Psych Crime Reporter

July 8, 2014

Maryland Sukhveen K. Ajrawat indicted for federal health care fraud

Filed under: fraud,Medicaid-Medicare fraud,mental health — Psych Crime Reporter @ 3:13 pm

Greenbelt, Maryland – A federal grand jury has indicted two doctors, Paramjit Singh Ajrawat, age 60, and his wife, Sukhveen Kaur Ajrawat, age 56, both of Potomac, Maryland, on charges of health care fraud in connection with the pain clinic they owned and operated. The indictment was returned on June 24, 2014.

The indictment was announced by United States Attorney for the District of Maryland Rod J. Rosenstein; Special Agent in Charge Robert Craig of the Defense Criminal Investigative Service – Mid-Atlantic Field Office; Special Agent in Charge Nicholas DiGiulio, Office of Investigations, Office of Inspector General of the Department of Health and Human Services; Special Agent in Charge Drew Grimm, Office of Personnel Management, Office of Inspector General; Special Agent in Charge Stephen E. Vogt of the Federal Bureau of Investigation; Special Agent in Charge Bill Jones, of the Washington Regional Office, U.S. Department of Labor – Office of Inspector General, Office of Labor Racketeering and Fraud Investigations; and Special Agent in Charge Paul Bowman of the U.S. Postal Service, Office of Inspector General.

According to the indictment, P. Ajrawat was a licensed physician in Maryland who specialized in interventional pain management. S. Ajrawat was a licensed psychiatrist in Maryland. The Ajrawats owned and operated Washington Pain Management Center (WPMC) located in Greenbelt.

The 16-count indictment alleges that from at least August 2008 through May 2014, the Ajrawats engaged in a scheme to defraud federal health benefit programs including: Medicare, Medicaid, TRICARE, Federal Employees Health Benefits Program and the Office of Workers’ Compensation Programs. Specifically, the indictment alleges that the Ajrawats filed claims for procedures that were not performed (rather, less expensive procedures were performed and then the Ajrawats falsely billed for procedures that provided higher reimbursements), or were not performed in compliance with the requirements for reimbursement.

For example the indictment alleges that the Ajrwats submitted claims that P. Ajrawat had performed an epidural, when instead P. Ajrawat had performed less invasive injections using lidocaine, which was not indicated for epidural use. The Ajrawats allegedly falsely documented the use of an ultrasound machine to direct needle placement in certain patient files and caused the alteration or destruction of patient files to conceal the scheme.

The indictment also seeks the forfeiture of $2,329,109, believed to be the proceeds of the scheme.

The defendants face a maximum sentence of 10 years in prison for each count of health care fraud. An initial appearance has not yet been scheduled.

An indictment is not a finding of guilt. An individual charged by indictment is presumed innocent unless and until proven guilty at some later criminal proceedings.

United States Attorney Rod J. Rosenstein praised DCIS, HHS-Office of Inspector General, OPM-Office of Inspector General, FBI, U.S. Department of Labor-Office of Inspector General, and the U.S. Postal Service-Office of Inspector General for their work in the investigation. Mr. Rosenstein thanked Assistant United States Attorney Kelly O. Hayes, who is prosecuting the case.

Source: “Doctors Indicted For Health Care Fraud,” news release of the United States Attorney’s Office, District of Maryland, June 26, 2014.

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January 11, 2013

Psychiatrists charged, disciplined nationwide August-October 2012

Filed under: health care licensing board discipline,mental health,psychiatrist — Psych Crime Reporter @ 3:36 pm

On October 24, 2012, the Virginia Board of Medicine reprimanded psychiatrist Daniel Acosta. The Board’s Consent Order states that on March 13, 2012, the North Carolina Medical Board reprimanded Acosta and ordered that he attend continuing medical education on record keeping and prescribing, based on findings that Acosta’s diagnosis, treatment and documentation of six patients failed to conform to the standards of acceptable and prevailing medical practice.

On September 7, 2012, the Michigan Department of Licensing and Regulatory Affairs summarily suspended the license of psychiatrist Nan Beth Alt on charges of negligence, lack of good moral character, fraud or deceit in obtaining or attempting to obtain a third party reimbursement and allowing an unauthorized person to use her medical license. The complaint filed against Alt states that allowed her father, also a physician, to work out of her office and also wrote provided pre-signed prescriptions forms for him. The senior Alt’s medical license had previously been suspended.

On August 31, 2012, the Texas Medical Board ordered psychiatrist Robert Alan Woodward to pay an administrative penalty of $5,000 in addition to ordering him successfully complete at least eight hours of continuing medical education on the topic of risk management, among other terms and conditions. According to the Board’s report, this disciplinary action was the result of Woodward having failed to renew his controlled substance prescribing certificate when it expired in November 2010 and wrote more than 500 prescriptions for controlled substances before finally renewing it in March 2011.

On September 17, 2012, the Medical Board of California issued an Accusation against psychiatrist Lana Le Chabrier, relative to Le Chabrier’s criminal conviction. According to the Board’s document, on or about July 12, 2012, Le Chabrier was found guilty of health care fraud and conspiracy to commit health care fraud against the Medicare program. Le Chabrier was sentenced to six and a half years prison.

On or about October 18, 2012, Harvard psychiatrist David Herzog surrendered his licensed to the Massachusetts Board of Medicine. Herzog, who founded the Harris Center at Massachusetts General Hospital (an eating disorders center), was found to have engaged in sexual misconduct with a bulimic patient. Administrative findings describe and increasingly friendly relationship between Herzog and the patient, culminating in a sexual encounter in the patient’s home while her husband was away.

January 2, 2013

Owner of chain of mental health centers pleads guilty to fraud

WASHINGTON – The owner of a string of community mental health centers pleaded guilty today in connection with a health care fraud and money laundering scheme involving defunct health care provider Health Care Solutions Network Inc. (HCSN), announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office.

Armando Gonzalez, 50, of Hendersonville, N.C., pleaded guilty before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to commit health care fraud and one count of conspiracy to commit money laundering.  Under the terms of his plea agreement, Gonzalez will also forfeit his interest in property valued at several million dollars, including $987,910 in currency seized in July 2012 as well as several vehicles and properties located in Hendersonville.

According to court documents, HCSN operated community mental health centers (CMHC) at three locations in Miami-Dade County, Fla., and one location in Hendersonville.  HCSN purported to provide partial hospitalization program (PHP) services to individuals suffering from mental illness.  A PHP is a form of intensive treatment for severe mental illness.

According to Gonzales’s plea agreement, HCSN obtained Medicare beneficiaries to attend HCSN for purported PHP treatment that was unnecessary and, in many instances, not even provided.  HCSN obtained beneficiaries in Miami by paying kickbacks to owners and operators of assisted living facilities (ALF).  According to court documents, HCSN routinely admitted patients in Miami who were ineligible for PHP treatment because they suffered from medical conditions – including mental retardation, dementia and Alzheimer’s disease – that could not be effectively treated by PHP services HCSN was purporting to provide.

According to Gonzalez’s plea agreement, his employees routinely fabricated patient census data and patient medical records that were then utilized to support false and fraudulent billing to government sponsored health care benefit programs, including Medicare and the Florida Medicaid program.

Gonzalez pleaded guilty to directing his employees in North Carolina to routinely submit fraudulent PHP claims for Medicare patients who were not even present at the CMHC or on days when the CMHC was closed due to snow.  Similar to HCSN’s Florida operations, patients who were suffering from conditions such as mental retardation were improperly and routinely admitted to HCSN for purported treatment.  To increase its patient base, HCSN Hendersonville employed “marketers” in North Carolina who recruited ineligible patients from surrounding counties.  HCSN would then transport the patients daily and reward them for their attendance by giving them cigarettes.

In furtherance of the North Carolina fraud scheme, HCSN employees and licensed therapists routinely fabricated patient progress notes purportedly documenting intensive mental health therapy.  In reality, patients were crowded into dysfunctional groups that often exceeded more than 20 people. HCSN therapists would then produce bogus therapy notes for sessions that had little therapeutic value and, in many cases, never even occurred.

According to Gonzales’s plea agreement, he was the president of Miami-based Psychiatric Consulting Network Inc., which he used as a shell corporation to launder HCSN health care fraud proceeds.

According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported mental health services. The false and fraudulent billing resulted in more than $28 million in payments from Medicare and Florida’s Medicaid programs.

In addition to Gonzalez, former HCSN employees John Thoen, Alexandra Haynes, Serena Joslin and Sarah Da Silva Keller have pleaded guilty to health care fraud and related charges.  ALF owners Daniel Martinez, Raymond Rivero, Ivon Perez and Alba Serrano have pleaded guilty to health care fraud and related charges for their roles in the scheme.  Alleged co-conspirators Paul Layman and Wondera Eason are scheduled for trial on Jan. 14, 2013, before judge Altonaga in the Southern District of Florida.

The cases are being prosecuted by Special Trial Attorney William J. Parente and Trial Attorneys Allan J. Medina and Steven Kim of the Criminal Division’s Fraud Section.  The case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

Source: “Leader of $63 Million Mental Health Fraud Scheme Pleads Guilty in Miami,” Department of Justice Office of Public Affairs press release, December 17, 2012.

October 31, 2012

County severs ties with psychiatrist who admitted sabotaging mountain bike trails

A man who the U.S. Forest Service says admitted to sabotaging bike trails in the Ashland watershed is no longer working as a psychiatrist for Jackson County, County Administrator Danny Jordan said Tuesday.

Jackson Tyler Dempsey, 57, is in negotiations with the state of Oregon seeking a plea agreement in his case, which both parties hope will be settled within two weeks, according to court records.

Dempsey was arrested in July when a Forest Service officer said that Dempsey admitted to stringing nylon cord and laying nails and vegetation across trails in the Ashland watershed.

Dempsey, who was charged with fourth-degree assault and three counts of reckless endangerment, said he sabotaged the trails because he “did not like downhill mountain bikers,” according to the Forest Service report.

Jordan confirmed that Dempsey stopped working for Jackson County Mental Heath on Oct. 19, but he would not say whether Dempsey was fired or resigned. Jordan also declined to answer any questions about the case or Dempsey’s employment.

Open positions for a psychiatrist, a mental health specialist and a division manager for the Mental Health Department were all posted on the county website last week.

When asked about Dempsey’s case last month, Jordan said Dempsey should be afforded due process of law and that his alleged crimes did not conflict with his ability to perform his psychiatry job.

Jordan said then that the county would pay close attention to whether the Oregon Medical Board pursued any sanctions against Dempsey’s medical license.

As of Tuesday, Dempsey was still a licensed psychiatrist with the state of Oregon, according to a representative with the Oregon Medical Board. The OMB has not reprimanded Dempsey in any way, the representative said.

Previous court dates of Sept. 24 and Oct. 29 were postponed because Dempsey and his attorney were working through negotiations with the state to resolve the case before it went to trial, according to court records.

A new trial date has been set for 1:30 p.m. Nov. 19 in Jackson County Circuit Court, provided a plea agreement isn’t reached.

Source: Teresa Ristow, “Jackson County severs ties with trail saboteur,” Mail Tribune, October 31, 2012.

October 30, 2012

State revokes psychiatrist Williams Ayres

Filed under: child molestation,mental health,psychiatrist — Psych Crime Reporter @ 10:45 am

On October 24, 2012, the Medical Board of California revoked the license of psychiatrist William Ayres.

Ayres was arrested in April 2007 on charges of lewd and lascivious conduct upon a child under age 14 years.

His trial commenced in July 2009 and ended in a mistrial.

Retrial was scheduled for April 2010.

In March 2010, Ayres’ counsel filed a request to inquire into Ayres’ competency to stand trial. The jury in that matter informed the court on June 17, 2011 that it was hopelessly deadlocked and unable to reach a verdict as to competence.

The court ordered Ayres to evaluation and treatment. He was admitted to Napa State Hospital on October 25, 2011. A February 2012 report from the hospital confirmed a diagnosis of dementia.

(A Napa Hospital psychologist later reported that Ayres faked having symptoms of dementia. News items reported that Ayres had been seen in public carrying on socially with friends and family without any signs of dementia.)

Source: Stipulation to Surrender and Revocation of License and Order in the Matter of the Accusation Against William H. Ayres, Physician and Surgeons Certificate No. G 8452, M.D., Case No. 03-2007-182874, Medical Board of California, Department of Consumer Affairs.

Psychologist says psychiatrist William Ayres, charged with child molestation, faked dementia symptoms

Filed under: child molestation,mental health,psychiatrist — Psych Crime Reporter @ 10:40 am

REDWOOD CITY, California  — The psychologist who branded William Ayres a malingerer took the stand Monday to explain why he believes the accused child molester has been lying about his symptoms of dementia.

Napa State Hospital sent Ayres, 80, back to San Mateo County this summer after concluding the former child psychiatrist was fit to undergo a second criminal trial on charges of sexually abusing five young boys who were sent to him for treatment. Ayres’ first criminal trial in 2009 ended in a hung jury.

John McIlnay, a forensic psychologist who specializes in sniffing out people who are faking mental problems to escape punishment, testified that Ayres exhibited abnormal swings between lucid and foggy states of mind. Ayres’ results on assessments of his overall ability to function day-to-day also varied widely, said McIlnay. He also noted that there were discrepancies between how the patient acted in clinical settings and during down time.

“I don’t believe that dementia can wax and wane to the degree that the behavioral observation and reports would suggest,” said McIlnay, who combed through Ayres’ records from before and after he was admitted to Napa in October 2011. He ultimately overruled several Napa clinicians who had diagnosed him with dementia.

Followed suggestion

One episode that caught McIlnay’s eye involved the level of staffing during lunch at the psychiatric facility. Concerned about his safety, Ayres sought out the nursing supervisor of his unit to request that she increase the number of staff present at that time. When the supervisor, having noticed the same issue, followed Ayres’ suggestion the next day, he sought her out to thank her.

That behavior contrasted sharply with some of Ayres’ interactions with clinicians. In one competency test regarding the legal system, McIlnay said, Ayres was uncooperative and evasive, claiming he didn’t know what a judge does.

Three Napa clinicians who testified Friday for the defense said it’s normal for the symptoms of people with dementia to vary from day to day.

Many questions

Ayres’ lead attorney, Jonathan McDougall, made the unusual decision Monday morning to testify as a witness regarding his client. McDougall described episodes of Ayres’ forgetfulness and the difficulty he has had strategizing with a client who doesn’t remember previous conversations.

When prosecutor Melissa McKowan asked about comments Ayres made at Napa indicating he believes he will be convicted if tried again, McDougall said Ayres misconstrued conversations the two men had regarding the case. McDougall said he’d told his client their chances of winning at trial would be worse if Ayres is not sharp enough to testify on his own behalf.

Prosecutors believe Ayres molested more than 30 boys, but most of the alleged victims fell outside the statute of limitations. After the 2009 mistrial, Ayres’ family hired McDougall, who soon raised questions about his client’s mental state. A trial on Ayres’ competency ended in 2011 with a hung jury, and the District Attorney’s Office conceded the defendant had dementia.

But McIlnay concluded Ayres was grossly exaggerating his cognitive problems. Now San Mateo County Superior Court Judge John Grandsaert is tasked with ruling on Ayres’ fitness. The competency hearing will continue Tuesday with more direct examination of McIlnay, followed by cross-examination.

Source: Aaron Kinney, “Napa psychologist brands William Ayres, accused child molester, a malingerer,” San Mateo County Times, October 29, 2012.

October 27, 2012

New York hospital owes $7 million for fraudulent mental health claims

Filed under: crime and fraud,mental health,psychiatric hospital or facility — Psych Crime Reporter @ 3:00 pm

VALHALLA, N.Y. – Westchester Medical Center in Valhalla will have to cough up $7 million for submitting false reimbursement claims to Medicaid from 2001 to June 2010, under a civil fraud settlement announced by U.S. Attorney Preet Bharara for the Southern District of New York.

Bharara said the Medical Center billed Medicaid for outpatient mental health services at its Behavioral Health Center without providing proper documentation.

“Medicaid is a vital resource for people who suffer from physical and mental illnesses and related conditions,” Bharara said in a statement. “We have absolutely no tolerance for those who fail to comply with the program, particularly in these lean times when budgets are stretched thin and belts are being tightened.”

Westchester Medical Center representatives were not immediately available for comment Wednesday afternoon.

Federal regulations require facilities like WMC to submit documents such as treatment plans and progress notes, which WMC did not, according to the U.S. Attorney’s office.

Medicaid costs are shared by federal and state governments. As part of the settlement, WMC will pay an undisclosed portion of the $7 million to New York State.

WMC’s Behavioral Health Center is a public facility that treats children, adolescents and adults who suffer from mental and emotional issues.

Source: Robert Michelin, “Westchester Medical Center Owes $7 Million In Fraud Settlement, Peekskill Daily Voice, October 24, 2012.

October 24, 2012

California psychiatrist Stephen Melcher loses Texas medical license following child molest conviction

Filed under: child molestation,crime and fraud,mental health,psychiatrist — Psych Crime Reporter @ 11:43 am

On August 3, 2012, a Disciplinary Panel of the Texas Medical Board temporarily suspended, without notice, the Texas Medical License of Stephen Melcher, M.D., of Sacramento, CA, after determining that Dr. Melcher poses a continuing threat to the public welfare.

It is alleged that on October 11, 2011, Dr. Melcher molested an 11-year-old boy during a dinner party at his residence and an arrest warrant was issued for Dr. Melcher, charging him with that offense. On May 25, 2012, Dr. Melcher entered a plea of no contest to the charge of felony sexual act with a minor and was sentenced to one year in jail with a five-year probationary term.

Melcher’s California Medical License was suspended in June. Melcher is board-certified in psychiatry.

The suspension remains in effect until the board takes further action. Dr. Melcher has a right to another hearing, with notice, as soon as is practicable.

Source: “TMB suspends Texas License of California Physician,” news release of the Texas Medical Board, August 3, 2012.

October 22, 2012

Employee of National Alliance on Mental Illness charged with distributing child porn

Filed under: child pornography,mental health — Psych Crime Reporter @ 8:47 pm
Tags: ,

AUGUSTA, Maine – A man from Augusta who worked at the National Alliance on Mental Illness and ran a martial arts studio has been arrested, charged with distributing child pornography.

Wade Hoover was arrested at the Augusta offices of the National Alliance on Mental Illness (NAMI) Wednesday morning.

According to a media release from State Police Spokesperson Steve McCausland, officers from the State Police Computer Crimes Unit and the federal Immigration and Customs Enforcement Agency were operating on a tip when they went to his office.

Police say they found Hoover was using a personal computer to distribute child porn images via NAMI’s internet service.

NAMI has cooperated with the investigation. Police say the organization was unaware as to how Hoover was allegedly using their internet connection.

Investigators say they found dozens of images of child porn on Hoover’s computer. They believe at least one of the children is from Maine.

Hoover also operates the Kosho Warrior’s Martial Arts studio and United Martial Arts Academy in Lewiston. He is a former instructor at the United Martial Arts Academy in Augusta.

Investigators believe more charges are coming.

Hoover is being held at the Kennebec County Jail.

Source: Krister Rollins, “Augusta man arrested on child pornography charges,” WCSH News Center 6 (Portland, Maine), October 3, 2012.

October 8, 2012

Armenian prosecutors launch criminal case against Vardenis psychiatric facility

Filed under: crime and fraud,mental health,psychiatric hospital or facility,psychiatrist — Psych Crime Reporter @ 1:54 pm

Sona Truzyan, press spokesperson for the General Prosecutor’s Office, informed Hetq Online that, as per the RA General Prosecutor’s decision, criminal proceedings for human trafficking have been launched in the case of Vardenis Psychoneurologic Boarding House state non-profit organization (SNCO), based on a previous report by Hetq Online.

Earlier, the General Prosecutor’s Office had stated that Vardenis Psychoneurologic Boarding House Director Nver Hovhannisyan had been arrested for exploiting 4 patients in his care. As reported previously, the patients were working in the nearby village of Nerkin Shorzha herding livestock belonging to the psychiatric hospital but also to Hovhannisyan himself. In particular, the director of the psychiatric hospital (which is under the RA Ministry of Labor and Social Affairs’ jurisdiction), abusing his official position and in the name of “work therapy,” from May 16, 2012, to Sept. 18, 2012, exploited 4 individuals under the psychoneurological boarding house’s care, suffering from serious illness, and only partly aware of the nature and significance of their act as a result of mental illness. In particular, for months, the director involved the patients in the work of grazing, milking, cleaning the shed and other forced work for about 70 large and about 130 small animals in the village of Nerkin Shorzha about 30 km from the psychiatric hospital.

“The criminal proceedings [launched Oct. 3, 2012] have been sent to the RA Police to carry out an investigation,” reads a statement issued by the General Prosecutor’s Office on Oct. 4.

Recall, another criminal case has been launched under RA Criminal Code Article 179 Section 2 Paragraphs 1 and 3 (“squandering or embezzlement”). The Fight Against Crime Unit as well as the Vardenis Division of the RA Police also discovered on Oct. 3 that from April to September of this year, Hovhannisyan embezzled 3,100 liters of the organization’s gasoline, causing 1,302,000 AMD (about $3,188 USD) of damages to the psychiatric hospital.

Source: Saro Baghdasaryan, “Criminal Case Launched Against Vardenis Psych Hospital Director for Exploiting Patients,” HetQ, October 4, 2012.

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