A federal grand jury has returned separate indictments charging a Dublin couple and doctor with health care fraud and alleging they billed government insurance programs for pain and scar creams that recipients said they never requested or wanted.
The case was part of a nationwide health care fraud take-down announced Thursday by Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Tom Price, M.D.
The indictments were announced Thursday as part of a nationwide crackdown on fraudulent health care providers.
Darrell Bryant and Gifty Kusi, a husband and wife who own and manage Health & Wellness Pharmacy in Dublin were indicted Thursday along with Dr. Jornel Rivera, the co-owner of the pharmacy.
The indictment alleges that they fraudulently received more than $3 million from the Ohio Department of Medicaid and Medicaid Managed Care Organizations (MCOs) through multiple schemes including billing for compound creams that were not provided or not requested by patients, billing for counseling services that were not provided or billing for group counseling sessions as individual counseling services. The indictment charges all three defendants with conspiracy to commit health care fraud and health care fraud.
“In the Health and Wellness Pharmacy case, the investigation found that people who legitimately needed drug treatment and counseling weren’t getting it – even though the company charged for it,” said Ohio Attorney General Mike DeWine. “In the midst of the opioid epidemic in Ohio, it is critical that healthcare providers are rendering services that are meant to help Ohioans struggling with addiction.”
“Health care fraud creates victims out of patients, providers, and taxpayers,” said Benjamin C. Glassman, United States attorney for the Southern District of Ohio. “It’s a crime that breaks the bonds of trust between doctor and patient, and between government and the people, just for the sake of personal greed.”
“The charges announced today should send a strong message to criminals that theft from vital health care programs will not be tolerated”, said Lamont Pugh III, Special Agent in Charge, U.S. Department of Health & Human Services. “The [Office of Inspector General] and our law enforcement partners will continue to be vigilant in our efforts to protect tax payer dollars that are intended to aid our most vulnerable citizens.”
Thursday’s nationwide enforcement action is the largest ever health care fraud enforcement action by the Medicare Fraud Strike Force, involving 412 charged defendants across 41 federal districts, including 115 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $1.3 billion in false billings.
Of those charged, over 120 defendants, including doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics. Thirty state Medicaid Fraud Control Units also participated in today’s arrests. In addition, HHS has initiated suspension actions against 295 providers, including doctors, nurses and pharmacists.
Glassman commended the investigation of this case by the HHS-OIG, Ohio Attorney General Mike DeWine’s Medicaid Fraud Control Unit and IRS Criminal Investigation, as well as Assistant United States Attorney Kenneth Affeldt and Special Assistant United States Attorney Maritsa Flaherty, who are representing the United States in this case.
