25 Californians Charged With $150M in Health Care Fraud - NBC Bay Area

25 Californians Charged With $150M in Health Care Fraud

The healthcare fraud schemes sought over $150 million from the Medicare and Medicaid programs, as well as private insurers and union health benefit plans, federal prosecutors said.



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    BERLIN, GERMANY - SEPTEMBER 05: A doctor checks a patient's blood pressure on September 5, 2012 in Berlin, Germany. Doctors in the country are demanding higher payments from health insurance companies (Krankenkassen). Over 20 doctors' associations are expected to hold a vote this week over possible strikes and temporary closings of their practices if assurances that a requested additional annual increase of 3.5 billion euros (4,390,475,550 USD) in payments are not provided. The Kassenaerztlichen Bundesvereinigung (KBV), the National Association of Statutory Health Insurance Physicians, unexpectedly broke off talks with the health insurance companies on Monday. (Photo by Adam Berry/Getty Images)

    Federal prosecutors in Los Angeles announced Wednesday that 25 people -- including 14 doctors or medical professionals -- have been charged in various health care schemes that fraudulently sought over $150 million from the Medicare and Medicaid programs, as well as private insurers and union health benefit plans.

    "Corruption drains dollars from private insurers and public programs such as Medicare and Medicaid," said U.S. Attorney Nick Hanna. "This office will continue to hold accountable anyone -- including medical professionals -- who seeks to bilk our nation's health care system."

    Those charged in 10 cases filed in Los Angeles federal court are:

    -- Dr. Ronald Weaver, 70, of Pacific Palisades; Sara Soulati, 49, of Santa Monica; Dr. John Weaver, 75, of Alhambra; Dr. Ronald Carlish, 78, of Pacific Palisades; Dr. Howard Elkin, 68, of Whittier; Dr. Wolfgang Scheele, 79, of Los Angeles; and Dr. Nagesh Shetty, 74, of Huntington Beach, who are accused of participating in a $135 million scheme to defraud Medicare through medically unnecessary cardiac treatments and testing through Global Cardio Care of Inglewood;

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    -- Navid Vahedi, 40, of Los Angeles; Vahedi's pharmacy, Fusion Rx Compounding Pharmacy; and marketer Joseph S. Kieffer, 39, of Los Angeles, who are charged in a fraud and kickback scheme. Vahedi and Kieffer allegedly paid commissions to marketers and some patients to obtain medically unnecessary compounded drugs to allow Fusion Rx to bill health care providers for those compounded drugs, many of which were reimbursed at rates much higher than average medications. To encourage patients to continue seeking the compounded drugs, Fusion Rx allegedly failed to collect co-payments from patients.

    To avoid the scheme being uncovered in an audit, they also allegedly directed Fusion Rx staff to use gift cards to pay the patients' co-payments for them so that it would appear they made the required co-payments, resulting in $17 million in losses to health care providers. The defendants, meanwhile, allegedly spent substantial sums of money on themselves, including Vahedi's purchase of a 1963 Ford Mustang Cobra.

    -- Hilda Haroutunian, 59, of Sun Valley; Dr. Keyvan Amirikhorheh, 60, of Seal Beach; physician's assistant Lorraine Watson, 56, of Valley Village; Noem Sarkisyan, 63, of North Hollywood; and medical assistant Edmond Sarkisyan, 40, of North Hollywood, who are accused of participation in a $10 million scheme to defraud the Family Planning, Access, Care and Treatment program administered by Medi-Cal.

    -- Amir Friedman, a 54-year-old anesthesiologist from Calabasas, who is charged in a conspiracy to commit honest services mail and wire fraud and Travel Act violations in connection with $800,000 in alleged kickbacks for compounded pharmaceutical drugs involving New Age Pharmaceuticals, in Beverly Hills.

    -- Susan H. Poon, a 54-year-old chiropractor who lives in Dana Point, who was arrested Wednesday after a federal grand jury charged her in a $2 million scheme to defraud Anthem, Aetna and other Blue Cross Blue Shield Association affiliates, including the Teamsters Western Region and Local 177 health care plans.

    Poon allegedly submitted false and fraudulent claims for chiropractic services never provided, medical diagnoses never given, and office visits that never occurred. She also allegedly submitted false and fraudulent prescriptions to a provider of durable medical equipment that relied on those bogus prescriptions in its reimbursement claims.

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    Employees and employee-dependents of the United Parcel Service and Costco Wholesale Corp., who never received the claimed services or sought the claimed medical equipment, were named as patients in Poon's alleged false claims and prescriptions.

    -- Antonio Olivera, 78, of Downey; Emelita Cephass, 57, of Downey; and Martin Canter, 70, of Rancho Palos Verdes, who are accused of participating in a hospice kickback scheme. Olivera was also charged with taking part in a scheme to defraud Medicare. Both alleged schemes involve Mhiramarc Management, a hospice located in Downey. In a separate case, hospice owner John O'Brien was charged with health care fraud conspiracy for his alleged role in the fraud scheme.

    -- Mahyar David Yadidi, 37, a chiropractor who lives in Los Angeles, who was charged with conspiracy to commit health care fraud for operating a scheme to defraud the International Longshore and Warehouse Union–Pacific Maritime Association health care benefit plan. Yadidi allegedly defrauded the ILWU-PMA Plan through his chiropractic clinic, San Pedro Philips Chiropractic, by offering kickbacks to patients for attending the clinic and by billing the benefit plan for services that were not rendered to patients, that were not medically necessary, and that were provided by unlicensed employees not qualified to perform them.

    Yadidi allegedly continued to operate his scheme after he was terminated as an authorized provider by the ILWU-PMA plan. Ivan Semerdjiev, 40, of Irvine, a chiropractor working for Yadidi, and Julian Williams, 44, of San Pedro, a personal trainer working for Yadidi, were also charged in connection with the alleged conspiracy. In total, Yadidi, Semerdjiev and Williams submitted almost $5 million in claims to the ILWU-PMA plan, according to federal prosecutors.

    -- Darren Hines, a 49-year-old chiropractor who lives in the Harbor City area of Los Angeles, was charged with health care fraud for allegedly operating a scheme to defraud the International Longshore and Warehouse Union–Pacific Maritime Association health care benefit plan. Hines allegedly defrauded the ILWU-PMA plan through his chiropractic clinic, Advanced Alternative Health, by billing for services not rendered and services being provided by unlicensed employees who were not qualified to perform them, all after Hines was terminated as an authorized provider by the ILWU-PMA plan. Hines allegedly submitted more than $500,000 in fraudulent claims over a short period of time.

    "Health plans are tempting targets for unscrupulous individuals," said Crisanta Johnson, Los Angeles regional director for the U.S. Department of Labor's Employee Benefits Security Administration. "When wrongdoers victimize health plans and their participants, EBSA and its fellow enforcement agencies will take prompt, aggressive and coordinated action to hold them accountable."

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