21 Defendants, Including Hospital and Lab CEOs, in Multistate Healthcare Reimbursement Conspiracy | USAO-EDTX

TYLER, Texas — The Justice Department announced criminal charges against 36 defendants in 13 federal districts across the United States for more than $1.2 billion in allegedly fraudulent telemedicine, cardiovascular and cancer genetic testing programs and durable medical equipment (DME).

As part of the nationwide effort, the U.S. Attorney’s Office for the Eastern District of Texas has indicted 21 people, including doctors, lab directors, hospital executives and marketers for their involvement in conspiracies to bribes and money laundering. Former True Health Diagnostics LLC CEO Christopher Grottenthaler, former Boston Heart Diagnostics Corporation Susan L. Hertzberg, former Rockdale Hospital d/b/a Little River Healthcare CEO Jeffrey Paul Madison, and others are accused in a lawsuit against the False Claims Act captioned United States ex rel. STF, LLC v True Health Diagnostics, LLC, et al., no. 4:16-cv-547 (ED Tex.). Additionally, 33 doctors and healthcare executives have agreed to pay more than $32 million to resolve False Claims Act allegations for their involvement in the scheme. The criminal and civil cases allege that the defendants illegally enriched themselves by paying and receiving illegal bribes in exchange for lab credentials.

Criminal cases

United States v. Hertzberg, et al

Susan L. Hertzberg, 64, of New York, Matthew John Theiler, 56, of Mars, Pennsylvania, David Weldon Kraus, 64, of Loudon, Tennessee, Jeffrey Paul Parnell, 54, of Tyler, Texas, Thomas Gray Hardaway , 49, from San Antonio, Texas, Laura Spain Howard, 48, from Allen, Texas, Jeffrey Paul Madison, 47, Georgetown, Texas, Todd Dean Cook, 57, Wimauma, Florida, William Todd Hickman, 59 , of Lumberton, Texas, Christopher Roland Gonzales, 45, of McKinney, Texas, Ruben Daniel Marioni, 37, of Spring, Texas, Jordan Joseph Perkins, 38, of Conroe, Texas, Elizabeth Ruth Seymour, 39, of Corinth, Texas, Linh Ba Nguyen, 58, of Dallas, Texas, Thuy Ngoc Nguyen, 54, of Dallas, Texas, Joseph Gil Bolin, 50, of Dallas, Texas, Heriberto Salinas, 62, of Cleburne, Texas , and Hong Davis, 54, of Lewisville, Texas have been charged with conspiracy to commit unlawful crimes. compensation in violation of the anti-kickback law. Anti-bribery law prohibits offering, paying, soliciting, or receiving compensation to induce the recommendation of items or services covered by Medicare, Medicaid, and other federal health care programs. The defendants were indicted for their role in a conspiracy by which doctors were tricked into referrals to critical access hospitals and an affiliated lab in exchange for bribes disguised as returns on investment; and in which marketers were tricked into ordering, arranging, or recommending the ordering of services from critical access hospitals and an affiliated laboratory in violation of anti-bribery law.

Two Texas critical access hospitals, Little River Healthcare (LRH) based in Rockdale, Texas, and Stamford Memorial Hospital based in Stamford, Texas, have partnered with Boston Heart Diagnostics (BHD), a clinical laboratory based in Framingham, Massachusetts , specializing in blood. test. For a fee, BHD allowed hospitals to charge insurers for their blood tests as so-called outpatient hospital services, with hospitals charging insurers a much higher rate than what BHD could receive as a clinical laboratory. The hospitals used a network of marketers who, in turn, operated management service organizations (MSOs) that provided investment opportunities for physicians throughout the state of Texas. In reality, MSOs were just a way to facilitate payments to doctors in exchange for doctors’ lab referrals. In accordance with the so-called kickback system, hospitals paid a portion of their lab revenue to marketers, who in turn passed on a portion of those funds to referring physicians who ordered BHD tests from hospitals or directly to BHD. BHD sales force leaders and staff leveraged MSO kickbacks to gain and increase referrals and, in turn, to increase their income, bonuses, and commissions. Between July 1, 2015 and January 9, 2018, at least $11,256,241.68 in illegal bribes were paid by the defendants in connection with the conspiracy.

On May 24, 2022, Laura Howard pleaded guilty to her involvement in the kickback conspiracy.

On July 20, 2022, Ruben Marioni pleaded guilty to his involvement in the kickback conspiracy.

United States vs. Peter Bennett

Peter Bennett, 47, of Houston, Texas, was charged with conspiracy to launder money, contrary to 18 USC § 1956(h) for his role in laundering proceeds of the bribe conspiracy. wine. To this end, he allegedly created shell trusts and shell companies through which he laundered the proceeds of the bribes, and as part of the money laundering conspiracy, Bennett laundered at least 2,724 $080.41 in proceeds of bribes.

United States vs. Stephen Kash

Stephen Kash, 48, of Winnie, Texas, was charged with conspiracy to commit money laundering, contrary to 18 USC § 1956(h) for his involvement in the money laundering conspiracy. Kash allegedly had the proceeds of the bribes laundered on his behalf and on several occasions obtained the proceeds of the bribe conspiracy.

United States vs. Robert O’Neal

Robert O’Neal, 63, of San Antonio, Texas, has been charged by information with conspiracy to commit illegal remuneration, in violation of the anti-kickback law, and conspiracy to commit money laundering , in violation of 18 USC § 1956(h). O’Neal was indicted for his involvement in the kickback conspiracy and money laundering conspiracy. His role in the kickback plot was to arrange physician referrals and recommend ordering services to critical access hospitals and an affiliated lab. O’Neal also had the proceeds of the bribes laundered on his behalf, and on several occasions obtained the proceeds of the bribe conspiracy.

On January 18, 2022, O’Neal pleaded guilty to his involvement in the kickback conspiracy and money laundering conspiracy.

The criminal cases were investigated by the Defense Criminal Investigative Services (DCIS), U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Veterans Affairs, Office of Inspector General (VA-OIG) and Federal Office. of Investigation Dallas – Frisco resident agency. They are being prosecuted by Assistant US Attorneys Nathaniel C. Kummerfeld and J. Kevin McClendon.

Civil Affairs and Settlements

Boston Heart Diagnostics Corporation, 33 physicians and healthcare executives have agreed to pay more than $32 million to resolve False Claims Act allegations of their involvement in a scheme to pay and receive bribes illegal in exchange for laboratory references. Former True Health CEO Christopher Grottenthaler, Former Boston Heart CEO Susan L. Hertzberg, Former Little River CEO Jeffrey Paul Madison and More Are Charged in False Claims Act Lawsuit subtitle United States ex rel. STF, LLC v True Health Diagnostics, LLC, et al., no. 4:16-cv-547 (ED Tex.). The United States filed an amended complaint in May 2022.

Civil settlements resolve allegations that doctors and healthcare executives violated anti-kickback law by receiving thousands of dollars in compensation from nine MSOs in exchange for ordering lab tests from Little River, True Health and /or Boston Heart. Little River reportedly funded some doctors’ compensation in the form of volume-based commissions paid to independent recruiters, who used MSOs to pay many doctors for their referrals. MSO payments to physicians were allegedly disguised as returns on investment, but were in fact based on, and offered in exchange for, physician recommendations.

The civil settlements are the result of a coordinated effort between the U.S. Attorney’s Office for the Eastern District of Texas and the Civil Division’s Commercial Litigation Division, Fraud Section, with assistance from HHS-OIG, DCIS, and the VA-OIG. Civil cases are handled by Assistant U.S. Attorneys James Gillingham, Adrian Garcia, and Betty Young, Lead Counsel Christopher Terranova, and Attorney General Gavin Thole.

A complaint, information or indictment is only an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in court.

Any patient who believes they have been contacted in connection with a fraudulent telemedicine, clinical laboratory, or EMR program should call to report this behavior to HHS-OIG at 1-800-HHS-TIPS.

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