Category: MIL-OSI

Source: United States Department of Justice Criminal Division

Note: View the settlement here.

Saad Enterprises Inc., doing business as Saad Healthcare, has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by knowingly submitting false claims for the care of hospice patients in Alabama who were ineligible for the Medicare hospice benefit because they were not terminally ill.

Hospice care is special, end-of-life care intended to comfort terminally ill patients. Patients admitted to hospice care generally stop receiving traditional medical care designed to cure their terminal condition and instead receive medical care focused on providing them with relief from the symptoms, pain, and stress of a terminal illness. Medicare patients are considered to be terminally ill and hospice-eligible when they have a life expectancy of six months or less if their illness runs its normal course.

“Respectful and appropriate end-of-life care is the crux of the hospice benefit under Medicare,” said Principal Deputy Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division. “The Department will hold accountable those who exploit this benefit for their own gain.”

“Caring for terminally ill people is a responsibility the United States and the Medicare program take seriously,” said Acting U.S. Attorney Keith A. Jones for the Southern District of Alabama. “Patients and taxpayers deserve not to be cheated, and the Department of Justice will continue to protect them.”

The settlement resolves allegations that between 2013 and 2020 Saad submitted, or caused the submission of, false claims to Medicare for 21 patients who did not meet the eligibility requirements for the Medicare hospice benefit as defined by statute and regulation, despite Saad knowing the patients were ineligible for the Medicare hospice benefit.

The civil settlement resolved a lawsuit filed under the qui tam or whistleblower provision of the False Claims Act, which permits private parties to file suit on behalf of the United States for false claims and share in a portion of the Government’s recovery. The qui tam lawsuit was filed by Melissa Wolff and Whitney Sims, former Saad employees, and is captioned United States ex rel. Wolff & Sims v. Saad Enterprises, Inc., Case No. 1:19-cv-00040 (S.D. Ala.). Ms. Wolff and Ms. Sims will receive $540,000 in connection with the settlement.

The resolution obtained in this matter was the result of a coordinated effort amongst the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section; the U.S. Attorney’s Office for the Southern District of Alabama; and the Department of Health and Human Services Office of Inspector General.

The investigation and resolution of this matter illustrates the government’s emphasis on combating healthcare fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).

Assistant U.S. Attorney Nina Herring for the Southern District of Alabama and Trial Attorney Rory Skaggs of the Civil Division handled the matter.

The claims resolved by the settlement are allegations only and there has been no determination of liability.

Source: United States Department of Justice Criminal Division

“Today the Department of Justice determined that multiple layers of removal restrictions shielding administrative law judges (ALJs) are unconstitutional.

Unelected and constitutionally unaccountable ALJs have exercised immense power for far too long. In accordance with Supreme Court precedent, the Department is restoring constitutional accountability so that Executive Branch officials answer to the President and to the people.”

Source: United States Department of Justice Criminal Division

Last night, extensive bilateral cooperation between the United States and Mexico resulted in the Mexico Attorney General’s Office “Fiscalía General de la República” (FGR) conducting a significant enforcement operation to dismantle a prolific transnational alien smuggling organization operating in Juarez, Chihuahua, along the U.S.-Mexico border.

The targeted alien smuggling organization, a group based in Juarez, Mexico, utilizes smuggling corridors centered in the Anapra, Chihuahua / Santa Teresa, New Mexico area, employs Mexican nationals, many of whom are current and former members of various Mexico-based cartels, and is alleged to be responsible for illegally smuggling large numbers of individuals, including children, from Central America into El Paso, Texas. The criminal organization is also alleged to have kidnapped aliens seeking to enter the United States illegally and extorted their families for money before completing their smuggling journey. The enforcement operation included the execution of two arrest warrants in Mexico for alleged alien smugglers Brian Alan Torres Gonzalez and Soledad Morales Nava. Torres and Morales are Mexican citizens and will be prosecuted in Mexico in part with evidence provided by the United States.

“On her first day in office, the Attorney General directed the Department of Justice to prioritize efforts to achieve the total elimination of cartels and transnational criminal organizations, and empowered Joint Task Force Alpha (JTFA) to increase their contributions to this fight,” said Supervisory Official Antoinette T. Bacon of the Justice Department’s Criminal Division. “Today’s action by Mexican authorities is the latest example of how JTFA provides critical contributions to marshal the investigative and prosecutorial resources of the Department, and its law enforcement partners, to target human smugglers and enhance coordination in transnational law enforcement efforts to better combat these criminal organizations.”

U.S. authorities provided assistance to the Mexico Attorney General’s Office through coordination under JTFA, which, since its creation in 2021, has marshalled the investigative and prosecutorial resources of the Department of Justice, in partnership with the Department of Homeland Security (DHS), to enhance U.S. enforcement efforts against the most prolific and dangerous human smuggling and trafficking groups operating in Mexico, Guatemala, El Salvador, Honduras, Colombia, and Panama. Attorney General Pamela Bondi has elevated JTFA to the Office of the Attorney General, to be jointly supervised by the Office of the Deputy Attorney General. The task force focuses on disrupting and dismantling smuggling and trafficking networks that abuse, exploit, and endanger migrants, pose national security threats, or are involved in organized crime. JTFA comprises detailees from U.S. Attorneys’ Offices along the border, along with dedicated prosecutor support by numerous components of the Justice Department’s Criminal Division, led by the Human Rights and Special Prosecutions Section (HRSP) and supported by the Money Laundering and Asset Recovery Section; the Office of Prosecutorial Development, Assistance and Training; the Narcotic and Dangerous Drug Section; the Office of Enforcement Operations; the Office of International Affairs; and the Violent Crime and Racketeering Section. JTFA also relies on substantial law enforcement investment from DHS, FBI, the Drug Enforcement Administration, and other partners. To date, JTFA’s work has resulted in more than 350 domestic and international arrests of leaders, organizers, and significant facilitators of human smuggling; more than 300 U.S. convictions; more than 245 defendants sentenced, including significant jail sentences imposed; and substantial seizures and forfeitures of assets and contraband including millions of dollars in cash, real property, vehicles, firearms and ammunition, and drugs.

U.S. Immigration and Customs Enforcement Homeland Security Investigations (ICE HSI) El Paso assisted foreign investigative efforts in the United States, working in concert with the U.S. Border Patrol. Support from ICE HSI-Mexico City was critical in providing coordination between American and Mexican law enforcement agencies. The Justice Department — including the U.S. Attorney’s Office for the Western District of Texas in El Paso, HRSP, and the Office of the Judicial Attache in Mexico City — provided significant assistance in this matter.

Source: United States Department of Justice Criminal Division

A Florida man was sentenced yesterday to 48 months in prison and ordered to forfeit more than $5.5 million to the United States as well as forfeit numerous real properties and cash, and to pay over $55 million in restitution for conspiracy to commit wire fraud, conspiracy to defraud the United States and willful violation of a workplace standard that resulted in the death of his employee. Manual Domingos Pita, of Wesley Chapel, previously pleaded guilty to those charges on July 9, 2024.

According to court documents, Pita owned and operated Domingos 54 Construction, a subcontracting business for the wood framing of new construction homes. Domingos 54 was a shell construction company that Pita used to provide workers, including undocumented aliens, with construction jobs. However, Pita failed to secure the required workers compensation insurance coverage for these employees by falsifying in worker’s compensation insurance applications the number of workers for which he sought coverage. In addition, Pita failed to pay any federal employment taxes on the wages that these workers earned during the course of the scheme between 2018 and 2022. As a result, Pita caused several worker’s compensation insurance companies to sustain a loss of over $22.7 million in premiums that they could have charged had they been aware of the number of workers which they had been manipulated into covering with their policies. In addition, Pita failed to pay to the IRS over $33.7 million in federal employment taxes on those workers’ wages.

Between February and July 2019, investigators with the Occupational Safety and Health Administration (OSHA) issued six citations to Domingos 54 for failure to provide fall protection to workers. Even after being cited for these violations, Pita continued to ignore OSHA requirements. In March 2020, Pita assigned a worker and three other carpenters to install sheeting on the roof of a residential home in windy conditions without providing the required fall-protection gear or ensuring its use. As a result, one of the workers was blown off the roof and died from his injuries.

“Pita’s history of OSHA violations and deception tragically led to a worker’s death,” said Principal Deputy Assistant Attorney General Adam Gustafson of the Justice Department’s Environment and Natural Resources Division. “We are committed to upholding the rule of law by prosecuting fraud and enforcing worker safety standards.”

“The defendant in this case engaged in a deliberate scheme to defraud insurance companies, the government and evade taxes, resulting in huge losses to the U.S. Treasury, and to personally enrich himself,” said Acting U.S. Attorney for the Middle District of Florida Sara C. Sweeney. “In addition, flagrant violations of OSHA safety standards put workers at unacceptable risk, ultimately resulting in the death of an employee. My office is committed to federally prosecuting and holding accountable anyone who violates these laws and regulations.”

“Mr. Pita repeatedly violated the longstanding policies designed to protect the workforce which resulted in a tragic death,” said Special Agent in Charge Matthew Fodor of the FBI’s Tampa Field Office. “The FBI and its partners will aggressively pursue those who selfishly ignore the laws and policies in place to protect America’s workforce.”

“Not only does this type of scheme give an illegal advantage over honest competitors, it intends to allow the use of illegal, undocumented labor to achieve that advantage,” said Special Agent in Charge Ron Loecker of IRS Criminal Investigation’s Tampa Field Office. “It’s a blatant form of cheating that undercuts fair competition, costs the government millions of dollars in tax revenue, and skirts our nation’s immigration laws. This case reaffirms our unwavering commitment to prosecuting those who engage in fraud at the expense of workers, taxpayers, and law-abiding businesses.”

The FBI, IRS Criminal Investigation, Homeland Security Investigations, Florida Department of Financial Services’ Bureau of Insurance Fraud-Criminal Investigations and the Department of Labor’s Office of Inspector General investigated the case.

Assistant U.S. Attorney Jay L. Hoffer for the Middle District of Florida and Senior Trial Attorney Banumathi Rangarajan of the Environment and Natural Resources Division’s Environmental Crimes Section prosecuted the case.

Source: United States Department of Justice Criminal Division

A Kansas man pleaded guilty today to operating an internet-based platform that generated false doctors’ orders to defraud Medicare and other federal health care benefit programs of more than $1 billion.

According to court documents, Gregory Schreck, 50, of Johnson County, admitted that he and his co-conspirators targeted hundreds of thousands of Medicare beneficiaries to provide their personally identifiable information and agree to accept medically unnecessary orthotic braces, pain creams, and other items through misleading mailers, television advertisements, and calls from offshore call centers. Schreck and his co-conspirators owned, controlled, and operated DMERx, an internet-based platform that generated false and fraudulent doctors’ orders for orthotic braces, pain creams, and other items for these beneficiaries. Schreck, a vice president of the company that operated DMERx, admitted that he offered to connect pharmacies, durable medical equipment (DME) suppliers, and marketers with telemedicine companies that would accept illegal kickbacks and bribes in exchange for signed doctors’ orders that were transmitted using the DMERx platform. Schreck and his co-conspirators received payments for coordinating these illegal kickback transactions and referring the completed doctors’ orders to the DME suppliers, pharmacies, and telemarketers that paid for them. The fraudulent doctors’ orders generated by DMERx falsely represented that a doctor had examined and treated the Medicare beneficiaries when, in reality, purported telemedicine companies paid doctors to sign the orders without regard to medical necessity and based only on a brief telephone call with the beneficiary, or sometimes no interaction with the beneficiary at all. The DME suppliers and pharmacies that paid illegal kickbacks in exchange for these doctors’ orders generated through DMERx billed Medicare and other insurers more than $1 billion. Medicare and the insurers paid more than $360 million based on these false and fraudulent claims.

Schreck pleaded guilty to conspiracy to commit health care fraud and faces a maximum penalty of 10 years in prison. A sentencing hearing will be scheduled at a later date. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Supervisory Official Antoinette T. Bacon of the Justice Department’s Criminal Division; Acting Special Agent in Charge Isaac Bledsoe of the Department of Health and Human Services Office of Inspector General (HHS-OIG) Miami Regional Office; Acting Special Agent in Charge Justin E. Fleck of the FBI Miami Field Office; Special Agent in Charge David Spilker of the Department of Veterans Affairs Office of Inspector General (VA-OIG)’s Southeast Field Office; and Special Agent in Charge Jason Sargenski of the Department of Defense Office of Inspector General, Defense Criminal Investigative Service (DCIS), Southeast Field Office made the announcement.

HHS-OIG, FBI, VA-OIG, and DCIS are investigating the case.

Trial Attorneys Darren C. Halverson and Jennifer E. Burns of the Criminal Division’s Fraud Section are prosecuting the case. Fraud Section Trial Attorneys Andrea Savdie and Shane Butland assisted in the prosecution.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, currently comprised of nine strike forces operating in 27 federal districts, has charged more than 5,800 defendants who collectively have billed federal health care programs and private insurers more than $30 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.