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Ten Year Sentence & $2.9 Million Forfeiture Ordered in Medicare Home Health Care Fraud

December 20, 2012 By: Cal Skinner Category: Bahir Haj Khali, House Call Physicians, Medicare, Medicare Fraud, Mohammed Khamis Rashed, Paschal U. Oparah, Patrick Otlewski, Ryan Hedges

A press release from the U.S. Attorney’s Office:

OWNER OF FORMER SOUTH SUBURBAN HOME HEALTH CARE BUSINESS SENTENCED TO 10 YEARS IN PRISON FOR $2.9 MILLION MEDICARE FRAUD

CHICAGO — The co-owner of a former south suburban home health care business was sentenced today to 10 years in federal prison for defrauding Medicare of more than $2.9 million by submitting tens of thousands of false claims annually that misrepresented medical services provided to beneficiaries.

BAHIR HAJ KHALIL, the executive manager and co-owner of House Call Physicians LLC, in Palos Hills, was the last of three defendants to be sentenced following Khalil’s conviction at a trial in September.

“I want the word to go forth from this sentence that this kind of crime does not pay and will be treated harshly,” U.S. District Judge Charles Kocoras said in Federal Court in Chicago. Judge Kocoras imposed the maximum sentence of 10 years on each of seven counts and ordered them to be served concurrently.

Khalil, 34, of Palos Hills, a native of Syria and a Canadian citizen who was not authorized to work in the U.S., has remained in federal custody since he was arrested in July 2011 and House Call Physicians closed its doors. He will be subject to deportation after completing his sentence.

“Khalil preyed on Medicare beneficiaries — people who were sick, elderly and disabled — and exploited them because they were vulnerable and easy to use to accomplish his fraud. To Khalil, the math was simple: Find people on Medicare; perform unnecessary tests and services; bill Medicare; get paid,” the government argued at sentencing.

Khalil was convicted of six counts of health care fraud and he and his business partner, MOHAMMED KHAMIS RASHED, 46, of Chicago, were also convicted of one count of visa fraud for attempting to illegally obtain a work visa for Khalil. Rashed, a former engineer for the City of Chicago who invested in House Call and was a co-owner, was sentenced by Judge Kocoras on Tuesday to six months in prison and fined $20,000.

A third defendant PASCHAL U. OPARAH, 47, of South Holland, a suspended podiatrist who pleaded guilty to health care fraud last April and cooperated with the government’s investigation, was sentenced on Dec. 12 to 18 months in prison, and was ordered to pay $791,095 in restitution.

Khalil was ordered to pay restitution and forfeiture, both in the amount of $2,934,392, representing proceeds from the fraudulent billing scheme.

The forfeiture includes approximately $155,575 that was seized when he was arrested.

Over the course of the fraud, Khalil wrote himself more than $400,000 in checks from the company’s bank account.

According to trial evidence and court records, the fraud scheme involved billing for:
services that were not medically necessary, including uncomfortable nerve conduction tests;
services purportedly provided by physicians when, in fact, they were performed by physician assistants; and services purportedly performed by a licensed podiatrist when, in fact, they were performed by Oparah, whose license was suspended.

Khalil also directed the false certification of patients as eligible for home health services when, in fact, they were not homebound as required by Medicare.

Although he had no medical training or license, Khalil established House Call Physicians in 2006 and engaged in Medicare fraud from that time until he was arrested in July 2011.

In secretly recorded conversations with physicians and physician assistants, Khalil made it clear that he believed that he, not the doctors, should decide when patients needed a procedure like a nerve conduction or bone density tests.

The government was represented by Assistant U.S. Attorneys Patrick Otlewski and Ryan Hedges.

Gary Shapiro

Gary Shapiro

The sentences were announced by Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois; Thomas R. Trautmann, Acting Special Agent-in-Charge of the Chicago Office of Federal Bureau of Investigation; Lamont Pugh III, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General; and James Vanderberg, Special Agent-in-Charge of the U.S. Department of Labor Office of Inspector General. The U.S. Railroad Retirement Board Office of Inspector General also participated in the investigation. The investigation was conducted by the Medicare Fraud Strike Force, which expanded to Chicago in 2011, and is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Justice Department and HHS to focus their efforts to prevent and deter fraud and enforce anti-fraud laws around the country.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

Two Ken Koehler Pieces Arrive Today

October 27, 2012 By: Cal Skinner Category: County Executive, Irene Napier, Ken Koehler, McHenry County, McHenry County Board., Medicare, Pro-Life, Senior, Senior Citizen

It’s a beautiful Saturday with people out raking leaves, taking leisurely walks and talking to neighbors.

And, I’ve been knocking on doors trying to convince people to vote against Jack Franks’ referendum to create a County Executive form of government.

The argument with which I am having the most success is pointing out that a County Executive would be able to spend up to $25,000 without prior County Board approval.

Hey, we live in Illinois. It doesn’t take a lot of imagination to envision abuses under such rules.

I even chafe when the McHenry County College Board spends up to $25,000 without going out for bid (allowed by a state law I did not vote for). I cringe to think of the potential abuses with no bids and no board approval.

In any event, when I went to the mailbox, I found two mailings from McHenry County Board Chairman and candidate for re-election in my District 2.

The first was addressed just me.

It was for senior citizens.

When did that happen?

In any event, the address side has a headline about “Fighting for Senior Healthcare in McHenry County!”

Ken Koehler’s senior piece came First Class. And it had a “Forever” stamp.

What’s that all about, I’m thinking as I look at it.

The back of senior healthcare post card from Ken Koehler says, “Medicare is being raided to the tun of $716 Billion and it is just wrong!”

There is a big headline on the back of the piece and a letter is teeny tiny print to U.S. House Speaker John Boehner opposing cuts in the Federal Medicare program.

I think it’s a stretch to use the issue in a county campaign, just as it is a stretch for Mike Madigan to use the issue four times (that I’ve published) on behalf of Independent Dee Beaubien.

There is also a sticker indicating that Koehler was endorsed by both the Northwest and Daily Heralds.

The second mailing was in an envelope from Pro-Life leader Irene Napier.

It came First Class, too.

Irene Napier argues that re-electing Ken Koehler will “promote good moral standards” as she bestows here “personal endorsement.”


Along with the letter came the same palm card that was enclosed with the pro-gun mailing.

Second Misleading Social Security-Medicare Post Card Sent on Dee Beaubien’s Behalf Last Week from Mike Madigan

October 21, 2012 By: Cal Skinner Category: Dave McSweeney, Dee Beaubien, Medicare, Mike Madigan, Social Security

When I posted the “David McSweeney will take away Social Security and Medicar”e post card from the Illinois Democratic Party on Dee Beaubien’s behalf, I didn’t know that two had hit the mailboxes last week.

I can’t be sure of the order, just that they both came the third week of October.

Including the two this week, I could a total of four negative Social Security mailings.

Here’s the other one. This makes four on the subject matter irrelevant to a state legislative race.

Talk about money to burn.

Same ol’, same ol’ on the back of the Mike Madigan Social Security hit piece aimed at David McSweeney. This is the address side.

Guide for people considering moving out of Illinois.

The back has a guy older than I with a cardboard sign saying, “Please Help.”

Maybe he’s asking people to help him move out of Illinois.

That, incidentally, was the conversation I had with a man after church today.

He had a book entitled something like “The 50 Best Small South Towns.”

He has found a couple of towns where four-bedroom homes run under $100,000.

And, where property taxes are $300-400 a year.

“Please Help,” says the old man’s sign, sent by Democratic Party Chairman Mike Madigan on behalf of Dee Beaubien’s campaign to defeat Republican Dave McSweeney.

Beaubien Sends Second Mailing on Social Security & Medicare

October 17, 2012 By: Cal Skinner Category: Dave McSweeney, Dee Beaubien, Medicare, Mike Madigan, Social Security

A second piece concerning Social Security and Medicare has been sent by the Illinois Democratic Party on behalf of Dee Beaubien (Ind.-Madigan).

Of course, state legislators have nothing whatsoever to do with either program, as Mike Madigan well knows.

But, one would imagine, his polling shows most seniors don’t know the difference between what Congressmen and state legislators do.

Here’s the address side:

Hey, you’re getting Social Security and Medicare. “You earned it,” the Dee Beaubien piece says.

Here’s the back:

Note that the subscript does not say Dave McSweeney wants to take away Social Security and Medicare.

More Medicare Fraud Takedowns, including Psychological Care for Dead People

October 04, 2012 By: Cal Skinner Category: Bhair Haj Khalil, House Call Physicians, Medicare, Medicare Fraud, Mohammed Khamis Rashed, Paschal U. Oparah, Patrick Otlewski, Paul Tzur, Robert Kolbusz, Ryan Hedges, Sharon Rinaldi, Stephen Lee, Tinos Diamantatos

A press release from the U.S. Attorney’s Office:

CHICAGO AREA DERMATOLOGIST AND PSYCHOLOGIST CHARGED IN NATIONWIDE MEDICARE FRAUD STRIKE FORCE TAKEDOWN

Total of 91 Defendants Charged Nationwide for Submitting
Approximately $430 Million in False Billing

CHICAGO — An area dermatologist and a psychologist were charged this week with engaging in separate health care fraud schemes to defraud the Medicare program and/or private health insurers of millions of dollars, federal law enforcement officials announced today. Also today, a co-owner of a former south suburban home health care business was convicted of a federal charge, a week after the other co-owner was convicted of health care fraud by a federal jury.

The Chicago charges are part of a nationwide takedown by Medicare Fraud Strike Force operations in seven cities, announced today by the Departments of Justice and Health and Human Services, that led to charges against 91 defendants for their alleged participation in schemes to collectively submit approximately $429.2 million in fraudulent claims.

In Chicago, two defendants were charged in separate indictments filed yesterday and Tuesday in U.S. District Court. One defendant, a licensed psychologist, was charged with health care fraud for allegedly over-billing the Medicare program, while the dermatologist was charged with mail and wire fraud for defrauding Medicare and private health insurance companies.

“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,” said Attorney General Holder. “Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program — they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans.”

“These cases ought to be taken as a warning that dishonest medical providers ought to think twice before cheating Medicare and private insurers,” said Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois.

Details of the Chicago cases follow:

United States v. Robert Kolbusz

Dr. Robert Kolbusz, a dermatologist in Downers Grove, was charged in a seven-count indictment returned yesterday with defrauding Medicare and private health insurance companies by submitting false claims for hundreds of patients resulting in millions of dollars of losses. Kolbusz falsely diagnosed patients with actinic keratosis, or sun-induced skin lesions that have the potential to become cancerous, and then billed Medicare, Blue Cross Blue Shield of Illinois, Aetna, and Humana for treatments that were ineffective and falsely documented.

Kolbusz, 55, of Oak Brook, was charged with four counts of wire fraud and three counts of mail fraud. He will be arraigned at a later date in U.S. District Court.

Between 2003 and 2010, Kolbusz allegedly falsely documented patients’ charts to support medically unnecessary, cosmetic treatments that he ordered. In some instances, he falsely documented the removal of more than 1,000 lesions from patients over several years of treatment, according to the indictment.

The government is represented by Assistant U.S. Attorneys Stephen Lee and Tinos Diamantatos. The case was investigated by the Federal Bureau of Investigation and the Health and Human Services Office of Inspector General (HHS-OIG.)

United States v. Sharon A. Rinaldi

Sharon A. Rinaldi, a licensed psychologist in Illinois, was charged in a five-count indictment returned on Tuesday with defrauding Medicare by submitting thousands of false claims for providing psychotherapy services to Medicare beneficiaries residing in skilled nursing homes in the Chicago area.

Rinaldi, 57, of Inverness, was charged with five counts of health care fraud. She is scheduled to be arraigned on Oct. 10 in U.S. District Court. The indictment also seeks forfeiture of more than $100,000 that was seized from her home and a personal bank account.

According to the indictment, between December 2008 and August 2012, Rinaldi claimed that she provided services to Medicare beneficiaries who were deceased at the time; that she provided services on certain dates when she was in other locations, such as Las Vegas and San Diego; and she inflated the number of hours that she had provided services on particular dates, often exceeding 24 hours in a single day.

The government is represented by Assistant U.S. Attorneys Paul Tzur. The case was investigated by the FBI and the HHS-OIG.

United States v. Khalil, et al.

In the home health care fraud case, which was indicted last year, a federal jury last week convicted Bhair Haj Khalil, the co-owner and executive manager of House Call Physicians LLC in Palos Hills, of six counts of health care fraud for submitting false claims totaling more than $2.5 million to Medicare, resulting in losses of more than $1.15 million.

Khalil, 34, formerly of Palos Hills and who is in federal custody, and his business partner, Mohammed Khamis Rashed, 46, of Chicago, were also convicted of visa fraud for attempting to illegally obtain a work visa for Khallil.

After a trial for both defendants last month, Khalil was convicted by a jury on Sept. 25, while Rashed’s case was tried by U.S. District Judge Charles Kocoras, who issued his guilty verdict today.

A third defendant, Paschal U. Oparah, a suspended podiatrist, pleaded guilty in the case last spring. All three are scheduled to be sentenced in December.

Evidence in the case showed that the fraud scheme involved billing for home health services as if they were performed by physicians when they were actually performed by physicians’ assistants; billing for podiatry services that were actually performed by Oparah, whose license was suspended; and falsely certifying that patients were eligible for home health services when they were not and causing medically unnecessary tests to be provided to Medicare beneficiaries.

The government is represented by Assistant U.S. Attorneys Patrick Otlewski and Ryan Hedges. The case was investigated by the FBI, the HHS-OIG, and the U.S. Department of Labor Office of Inspector General.

The charges in these cases carry the following maximum penalties on each count: health care fraud and visa fraud — 10 years in prison, and mail and wire fraud — 20 years in prison, and a $250,000 maximum fine, or an alternate fine totaling twice the loss or twice the gain, whichever is greater. If convicted, the Court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.

The Medicare Fraud Strike Force operations, which expanded to Chicago in February 2011, are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Gary Shapiro

The results of the nationwide takedown were announced today by Attorney General Holder, HHS Secretary Kathleen Sebelius, Assistant Attorney General Lanny A. Breuer of the Criminal Division, FBI Associate Deputy Director Kevin Perkins, Inspector General Daniel R. Levinson of the HHS-OIG, and Dr. Peter Budetti, Deputy Administrator for Program Integrity of the Centers for Medicare and Medicaid Services (CMS). Mr. Shapiro announced the Chicago charges together with William C. Monroe, Acting Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation, and Lamont Pugh III, Special Agent-in-Charge of the Chicago Regional Office of the HHS-OIG.

The public is reminded that indictments contain only charges and are not evidence of guilt. The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

Feds Take on More Accused of Kickbacks of $300-$600 for Home Health Care Referrals

September 25, 2012 By: Cal Skinner Category: Ana Nerissa Tolentino, Edgardo Hernal, Frederick Magsino, Halley Guren, Home Health Care, Kickbacks, Medicaid, Medicaid Fraud, Medicare, Medicare Fraud, Rosner Home Healthcare, Ttenej Senior Referral Agency

A press release from the U.S. Attorney’s Office:

NINE DEFENDANTS, INCLUDING TWO OWNERS OF A HOME HEALTH CARE AGENCY AND TWO PHYSICIANS, INDICTED FOR ALLEGEDLY PAYING AND RECEIVING KICKBACKS FOR MEDICARE PATIENT REFERRALS

CHICAGO — Two owners of a home health care agency in suburban Skokie and two physicians were among nine defendants indicted on federal charges for paying and receiving kickbacks in exchange for the referral of Medicare patients for home health care services, federal law enforcement officials announced today.

Defendants Ana Nerissa Tolentino, a registered nurse, and Frederick Magsino, both part owners of Rosner Home Healthcare, Inc., and Edgardo Hernal, a former Rosner employee, allegedly conspired to pay kickbacks to six co-defendants for the referral and retention of Medicare patients that enabled Rosner to bill Medicare.

Also indicted were

  • Emmanuel Nwaokocha and Masood Syed, both physicians;
  • Jenette George, who operated Ttenej Senior Referral Agency which provided senior citizens with referrals to home health agencies; and
  • Jennifer Holman, who was an office manager at a doctor’s office.

Co-defendants Titis Jackson and Carla Phillips-Williams were marketers of Rosner’s services.

The 27-count indictment was returned by a federal grand jury last Thursday.

Tolentino, 43,of Morton Grove; Magsino, 59, of Morton Grove; Nwaokocha, 59, of Skokie; Syed, 53, of Mt. Prospect; Jackson, 36, of Chicago; George, 59,of Chicago; and Phillips-Williams, 42, of Chicago, were initially arrested and charged in criminal complaints in late July of this year.

All seven were released on bond. Hernal, 55, of Westchester, and Holman, 53, of Chicago, were charged for the first time in the indictment.

All nine defendants will be arraigned in U.S. District Court on dates to be determined.

Three defendants — Tolentino, Magsino, and Hernal — were charged with one count of conspiracy to pay illegal kickbacks for Medicare patient referrals. Eight of the nine defendants were charged with two or more counts of violating the anti-kickback statute.

Gary Shapiro

The indictment was announced by Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois; Lamont Pugh III, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services, Office of Inspector General; and William C. Monroe, Acting Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation.

According to the indictment between January 2008 and July 2012, Tolentino, Magsino, and Hernal conspired with others to pay kickbacks and bribes to

  • doctors, such as Nwaokocha and Syed;
  • marketers, such as Jackson, George, and Phillips-Williams;
  • medical office employees, such as Holman;
  • nurses, and
  • others to refer Medicare patients to Rosner.

The three defendants charged with conspiracy allegedly paid kickbacks to increase Rosner’s patient census and to enrich Rosner and themselves.

The amount of kickbacks varied but generally ranged from $300 to $600 for each new patient’s completion of five home health visits in one cycle, and ranged between the same amounts for the repeat admission of a previous patient in a new cycle of home health care.

According to the previously filed complaints, Medicare paid Rosner approximately $13 million for claims submitted for home health services between January 2008 and January 2012. Neither the complaints nor indictment allege how much of Rosner’s total Medicare billings were fraudulent.

The complaints charged that between March and July 2012 alone, the following co-defendants received the amount of kickbacks listed:

  • Nwaokocha, $4,800;
  • Syed, $1,500;
  • Jackson, $24,000;
  • George, $13,500; and
  • Phillips-Williams, $3,000.

Conspiracy and each count of violating the anti-kickback statute carry a maximum penalty of five years in prison and a $250,000 fine. If convicted, the Court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.

The government is being represented by Assistant U.S. Attorney Halley Guren.

The public is reminded that an indictment is not evidence of guilt. The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.

The case falls under the umbrella of the Medicare Fraud Strike Force, which expanded operations to Chicago in February 2011, and is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Justice Department and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Nearly five dozen defendants have been charged in health care fraud cases since the strike force began operating in Chicago last year. Since June 2012, 16 defendants, including owners of other Chicago area home health care agencies and several other physicians, have been indicted in unrelated cases alleging Medicare referral kickback schemes.

Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention & Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

Democrats Use National Issues to Promote Dee Beaubien’s State Rep. Campaign

September 20, 2012 By: Cal Skinner Category: David McSweeney, Dee Beaubien, Democrat, Medicare, Mike Madigan, Social Security

The mailings from Mike Madigan’s Democratic Party of Illinois are getting stranger and stranger.

One promoted windmills that anyone with a brain knows that if proposed for her home town of Barrington Hills would cause her neighbors to go ballistic.

Dee Beaubien (Ind.-Madigan) goes after Republican Dave McSweeney as a “career politician” supported by “the same politicians who  want to cut Social Security and Medicare.”  She says she will “protect programs like Social Security and Medicare,” but gives no clue how.

Today comes one promising that Dee Beaubien will protect seniors from cuts in Social Security and Medicare.

On the back, the Democrats continue to stress that Dee Beaubien will be “an independent voice.”

In sixteen years in the Illinois General Assembly I don’t remember one vote on either subject.

Why?

Congress controls both programs.

Tribune Notices Medicare Penalties for Hospitals with High Readmission Rates

September 13, 2012 By: Cal Skinner Category: Centegra, Centegra Memorial Medical Center, Good Shepherd Hospital, Medicare, Northern Illinois Medical Center, Penalty, Sherman Hospital

Almost twenty days ago, McHenry County Blog reported on Medicare penalties being levied by the Federal government on local hospitals.

While the article focused on hospitals serving local patients, a Chicago Tribune article Thursday reported on hospitals statewide.

Being early in the alphabet helps businesses in the phone book, but is not necessarily an advantage in a list of hospitals being penalized.

Those Illinois hospitals getting the biggest penalty for high readmission rates within a month for Medicare patients are show in the graphic above.  Click to enlarge.

Hospitals McHenry County patients use most are listed below

  • Centegra Health System – Woodstock Hospital, Woodstock 1.00%
  • Centegra Health System – McHenry Hospital, McHenry 1.00%
  • Swedish American Hospital, Rockford 0.64%
  • Sherman Hospital, Elgin 0.61%
  • Advocate Good Shepherd Hospital, Barrington 0.48%
  • Provena – Saint Joseph Hospital, Elgin, 0.27%
  • Rockford Memorial Hospital, Rockford 0.26%
  • Saint Anthony Medical Center, Rockford 0.04%

South Barrington Doctor Gets 10 Months for Medicare Fraud

September 05, 2012 By: Cal Skinner Category: Amarjeet S. Bhachu, John Natale, Medicare, Medicare Fraud, South Barrington

A press release from the U.S. Attorney’s Office:

CHICAGO AREA SURGEON SENTENCED TO 10 MONTHS IN CUSTODY FOR MAKING FALSE STATEMENTS ABOUT SERVICES AND MEDICARE BENEFITS

CHICAGO — A Chicago area vascular and thoracic surgeon was sentenced today to 10 months in federal custody after being convicted at trial of making false statements in post-operation reports relating to health care services and Medicare benefits.

The defendant, DR. JOHN NATALE, was found guilty following a week-long trial in May of two counts of making false statements by a jury that also acquitted him of two counts of health care fraud and one count of mail fraud for allegedly defrauding Medicare.

Natale, 63, of South Barrington, was ordered to begin serving his sentence on Nov. 1by U.S. District Judge Rebecca Pallmeyer, who also imposed a fine of $40,000 and periods of community service during one year of supervised release after incarceration.

“The goal here was to collect more than he [Natale] otherwise would have been entitled,” Judge Pallmeyer said in determining that there was an intended loss to Medicare of at least $10,000.

Natale faced a maximum sentence of five years in prison and a federal sentencing guideline range of 15 to 21 months after Judge Pallmeyer also found that Natale had obstructed justice while testifying in his own behalf at trial.

Natale specialized in repairing abdominal aortic aneurysms, which is a weakening of the artery, and the trial focused on six surgeries he performed in 2003 and 2004 on patients at Northwest Community Hospital in Arlington Heights.

Natale later operated at Swedish Covenant Hospital in Chicago, according to his trial testimony.

Northwest Community Hospital medical officials, who also testified at trial, cooperated with the government’s investigation.

The evidence at trial showed, and the jury found, that for at least two patients in 2004, Natale prepared false post-operation reports that, among other things, contained extensive details about aneurysm repairs that he never performed, and falsely described the surgeries he did perform as being more complex and elaborate than they actually were.

In the case of one patient whose medical condition deteriorated a year after Natale operated, another surgeon testified that he had to untangle the falsehoods in Natale’s records, which, if relied upon, would have had a serious impact on his subsequent treatment of that patient.

The government was represented by Assistant U.S. Attorney Amarjeet Bhachu.

The sentence was announced by Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois; Lamont Pugh III, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General; and Thomas P. Brady, Inspector-in-Charge of the Chicago Office of the U.S. Postal Inspection Service.

The investigation was conducted by the Medicare Fraud Strike Force, which expanded to Chicago in 2011, and is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Justice Department and HHS to focus their efforts to prevent and deter fraud and enforce anti-fraud laws around the country.

20 Months for Home Health Care Kickback Scheme

August 30, 2012 By: Cal Skinner Category: Chalice Home Healthcare Services, Fraud, Frederick Kapala, Home Health Care, Kickbacks, Medicare, Medicare Fraud, Merigrace Orillo

A press release from the U.S. Attorney’s Office:

HOME HEALTH CARE ADMINISTRATOR SENTENCED TO 20 MONTHS IN FEDERAL PRISON FOR HEALTH CARE FRAUD AND KICKBACK SCHEME

ROCKFORD — An Elmhurst, Ill., woman was sentenced today in federal court to 20 months in federal prison on her conviction for health care fraud and a kickback scheme. Merigrace Orillo, 45, co-owned and operated Chalice Home Healthcare Services, Inc., with her husband Virgilio Orillo. Chalice had offices in Chicago, Freeport, and Morris, Illinois.

Medicare is a national healthcare program which provides free or below-cost health care to eligible beneficiaries, primarily persons who are 65 years of age or older. Chalice was an enrolled provider with the Medicare program since 2004.

According to a written plea agreement, Chalice’s nurses, nurses aids, physical therapists, and occupational therapists provided services to patients in their homes. Chalice was usually paid for these services through the Medicare program.

Orillo admitted that from January 2007 through April 2010, she and her husband falsified documents in order to increase the payments Chalice received from Medicare.

The falsifications made Chalice’s patients appear to be sicker than they actually were and in need of greater care than they actually required.

Orillo also admitted that she knowingly assisted her husband in paying cash kickbacks to a Chicago doctor.

The kickbacks were paid in return for the doctor referring patients to Chalice for home healthcare services.

Orillo admitted that she withdrew cash from Chalice’s bank account and provided that cash to her husband to be used to pay these kickbacks. At the sentencing hearing, the court found that Orillo’s scheme caused a loss of more than $700,000 to the Medicare program.

The indictment, which was filed on February 15, 2011, charged both Orillo and her husband Virgilio with healthcare fraud.

The charges against Virgilio Orillo were dismissed after he died on August 30, 2011.

Frederick Kapala

Today’s sentencing hearing was conducted by United States District Judge Frederick J. Kapala.

In addition to the 20 month federal prison sentence, Judge Kapala also ordered Orillo to pay $744,481 in restitution to the Medicare Trust Fund. Orillo will not be eligible for parole on her prison sentence.

The investigation was conducted by the Medicare Fraud Strike Force, which expanded to the Northern District of Illinois in 2011, and is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Justice Department and HHS to focus their efforts to prevent and deter fraud and enforce anti-fraud laws around the country.

The sentencing was announced by Gary S. Shapiro, Acting United States Attorney for the Northern District of Illinois; Robert D. Grant, Special Agent-in-Charge of the Chicago Office of Federal Bureau of Investigation; and Lamont Pugh, III, Special Agent-in-Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Chicago.
The government was represented by Assistant U.S. Attorney Scott A. Verseman.