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Pharmacist Sentenced to Two Years in Prison for Illegal Distribution of Oxycodone, Structuring and Filing False Income Tax Return

On January 9, 2012, the United States Attorney’s Office, Southern District of Ohio, issued the following press release:

‘Harold Eugene Fletcher, 43, owner of the East Main Street Pharmacy in Columbus, was sentenced in U.S. District Court to 24 months in prison for illegally distributing the painkiller oxycodone, structuring financial transactions to avoid reporting requirements, and filing false income tax returns for five years.

Carter M. Stewart, United States Attorney for the Southern District of Ohio, Robert L. Corso, Special Agent in Charge, U.S. Drug Enforcement Administration (DEA), and Darryl Williams, Special Agent in Charge, Internal Revenue Service (IRS), announced the sentence handed down today by U.S. District Judge Algenon L. Marbley.

Fletcher was also sentenced to spend five years under court supervision after he completes his prison term. He will spend the first year of supervised release on home confinement and perform 208 hours of community service during the second year.

The sentence includes a $75,000 fine and restitution of $275,000 to the IRS. He is also required to cooperate with the IRS to file any corrected income tax returns for 2005 through 2009. His sentence includes a lifetime ban on practicing as a pharmacist or having any connection with a pharmacy or the distribution of drugs.

Fletcher owned and operated the East Main Street Pharmacy at 1336 East Main Street in Columbus. He pleaded guilty on January 11, 2011.

Fletcher is the first pharmacist convicted and sentenced to prison in the Southern District of Ohio for the illegal distribution of drugs.

According to a statement of facts read during the plea hearing, Fletcher distributed oxycodone outside the usual course of professional practice and without any legitimate medical purpose in February 2006. Fletcher also structured bank deposits of more than $100,000 by breaking the cash amounts into deposits of less than $10,000 each in an attempt to evade federal reporting requirements regarding cash deposits. Fletcher also admitted to filing false federal income tax returns for five years.

“We will continue to prosecute those involved in the illegal distribution of prescription drugs,” Stewart said. “This should send a message of deterrence to any licensed medical professional or others involved in such actions.”

Stewart commended the cooperative investigation by IRS and DEA agents and diversion investigators, along with Assistant U.S. Attorneys Michael Marous and David J. Bosley, and Special Assistant U.S. Attorney Brad Tammaro with the Ohio Attorney General’s Office and former Special Assistant U.S. Attorney Segev Phillips, who prosecuted the case.’

For more information about the United States Attorney’s Office, Southern District of Ohio, see http://www.justice.gov/usao/ohs/.

For information about the BWC Special Investigations Department be sure to read our SID FY 2011 Annual Report.

If you suspect anyone is committing workers’ compensation fraud in Ohio, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

Hannah News reported: “State Secures First Pill Mill Conviction of 2012”

On January 6, 2012, Hannah News reported as follows:

‘Another Ohio pill mill has fallen to a multi-agency initiative launched by the Ohio Attorney General’s Office, the Ohio Pharmacy Board and State Medical Board, the Ohio Bureau of Workers’ Compensation, the Regional Agencies Narcotics & Gun Enforcement Task Force (R.A.N.G.E.), as well as local and federal authorities. Dr. Han M. Yang is the latest conviction, pleading guilty Thursday to eight felony counts.

Yang, 69, could get 17 years in jail and $80,000 in fines for his trouble. That would add to $100,000 in drug profits he has already surrendered.

State, local and federal officers raided his Dayton and Bethel Township offices in Montgomery and neighboring Clark counties in October as part of a year-long investigation into prescription drug abuse, medical fraud, and money laundering. (See The Hannah Report, 10/3/11.) Authorities found would-be customers lined up outside for quick prescriptions, though facilities were largely bereft of exam tables and other equipment needed for legitimate medical services. Undercover agents previously witnessed Yang writing prescriptions within minutes of a patient’s arrival, and with no examination.

Formerly affiliated with Good Samaritan Hospital and Miami Valley Hospital in Dayton, Yang was since charged with six counts of trafficking in prescription drugs, including five fourth-degree felonies and one fifth-degree felony; one second degree count of engaging in a pattern of corrupt activity; and one fourth-degree count of theft by deception involving health care fraud. Clark County Common Pleas Court Judge Richard O’Neill accepted Yang’s guilty plea Thursday.

“We are committed to driving pill mills, and their trail of suffering and death, out of Ohio,” Attorney General Mike DeWine said in a statement. “More work remains, but rest assured we will continue the fight.”

In addition to state and federal officials, the investigation involved Clark County Sheriff Gene Kelly, Montgomery County Sheriff Phil Plummer, Clark County Prosecutor Andrew Wilson, and Montgomery County Prosecutor Mat Heck. A local pharmacist had alerted authorities in October 2010 after a woman nine months pregnant showed up with a prescription written by Yang for powerful painkillers.

DeWine said sentencing will be announced later, but indicated Yang faces penalties ranging up to 18 years in prison and fines up to $77,500.

The arrest and conviction follows at least four convictions, investigations and/or license revocations involving Ohio physicians in 2011, including Dr. James Lundeen, Dr. Victor Georgescu, Dr. George D.J. Griffin, and a fourth doctor who colluded in a prescription drug scheme with former Cincinnati attorney Kenneth Lawson, who was stripped of his law license in September. (See The Hannah Report, 4/5/11, 9/20/11, 12/15/11, 12/20/11.)

The governor, state Legislature and DeWine launched the coordinated offensive against pill mills and over-prescribing doctors in early 2011. (See The Hannah Report, 2/8/11, 2/9/11, 2/21/11.)’

For more information about the BWC Special Investigations Department be sure to read our SID FY 2011 Annual Report.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

BWC Investigations Result in Five Workers’ Comp Fraud Convictions in November

December 21, 2011 1 comment

Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Stephen Buehrer announced five individuals were convicted of or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during the month of November. The court actions are the result of investigations conducted by BWC’s Special Investigations Department (SID), which works to deter, detect, investigate, and prosecute workers’ compensation fraud. The cases bring the total number of convictions this year to 119.

“With another month comes five more fraud convictions, the result of our investigators’ outstanding work following up on leads and proactively identifying fraud,” said Buehrer. “What many perpetrators often do not understand is that if their activity does not generate tips from suspicious neighbors, co-workers or others surrounding them, their activity will raise red flags among BWC staff trained to detect suspected fraud.”

Following are four of the cases that resulted in a guilty plea or conviction during the month of November.

Michael Roe Booking PhotoMichael Roe (Middletown, Butler County) was sentenced November 28 for working while receiving benefits. SID received an allegation through BWC’s fraud hotline indicating Roe was working for a friend while collecting temporary total disability benefits. Investigators found Roe was working as a part-time tow truck driver for Lightening Towing and Recovery in Middletown. Roe pleaded guilty in the Franklin County Common Pleas Court to a felony count of workers’ compensation fraud. Roe was ordered to pay restitution of $5,163.91, and another $2,000 for investigative costs. He was also placed on community control for two years. Roe must pay full restitution by June 15, 2012 and obtain no further felony convictions or he will serve six months in jail.

James Mann (Toledo, Lucas County) was sentenced November 30 for fraud after he was found treating injured workers without a medical license. BWC’s Health Care Provider team investigated Mann after an employer reported inconsistencies with the treatment provided to an injured worker by Mann, owner of Toledo Medical Evaluators, LLC. The team found Mann was performing disability exams and file reviews in both Ohio and federal workers’ compensation cases although he lost his license to practice medicine in 1991 after he was convicted of illegal processing of drug documents. Mann was attempting to conceal the fact that he was personally conducting exams by erroneously reporting that one of the licensed physicians in his practice conducted the exam. Mann then submitted the fraudulent exam reports to the Ohio Industrial Commission. Mann pleaded no contest to a bill of information in Lucas County Common Pleas Court to one count of workers’ compensation fraud. He was sentenced to serve five years of probation and pay $90,278 in restitution, in addition to $10,530 for investigative costs. Mann previously pleaded guilty in the United States District Court, Northern District of Ohio, to three counts of Mail Fraud.

Thomas McallisterThomas McAllister (Steubenville, Jefferson County) pleaded guilty to deception to obtain narcotics. BWC’s Intelligence Unit identified Thomas McAllister as potentially receiving prescriptions from several physicians and pharmacies. SID’s investigation confirmed that he used deception to obtain 11 prescriptions from three prescribing physicians. McAllister entered a guilty plea in October to a felony count of deception to obtain dangerous drugs. A Franklin County judge sentenced McAllister November 30 to 30 days in jail. He was also ordered to pay $424 in restitution, and his driver’s license will be suspended for six months.

Gary Metz (Sharonville, Hamilton County) was sentenced November 22 for working while receiving benefits. BWC’s Special Investigations Department investigated Metz after receiving a tip and found he was working as a cable technician for his brother’s company Comteam, Inc., while receiving Living Maintenance and Non-Working Wage Loss benefits. Metz pleaded guilty in the Franklin County Common Pleas court to one felony count of workers’ compensation fraud. He was ordered to pay restitution of $6,165 and investigative costs of $1,000. He was also sentenced to six months in Ohio Department of Rehabilitation and Correction, suspended if he pays restitution and court costs by Dec. 30.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

https://www.ohiobwc.com/home/current/releases/2011/121511.asp

Lack of medical license not enough to keep Toledo man from treating injured workers

James E. Mann sentenced for workers’ comp fraud

A Toledo (Lucas County) man who treated injured workers without a medical license must repay the Ohio Bureau of Workers’ Compensation (BWC) more than $100,000 as a result of his sentencing yesterday for workers’ compensation fraud. James E. Mann owned and operated Toledo Medical Evaluators, LLC, and performed disability exams and file reviews in both Ohio and federal workers’ compensation cases although he lost his license to practice medicine in two decades ago.

“We cannot endanger the health of injured workers by allowing anyone who is not a licensed physician to direct their care,” said BWC Administrator/CEO Stephen Buehrer. “Employers have workers’ comp coverage to ensure their workers receive quality care and they rightfully do not expect their premiums to go to anyone who would take advantage of the system.”

Mann, who has not held a medical license since his conviction in 1991 on nine counts of illegal processing of drug documents, contracted with two licensed physicians to perform exams on injured workers. However, an investigation by the BWC Special Investigations Department showed Mann personally conducted exams and erroneously reported that one of the licensed physicians conducted the exam. Mann then submitted the fraudulent exam reports to the Ohio Industrial Commission.

Mann pleaded no contest to a bill of information charging him with one felony count of Workers’ Compensation Fraud. Judge James Jensen of the Lucas County Court of Common Pleas found him guilty and ordered he pay $90,278.86 in restitution and $10,530.17 in investigative costs, as well as court costs and a supervision fee. Mann was also sentenced to five years of community control. He will serve 12 months in prison if he violates community control.

Mann previously pleaded guilty in the United States District Court, Northern District of Ohio, to three counts of mail fraud. He was sentenced in that case on November 21 to one year of supervised release. Judge James Carr ordered Mann to pay $91,482.81 in restitution to the federal workers’ compensation program, in addition to a $100,000 fine and a $300 special assessment fee.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

https://www.ohiobwc.com/home/current/releases/2011/120111a.asp

BWC Investigations Result in 13 Workers’ Comp Fraud Convictions in October

 Ohio Bureau of Workers’ Compensation (BWC) Administrator/CEO Stephen Buehrer today announced 13 individuals were convicted of or pleaded guilty to charges related to defrauding Ohio’s workers’ compensation system during October. The court actions are the result of investigations conducted by BWC’s special investigations department (SID). The department works to deter, detect, investigate and prosecute workers’ compensation fraud. The cases bring total convictions in calendar year 2011 to 114.

“Cases like these remind us why detecting and prosecuting fraud must be a very high priority,” said Buehrer. “Whether it’s an injured worker, an employer or provider, it is incredible that anyone would game the system to gain something is not rightfully theirs, at the expense of others who end up paying the bill.”

Below is a sampling of cases that resulted in a guilty plea or conviction during October.

James Landis (Canfield, Mahoning County) pleaded guilty Oct. 24 to a felony count of workers’ compensation fraud for working while receiving benefits. An anonymous tip led to an investigation into whether Landis was working at his business, Mum’s The Word Florist, while receiving workers’ comp benefits. Landis stated on multiple occasions that he was incapable of working in any capacity. However, SID verified Landis was the primary operator of the business while on temporary total disability. He interacted with customers, arranged and delivered flowers, set up floral displays at events, and did all administrative paperwork. Landis is scheduled to be sentenced on Dec. 15. As a condition of his sentencing, he has agreed to repay $8,065.81 in investigative costs. He has repaid 19,000 he received improperly.

Roger Bolin (Nelsonville, Athens County) pleaded guilty Oct. 17 to workers’ compensation fraud and deception to obtain after he filed a false claim to receive narcotic prescriptions. SID received an allegation from an employer indicating Bolin filed a false claim. He indicated he was injured in September 2010, although he not worked for the company since June. Investigators obtained documentation showing Bolin did file a false claim and obtained a narcotic prescription by deception. The Hocking County Common Pleas Court sentenced Bolin to eight months prison to run consecutively on each count. Bolin is currently serving a prison sentence related to a parole violation. The court ordered the new charges to be served consecutively to this sentence.

Donald Johnson (Trenton, Butler County) was sentenced Oct. 17 for deceptively obtaining numerous BWC paid narcotics from multiple physicians and using multiple pharmacies. SID identified Johnson for possible doctor shopping for narcotic drugs and an investigation revealed his deception to obtain narcotics. Johnson agreed in the Butler County Common Pleas Court to pay restitution owed the amount of $2,177.86.

Daniel Engle (Shaker Heights, Cuyahoga County) pleaded guilty to one count of workers’ compensation fraud for working while receiving benefits. SID opened an investigation after a BWC claims service specialist noted that Engle’s employer, the city of Shaker Heights, submitted a letter prepared by Engle. In the letter, Engle informed the city that he was resigning to start his own computer business. SID’s investigation verified Engle owned and operated DNC Computer while receiving BWC temporary total disability benefits. He claimed he was incapable of working in any capacity. Investigators established that Engle repaired computers, sold computers, and sold computer parts. Additionally, Deluxe Transportation/New Valley Taxi employed Engle as a taxi driver. Engle entered a guilty plea in Franklin County Municipal. He was sentenced to 180 days in jail suspended in lieu of three years probation. The court also ordered Engle to pay a $75 fine, court costs and investigative costs in the amount of $4,000. Engle has paid $15,500 in restitution.

Thomas McAllister (Amsterdam, Jefferson County) was sentenced for deception to obtain dangerous drugs. BWC’s intelligence unit began investigating McAllister after suspecting he was receiving narcotic prescriptions from several physicians and pharmacies. The investigation confirmed that McAllister used deception to obtain narcotic medication from various prescribing physicians. On Oct. 12, McAllister entered a plea of guilty to deception to obtain dangerous drugs, a fifth degree felony. The parties agreed to $424 in restitution. McAllister will be sentenced Nov. 30.

Mark Robinson (Fairfield, Butler County), pleaded guilty Oct. 2 to one count workers’ compensation fraud for working while receiving benefits. Robinson worked as a general contractor for Bed and Breakfast properties in Hamilton while collecting temporary total disability. He performed maintenance and contractor work at various rental properties. Robinson paid back the full criminal overpayment of $6,463.25 and investigative costs of $1,207.38 for a total of $7,670.63 restitution paid to the BWC.

Daren Snyder (Chillicothe, Ross County) pleaded guilty Oct. 3 in a Franklin County courtroom to fraud for working while receiving benefits. SID opened an investigation after receiving an allegation indicating Snyder was working while receiving temporary total disability and living maintenance. Investigators found Snyder did return to work as a self-employed plumber during the period he received benefits. Sentencing is scheduled for Dec. 2.

If you suspect anyone is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

https://www.ohiobwc.com/home/current/releases/2011/111511a.asp

In summary: SID Health Care Provider Team (HCPT)

October 27, 2011 1 comment

When providers commit workers’ compensation system fraud and other crimes against the State Insurance Fund, the SID Health Care Provider Team (HCPT) responds to ensure compliance and integrity of the system. The team is comprised of dedicated analysts and agents located statewide. SID has recently increased its staffing to combat provider fraud, such as billing for unnecessary or non-rendered services, practicing without an active license, overprescribing narcotics, operating pill mills, trafficking in drugs, operating injury mills, unbundling and/or upcoding.

In the last article, we explained that SID staff members furnish orientation and training to MCOs in how to meet their contractual obligation to detect and report fraud. These SID staff members, who successfully drafted and finalized “Special Investigations – MCO Fraud Reporting and Referral Requirements,” are professionals assigned to HCPT.

To bring criminal providers to justice, these talented HCPT professionals conduct joint investigations with dozens of other agencies, such as the FBI, IRS – Criminal Investigations, U.S. Department of Justice – Drug Enforcement Administration (DEA), and local law enforcement narcotics units, vice units and drug task forces. During the last two years, HCPT made 36 criminal referrals for prosecution to state, county and local prosecutors. During last year alone, their work resulted in the identification of over $8.2 million in savings to the State Insurance Fund.

Be on the Lookout

This concludes our provider fraud awareness series. Look for our next fraud awareness article that will describe how we collect on the debts owed to the BWC State Insurance Fund by subjects of our investigations. In the meantime, be sure to read more about the BWC Special Investigations Department’s strategies and successes in our SID FY 2011 Annual Report.

If you suspect that a subject is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.

Managed care organizations (MCOs): Medically managing claims and combating fraud

BWC contracts with managed care organizations (MCOs) to provide several services to both employers and injured workers. The primary service they provide is case management of the medical services the injured worker needs to get better and return to work at the earliest, safest interval. In providing medical case management services, MCOs are in close contact with injured workers, providers of record, and employers to promote the delivery of treatment and a timely return to work.

To provide effective case management, MCOs furnish core medical services, such as:

  • Ongoing contact with the injured worker to assist in finding a physician to provide treatment, to assess their work status, and to help move treatment forward;
  • Ongoing contact with the provider of record (the injured worker’s lead physician) to determine the best treatment plan or plan of care for the injured worker, the status of treatment, and the injured worker’s work restrictions, if any;
  • Ongoing contact with the employer to determine the injured worker’s work status and the availability of light duty or restricted work; and
  • Constant coordination between the provider of record and employer regarding treatment expectations and facilitation of a safe and efficient return to work.

While performing these services, the MCO is in position to identify potential fraudulent activity. After being in close contact with the provider and having knowledge of a specific claim, often the MCO may be alerted to inconsistencies or red flags. Meticulous reviews of the medical documentation and provider billing data may detect errors and fraud. If fraud is suspected, the MCO should timely report such to BWC for investigation. This obligation of each MCO to combat fraud is specified in a signed MCO agreement with BWC. The obligation includes:

“The MCO agrees to identify and report any suspected fraudulent or deceptive behavior committed by injured workers, employers, providers or any other person or entity…”

This fraud detection and reporting obligation is essential. To support each MCO in meeting its obligation, we furnish clear guidance and direction, as specified in an 8-page appendix to the MCO agreement, entitled “Special Investigations – MCO Fraud Reporting and Referral Requirements.” For example, each MCO is required to establish and maintain an effective fraud detection and corrections program. We furnish orientation and training to MCOs in how to meet this requirement because they can and should detect fraud.

A Case in Point

An MCO employee furnished an allegation to the SID Health Care Provider Team (HCPT) pertaining to a provider. The source detected the provider subject was over-prescribing in claims.

HCPT conducted an investigation in conjunction with the U.S. Department of Justice – Drug Enforcement Administration (DEA) and a local law enforcement vice unit. The multi-agency investigation included an undercover operation, a search warrant, and interviews with patients, employees and former employees. The investigation found the subject billed for services not rendered, upcoded bills, tampered with records, and engaged in drug trafficking. Even while under investigation, the subject voluntarily surrendered his DEA certificate. The State Medical Board of Ohio permanently revoked the subject’s license to practice medicine in the State of Ohio.

The case resulted in the identification of savings to the Ohio workers’ compensation system of more than $685,000. The Office of the United States Attorneys for Ohio’s Northern District is currently reviewing the case for prosecutorial merit.

Be on the Lookout

Look for our next fraud awareness article that will conclude this series pertaining to provider fraud. Meanwhile, be sure to read more about provider fraud investigations in our SID FY 2011 Annual Report.

If you suspect that a subject is committing workers’ compensation fraud, let us know. You may report it online at http://bit.ly/reportfraud or you may speak with a fraud hotline agent by calling 1-800-OHIOBWC.