent of cases missing annual accounting reports and 80 percent missing initial inventory reports in Webb County courts at law I and II.

Of those statistics, 97 cases in County Court at Law II were reported as missing annual reports, 88 were missing initial inventories and 79 were missing annual accounting reports.

A supplemental report shows County Court at Law II had 69 open cases where the ward was deceased, eight cases with deceased wards who had assets over $10,000, 84 cases where minors had reached the age of majority and 31 cases where the docket showed expired temporary orders or other miscellaneous deficiencies.

The Office of Court Administration additionally recommended the dismissal of 41 cases in Garza’s court due to guardianship not being established.

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Zaffirini Voices Concern

No bail for alleged leader in $1B Florida health care fraud

MIAMI — A businessman accused of orchestrating a $1 billion Medicare and Medicaid fraud scheme in South Florida will be staying in jail until his trial.

Court records show a Miami federal judge on Friday denied bail for 47-year-old Philip Esformes, finding he was a flight risk and might obstruct the ongoing investigation. Esformes faces a potential life prison sentence if convicted of multiple fraud, conspiracy and other charges.

Authorities say Esformes ran 30 nursing homes and assisted living facilities that used a network of corrupt doctors and hospitals to refer thousands of patients to the facilities even though they did not qualify for services. Esformes and others also allegedly got kickbacks for steering patients to other health centers.

The Justice Department says it's the largest health fraud case in U.S. history.

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No bail for alleged leader in $1B Florida health care fraud

Nurse pleads guilty to taking Insys kickbacks as Subsys marketing probe continues

In an apparent sign that federal prosecutors are zeroing in on the pain-drug maker Insys Therapeutics ($INSY), a Connecticut nurse and top prescriber has pleaded guilty to accepting $83,000 worth of kickbacks from the company.

As The New York Times reports, Insys previously disclosed that the feds are looking into its marketing practices. The company's biggest drug is Subsys, a spray form of the high-powered painkiller fentanyl approved only for use in cancer patients.

The nurse, Heather Alfonso, was one of Insys' paid speakers, and often collected fees for events attended only by an Insys sales rep, or by her own friends and colleagues, the NYT reports. As part of her plea agreement, Alfonso admitted that the speaking fees influenced her prescribing decisions.

Prosecutors said that Alfonso prescribed Subsys to many patients who did not have cancer, the drug's only approved indication.

Subsys sales have grown quickly, despite its narrow market. The sublingual spray brought in $219.5 million for 2014, more than double its $95.8 million total the previous year. Fourth-quarter 2014 sales alone amounted to more than $60 million.

Insys sales reps previously told the Times that they were trained to begin talking about cancer pain with doctors and other potential prescribers--like Alfonso--and then move into a more general discussion about pain. Last year, script numbers showed that half of Subsys prescriptions were being written not by oncologists or pain specialists--as the FDA had directed--but by other types of providers, including GPs and dentists.

Former federal prosecutor Marcella Auerbach

Now, the prosecutors' move against Alfonso can't be a good sign for the company, one legal expert told the newspaper. "I think it means big trouble for the company," former federal prosecutor Marcella Auerbach told the Times. "I think it takes two to tango to do kickbacks--a giver and a receiver."

There's precedent for that sort of thinking. The long-term care pharmacy provider Omnicare ($OCR) in 2009 settled kickback claims with the Department of Justice, which cited its recommendations in favor of Johnson & Johnson's ($JNJ) antipsychotic drug Risperdal. J&J later found itself fighting DOJ claims that it paid kickbacks to Omnicare, aiming to boost Risperdal scripts.

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Nurse pleads guilty to taking Insys kickbacks as Subsys marketing probe continues

Miami Nursing Home To Pay Record $17M in Whistleblower Suit

A Miami-based nursing home network agreed Tuesday to pay a record $17 million to settle a False Claims Act suit brought by its former CFO, accusing it of running a kickback scheme. The case is United States of America et al v. Plaza Health Network et al., aka Hebrew Homes.

From 2006 through 2013, Hebrew Homes allegedly hired physicians as medical directors —really “ghost positions” — at its facilities, who had to perform few or no contractual job duties.  Instead, these physicians were paid to refer patients to Hebrew Homes facilities, dramatically increasing the number of referrals. Each facility had several of these medical directors, who were paid thousands monthly.  Hebrew Homes did not admit to liability with the settlement.

“Illegal inducements paid to physicians in exchange for patient referrals will not be tolerated,” Benjamin C. Mizer, principal Deputy Assistant Attorney General for the DOJ's Civil Division, said in a statement. “Medicare funds should be used to provide care for our senior citizens, not as an inducement to physicians to refer business.”

The settlement is the largest in U.S. history for a nursing home allegedly violating the Anti-Kickback Statute. The company entered a five-year Corporate Integrity Agreement with the U.S. Department of Health and Human Service’s Office of the Inspector General and agreed to alter its policies regarding how it will hire and maintain medical directors. The former CFO will receive more than $4 million from the settlement.

This decision underscores the need for employers in the health care industry to rigorously comply with the federal Anti-Kickback Statute, which prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of federal health care program business. It is broadly drafted and establishes penalties for individuals and entities on both sides of the prohibited transaction. Conviction for a single violation may result in a fine of up to $25,000 and imprisonment for up to five years. In addition, conviction results in mandatory exclusion from participation in federal health care programs. Absent a conviction, individuals who violate the Anti-Kickback Statute may still face exclusion from federal health care programs. The government may also assess substantial civil money penalties. Under the False Claims Act, whistleblowers may bring “qui tam” actions alleging violations of the Anti-Kickback Statute.  If the Federal government brings a successful action as a result of the qui tam action, the whistleblower receives a percentage of the ultimate recovery.

Employers should regularly audit their practices to look for any signs of inappropriate financial transactions in exchange for referrals. Their employment agreements and policies should expressly forbid such conduct, and employers should also establish internal procedures through which employees who wish to raise complaints are encouraged to come forward. Establishing an office of an ombudsperson to handle complaints can provide employees with a vehicle to have their voices heard. Further, individuals who come forward should be informed that they have the right to make complaints without fear of retaliation. By taking proactive steps, health care industry employers can reduce the risk that the first time they learn about a kickback issue is upon receipt of a whistleblower lawsuit.  

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Miami Nursing Home To Pay Record $17M in Whistleblower Suit

Doctor admits taking kickbacks for prescribing risky drug

A suspended doctor pleaded guilty Friday to a felony charge of taking kickbacks and other benefits from a pharmaceutical company to prescribe its risky antipsychotic drug for thousands of his patients.

Michael Reinstein, who for decades treated patients in Chicago nursing homes and mental health wards, admitted in a 22-page plea agreement with prosecutors that he was given nearly $600,000 in benefits over the years for prescribing various forms of the drug clozapine, known as a risky drug of last resort, to patients in his care.

Prosecutors revealed in court that Reinstein is cooperating in an ongoing investigation. Under preliminary sentencing calculations, he faces up to four years in prison, but if he continues to assist investigators, the government will recommend a reduced sentence of a year and a half behind bars, according to his plea agreement.

At the same time Reinstein was entering his guilty plea, he also settled a civil lawsuit brought by the U.S. attorney's office and Illinois Attorney General Lisa Madigan alleging he submitted more than 140,000 false Medicare and Medicaid claims as part of the kickback scheme. The settlement calls for Reinstein to pay more than $3.7 million in penalties to the U.S. government and the state of Illinois.

In addition, Reinstein must forfeit an additional $592,000 as part of his guilty plea to the criminal charge.

Reinstein, 71, of Skokie, appeared in court in a rumpled gray suit. He told the court he’s suffering from a number of ailments, including bladder cancer, hypertension, diabetes and an enlarged prostate.

Two decades ago, Reinstein was known as one of the most prolific Medicaid billers in Chicago history, once charging the taxpayer-funded program for the care of 490 patients in just five days.

In 2009, a joint Tribune-ProPublica investigation found that Reinstein had been overprescribing powerful antipsychotic drugs in Chicago nursing homes and mental health facilities, amassing a worrisome record of assembly-line care that was linked to three patients' deaths and triggered lawsuits as well as accusations of kickbacks and fraud.

Now, six months after state regulators indefinitely suspended Reinstein's medical license, federal authorities filed a criminal charge alleging Reinstein took kickbacks from a pharmaceutical company to prescribe clozapine — known as a risky drug of last resort — to patients in his care.

In a telephone interview earlier this month, Reinstein's attorney, Terence Campbell, said that Reinstein was "working toward resolving the issues raised by the government and hopes to put this episode behind him soon."  (Continue Reading)

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Doctor admits taking kickbacks for prescribing risky drug

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Huge Prescriber of Risky Antipsychotic Drug to Plead Guilty to Taking Kickbacks

Huge Prescriber of Risky Antipsychotic Drug to Plead Guilty to Taking Kickbacks

A former Chicago psychiatrist who was the nation's top prescriber of the most powerful and riskiest antipsychotic drug intends to plead guilty to a federal felony charge of taking kickbacks from its manufacturer in exchange for prescriptions, court records show.

The U.S. Attorney for the Northern District of Illinois filed a single felony charge against Dr. Michael Reinstein this week for taking $2,000 in November 2009 from drugmaker Teva "in return for Reinstein's referrals of patients" for clozapine prescriptions.

Clozapine, also known as Clozaril and FazaClo, is approved to treat schizophrenia patients who don't respond to other medications. But it can have dangerous side effects, including seizures, inflammation of the heart muscle, and a drop in white blood cells. The drug is considered particularly risky for elderly patients.

A note in court records says that Reinstein intends to plead guilty at his arraignment next Friday. The action was first reported by the Chicago Tribune.

Reinstein's prescribing patterns have been detailed in two ProPublica reports.

In 2009, ProPublica and the Chicago Tribune reported how in one year Reinstein prescribed more of the antipsychotic clozapine to patients in Medicaid's Illinois program than all doctors in the Medicaid programs of Texas, Florida and North Carolina combined. Autopsy and court records showed that at least three patients under Reinstein's care had died of clozapine intoxication. At that time, Reinstein defended his prescription record, arguing that clozapine is effective and underprescribed.

Then, in 2013, as part of a ProPublica investigation into Medicare's failure to monitor problem prescribers, we reported that Reinstein prescribed even more clozapine in Medicare's prescription drug program for seniors and the disabled. Medicare continued to let him prescribe in the program even after the U.S. Department of Justice accused him of fraud and Illinois' Medicaid program suspended payments to him.

The U.S. Attorney's office declined to discuss Reinstein's upcoming plea. Reinstein's attorney, Terence Campbell, did not immediately return a phone call from ProPublica seeking comment. He told the Tribune on Thursday that Reinstein was "working toward resolving the issues raised by the government and hopes to put this episode behind him soon."

The Tribune reached Reinstein, as well, yesterday. He would not discuss the criminal case but denied any payments from Teva, clozapine's manufacturer, were for prescribing the drug. The doctor instead said the money was for lectures he gave.

In November 2012, the federal government filed a civil fraud lawsuit against Reinstein, saying he "received illegal kickbacks from pharmaceutical companies and submitted at least 140,000 false claims to Medicare and Medicaid for antipsychotic medications he prescribed for thousands of mentally ill patients in area nursing homes."

Last August, Illinois medical regulators indefinitely suspended Reinstein's medical license after determining that Reinstein received " illegal direct and indirect remuneration" from the maker of generic clozapine, did not consider alternative treatments for his patients, and disregarded patients' well-being. In response to the medical board's accusations, Reinstein's lawyers invoked his right against self-incrimination.

Early last year, Teva Pharmaceutical Industries Ltd., the maker of generic clozapine, agreed to pay more than $27.6 million to settle state and federal allegations that it induced Reinstein to prescribe the drug.

Reinstein's prescribing of clozapine appears to have declined after our 2009 articles about him. From 2007 to 2009, he wrote an average of 20,000 Medicare prescriptions annually for clozapine and the brand-name version, FazaClo. That figure dropped to about 8,000 in 2012, according to data obtained by ProPublica.

Check out how your doctor's prescribing within Medicare compares to others in his or her specialty in your state. Visit our Prescriber Checkup tool.

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Huge Prescriber of Risky Antipsychotic Drug to Plead Guilty to Taking Kickbacks