Fourteen Charged in Illinois in Eight Separate Federal Health Care Fraud Cases

Published: 2011-02-27 22:09:39
Author: 7th Space | February 18, 2011

CHICAGO—One Chicago area physician, two chiropractors, three nurses, a pharmacist, and several home health industry administrators and recruiters are among 14 defendants charged this week in eight separate, unrelated federal health care fraud cases, federal law enforcement officials announced today. Federal arrest warrants were executed this morning for 10 of the defendants. Nine defendants allegedly work in the home health care industry, of which seven were charged with conspiring to violate the criminal anti-kickback statute, which makes it illegal to offer or solicit kickbacks in exchange for referrals of Medicare patients. Several of today’s enforcement activities in the Chicago area are being conducted as part of a nationwide takedown by Medicare Fraud Strike Force operations that led to charges against 111 defendants for their alleged participation in numerous Medicare fraud schemes.

The Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. The Departments of Justice and Health and Human Services today announced that the Medicare Fraud Strike Force, previously operating in seven locations across the country, has expanded operations to Chicago and Dallas. Five of the eight cases announced today were brought as a part of strike force operations. “With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country.

We have safeguarded precious taxpayer dollars. And we have helped to protect our nation's most essential health care programs, Medicare and Medicaid,” said Attorney General Holder. “As today's arrest prove, we are waging an aggressive fight against health care fraud.” Patrick J Fitzgerald, United States Attorney for the Northern District of Illinois, announced the formation of the HEAT Strike Force in the Northern District of Illinois. “Health care fraud has become an increasingly important priority of federal law enforcement in the Chicago area.

We are organizing to deploy all of our resources to ensure that dishonest medical providers do not profit from cheating Medicare, Medicaid, and private insurers,” said Mr Fitzgerald. Speaking particularly of the kickback violations alleged against several defendants in the home health care industry, Mr Fitzgerald explained, “Paying for Medicare and Medicaid patients is a crime. We are focusing our resources on making sure that those who offer or solicit kickbacks are held accountable by the criminal justice system.” Also announcing the charges was Robert D Grant, Special Agent in Charge of the Chicago office of the Federal Bureau of Investigation. “Health care fraud will not be tolerated,” said Mr Grant.

“It affects every citizen through increases in insurance premiums and rising costs for both Medicare and Medicaid. As consumers of health care services, we should all be cognizant of possible fraud and promptly report suspicious charges to our insurance carriers or law enforcement.” “Health care fraud is a crime committed against vulnerable patients, United States taxpayers, and the government programs funding vitally-needed health services,” said Lamont Pugh III, the Chicago Region's Special Agent in Charge for the Office of Inspector General of the Department of Health & Human Services. “The actions we have taken today are part of a coordinated, nationwide crackdown in our continuing battle against criminals who enrich themselves at our great expense.” James Vanderberg, Special Agent-in-Charge for the Chicago Regional Office of the United States Department of Labor, Office of Inspector General said: “Today's charges represent the OIG's firm commitment to actively investigate health care fraud schemes in which union sponsored health and welfare funds are defrauded. We will continue to work vigorously with the United States Attorney's Office and our law enforcement partners to investigate crimes that undermine the financial well-being of union affiliated benefit funds.” Mr Fitzgerald announced the cases, all eight of which were charged this week in United States District Court, with Robert D Grant, Special Agent in Charge of the Chicago Office of Federal Bureau of Investigation; Lamont Pugh, Special Agent-in-Charge of the United States Department of Health and Human Services Office of Inspector General in Chicago; and James Vanderberg, Special Agent-in-Charge of the United States Department of Labor Office of Inspector General in Chicago.

The Office of Criminal Investigations of the Food and Drug Administration, the Office of the Inspector General of the United States Railroad Retirement Board, the City of Chicago Office of Inspector General, and the United States Department of Labor Employee Benefits Security Administration also participated in the investigations. The defendants were each charged with one or more counts of health care fraud, mail fraud, false statements relating to health care matters, and/or conspiracy. If convicted of health care fraud, each count carries a maximum penalty of 10 years in prison and a $250,000 fine. If convicted of mail fraud, each count carries a maximum penalty of 20 years in prison and a $250,000 fine.

If convicted of false statements relating to health care matters, each count carries a maximum penalty of five years in prison and a $250,000 fine. If convicted of conspiracy, each count carries a maximum penalty of five years in prison and a $250,000 fine. The court, however, would determine the appropriate sentence to be imposed under the advisory United States Sentencing Guidelines. In each case, the public is reminded that charges are not evidence of guilt.

The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt. The details of each case follow: United States v. Virgilio Orillo and Merigrace ("Grace") Orillo Virgilio Orillo and Merigrace (“Grace”) Orillo, who co-own and operate Chalice Home Healthcare Services, Inc. (“Chalice”), with offices in Chicago, Freeport, and Morris, Illinois, were charged with three counts of health care fraud in a criminal indictment filed on Tuesday.

According to the charges, Chalice nurses, nurse aides, physical therapists, and occupational therapists provide services to patients at their homes. The indictment alleges that the Orillos falsified documents in order to increase the payments Chalice received from Medicare. These falsifications were allegedly made on documents known as OASIS forms and made Chalice's patients appear to be sicker than they actually were and in need of greater care than they actually required. The indictment alleges that the Orillos' fraud scheme cause a loss of more than $500,000 to the Medicare program.

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