/>iBig Baby’s Big Foul: Former NBA Star Glen 'Big Baby' Davis Sentenced to 40 Months for Healthcare Fraud Scheme
On May 9, former Boston Celtics forward Glen “Big Baby” Davis was sentenced to 40 months in prison following his conviction for wire fraud, healthcare fraud, healthcare fraud conspiracy, and conspiracy to make false statements related to healthcare matters.
As background, prosecutors accused Davis of submitting fraudulent invoices to the National Basketball League (NBA) Players’ Health and Welfare Benefit Plan, causing the Plan to pay out funds for non-existent medical services. Davis’s alleged actions involved collaboration with Terrence Williams, another former NBA player, whereby the pair utilized forged documents and staged medical appointments to file fake claims. As a result of the alleged scheme, the Plan paid out over a million dollars in fraudulent claims.
Following trial, Davis was found guilty of one count of conspiracy to commit health care fraud, one count of conspiring to make false statements relating to health care matters, one count of health care fraud, and one count of wire fraud.
Prosecutors had originally requested a sentence of 37 to 46 months, as outlined by applicable federal sentencing guidelines. The 40-month sentence ultimately handed down by the Honorable Valerie E. Caproni fell within these guidelines, and also included three years of supervised release and an order for Davis to pay $80,000 in restitution jointly with co-defendant Rashad Sanford, an Atlanta-area chiropractor who conspired with Davis in a separate scheme.
The case is USA v. Williams, case number 1:21-cr-00603 in the US District Court for the Southern District of New York.
Elara Caring Settles for $4.2 Million False Claims Act Case Involving False Hospice Claims in Texas
On May 1, the US Department of Justice (DOJ) announced that Elara Caring and several of its subsidiaries, including JHH/CIMA Holdings Inc., CIMA Healthcare Management Inc., and several CIMA Hospice locations in Texas, had agreed to pay $4.2 million to resolve allegations of numerous violations of the False Claims Act (FCA).
As background, prosecutors accused Elara Caring of knowingly submitting false claims and retaining overpayments for hospice care provided to patients in Texas who were not terminally ill and thus were ineligible for Medicare hospice benefits. The alleged scheme primarily involved Elara Caring’s Texarkana location, operating previously as CIMA Hospice from 2014 to 2019 and in 2020, with additional claims involving two patients at other Texas locations from 2015 to 2021.
The settlement resolves these allegations, as well as accusations that Elara Caring improperly concealed or failed to repay overpayments related to these patients. The case was brought under the whistleblower provisions of the FCA, which allows individuals to sue on behalf of the US government and partake in a portion of the recovered funds. The whistleblower here, Aneko Jackson, was a former employee of Elara Caring and received $672,000 as part of the settlement.
A link to the DOJ press release can be found here.
Baptist Health Pays $1.5 Million to Settle False Claims and Kickback Allegations
On May 6, the DOJ announced that Baptist Health System Inc. has agreed to pay $1.5 million to resolve allegations that it violated the FCA. The allegations stem from claims that Baptist Health knowingly caused its subsidiaries to offer discounts of up to 50% or more to certain Medicare beneficiaries to induce them to purchase or refer Baptist Health services that were reimbursed by federal health care programs. These discounts, which were reportedly provided without consideration of the financial needs of the beneficiaries, from January 1, 2016, through August 15, 2022, violated the Anti-Kickback Statute (AKS), which bars exchanging remuneration for referrals of services paid by federal healthcare programs.
In addition to the financial settlement, Baptist Health took significant steps to cooperate with the government’s investigation. Specifically, it voluntarily disclosed the conduct in question and took remedial measures, including discontinuing its discount policy, conducting an internal compliance review, and providing the United States with a detailed disclosure statement and other supplemental information.
A link to the DOJ press release can be found here.
Apollo Health and Owner Pay $1 Million to Settle Medicare Fraud Claims
On May 3, the DOJ announced that Brian J. Weinstein and his company, Apollo Health Inc., had agreed to pay $1 million to settle a civil lawsuit involving the submission of numerous false claims to Medicare. The DOJ alleged that, under Weinstein’s guidance, Apollo Health submitted 12,592 false claims for care plan oversight services (CPO) that were never actually provided. These services, which involved a physician’s supervision of complex or multidisciplinary medical care, were claimed on behalf of 25 providers who were purportedly employed by Apollo but had not performed the CPO services as documented.
Last year, in a related criminal prosecution, Weinstein pleaded guilty to a federal health care fraud charge and was sentenced to three years of probation.
A link to the DOJ press release can be found here.
California Doctor Pleads Guilty to Multimillion Dollar Medi-Cal Fraud Scheme
On May 7, the DOJ announced that Robert Eyzaguirre, the owner and sole physician at Dr. Robert’s Medical Center in Bellflower, California, had pleaded guilty to submitting millions of dollars in false claims to Medi-Cal’s Family Planning, Access, Care, and Treatment (Family PACT) program, resulting in over $2.5 million in losses. Eyzaguirre pleaded guilty to one count of health care fraud, which carries a maximum sentence of 10 years in federal prison. Eyzaguirre is awaiting sentencing, which is currently scheduled for October 28.
The DOJ also accused Eyzaguirre’s co-conspirators, Gary Lee Didio and Sandra Rios, of creating fake patient files with fabricated information, which Eyzaguirre then signed, falsely certifying that he had provided family planning services and necessary laboratory tests. Specifically, DOJ accused Eyzaguirre, Didio, and Rios of choosing random names from an online directory to create these fake patient profiles and then submitting these to the Family PACT program for reimbursement.
The scheme extended to a laboratory in Northern California, which paid over $372,000 in illegal kickbacks for referrals of these nonexistent patients from Dr. Robert’s Medical Center, resulting in additional claims of over $1 million paid by Medi-Cal. As law enforcement closed in, the DOJ also accused Eyzaguirre of trying to cover up the illegal activities by instructing Didio to remove and hide the fake files, later attempting to shred them. Both Rios and Didio have pleaded guilty to conspiring to receive illegal remunerations for healthcare referrals and are awaiting sentencing.
A link to the DOJ press release can be found here.
