Some doctors attempt to defraud Medicare by submitting bills for medications that were never prescribed. Many other perpetrators of health care fraud take those drugs and distribute them illegally. And then there are those medical practitioners who find ways to bilk our nation’s health insurance programs out of millions by approving medical tests that are completely unnecessary. Chicago’s Dr. Omar Garcia is one of those people.
Garcia was convicted this past Monday.
As reported by the Northern District of Illinois branch of the United States Justice Department, the 52 year-old physician’s scheme involved the approval of medically unnecessary percutaneous allergen tests for numerous Medicare beneficiaries.
Originally from Ocala, Florida, Garcia worked for Grand Medical Clinic Inc. in Chicago. During his time there, he authorized numerous tests that weren’t just medically unnecessary – they had often been completed before he issued approval. This resulted in the submission of many fraudulent climes to Medicare.
Garcia’s scheme took place between 2011 and 2015.
As the DoJ report details, “Dr. Garcia and others submitted the fraudulent bills from Grand Medical and other medical entities in an attempt to reduce the volume of billing by any single company and minimize scrutiny from Medicare. After the entities received payments from Medicare, Dr. Garcia was paid via checks reflecting his percentage of the payments.”
Garcia was convicted on six counts of health care fraud. Each count is punishable by a maximum sentence of ten years in prison. Sentencing is scheduled for May 6, 2020.
Zachary Ohebshalom pleaded guilty to a kickback conspiracy.
Also on Monday, a Fort Lee, New Jersey, man admitted to participating in a conspiracy to pay and accept kickbacks in exchange for medically unnecessary prescriptions. As reported by the District of New Jersey branch of the United States Department of Justice, 34 year-old, Zachary Ohebshalom didn’t even bother to go through the trial process in order to have a guilty verdict passed down on him.
He pleaded guilty to charges of conspiring to violate the federal anti-kickback statute. Ohebshalom allegedly worked with three other individuals in a kickback conspiracy that began in May of 2016.
According to the DoJ report, Ohebshalom worked to fraudulently obtain millions of dollars in health benefits from the federal workers’ compensation program by prescribing and dispensing expensive, but medically unnecessary, pain creams. One of his co-conspirators, Dr. Mark Filippone treated hundreds of now-former U.S. Postal Service employees for injuries they purportedly suffered on the job.
Filippone prescribed expensive topical pain creams.
These creams were not needed or wanted by many of his patients. He steered these prescriptions to a pharmacy in Fair Lawn, New Jersey which was owned and operated by Joseph Vangelas and Marlene Vangelas. Estela Blaustein was the pharmacist-in-charge.
Along with Ohebshalom, the Vangelas’ directed Blaustein and others to mine reimbursement rates within the federal workers’ compensation program for the ingredients of the pain creams in order to determine the most lucrative formulations. They also got her to print prescription labels for Filippone to use for the prescriptions sent back to the Fair Lawn Pharmacy. Sentencing for Ohebshalom is scheduled for May 21, 2020.
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