Tuesday, June 25, 2019

Docs & Nurses Busted in TRICARE Fraud

The Justice Department issued the following statement.


Two Mississippi-licensed physicians and two Mississippi-licensed registered nurses were charged in an indictment unsealed today for their roles in a multimillion dollar scheme to defraud TRICARE, the health care benefit program serving U.S. military, veterans and their respective family members, as well as private health care benefit programs Blue Cross & Blue Shield of Mississippi and United Healthcare of Mississippi.
 

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Mike Hurst of the Southern District of Mississippi, Acting Special Agent in Charge Steven J. Jensen of the FBI’s Jackson, Mississippi Field Office and Special Agent in Charge Cyndy Bruce of the Defense Criminal Investigative Service’s (DCIS) Southeast Field Office made the announcement.
Shahjahan Sultan, M.D., 37, of Madison, Mississippi, Thomas Edward Sturdavant, M.D., 56, of Kingsport, Tennessee, Freda Cal Covington, R.N., 54, of Hattiesburg, Mississippi, and Fallon Deneem Page, R.N., 36, of Soso, Mississippi were each charged in various counts of a 15-count indictment returned on June 11, 2019 in the Southern District of Mississippi.  The indictment was unsealed upon the defendants’ arrests today.  The defendants will make their initial appearances this week before U.S. Magistrate Judge Michael T. Parker of the Southern District of Mississippi.

Sultan, Sturdavant, Covington and Page were each charged with one count of conspiracy to commit health care fraud and mail fraud.  In addition, Sultan was charged with two counts of mail fraud, one count of conspiracy to distribute and dispense a controlled substance, two counts of distributing and dispensing a controlled substance, one count of conspiracy to pay and receive health care kickbacks and four counts of paying health care kickbacks.  Sturdavant was also charged with two counts of mail fraud, one count of conspiracy to distribute and dispense a controlled substance and two counts of distributing and dispensing a controlled substance.  Page was also charged with two counts of mail fraud.
The indictment alleges that Sultan, Sturdavant, Covington and Page participated in a scheme to defraud TRICARE and private health care benefit programs by prescribing and dispensing medically unnecessary compounded medications, some of which included ketamine, a controlled substance, to individuals, at times without first examining them, for the purpose of having an Ocean Springs, Mississippi-based compounding pharmacy dispense these medically unnecessary compounded medications.  In addition, the indictment alleges that, between March 2014 and February 2015, the defendants’ scheme caused TRICARE and private health care benefit programs to reimburse the compounding pharmacy more than $7 million for dispensing the compounded medications prescribed by Sultan and Sturdavant.  The indictment further alleges that Sultan was paid at least 25 percent of the reimbursements received from health care benefit programs, including TRICARE, for compounded medications prescribed by Sultan and Sturdavant. Sultan is alleged to have then paid Sturdavant for prescribing compounded medications to TRICARE beneficiaries and to have paid other co-conspirators for identifying and recruiting TRICARE beneficiaries to receive compounded medications.
An indictment is merely an allegation and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
This case was investigated by the FBI and DCIS.  Assistant Chief Dustin M. Davis and Trial Attorney Sara E. Porter of the Criminal Division’s Fraud Section and Assistant U.S. Attorneys Mary Helen Wall and Kathlyn R. Van Buskirk of the Southern District of Mississippi are prosecuting the case.
The Medicare Fraud Strike Force is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

14 comments:

Shed Wite said...

Where was Jim Hood in 3...2...1

Anonymous said...

What bothers me most is i always find out the names of these "Doctor Feelgoods" after the fact. I hear ketamine is amazing and wish I i could get a prescription to legally use it.

We have some really wonderful prescription pharmaceuticals available that can really make life comfortable and relaxing.

Liquor makes me ill, I would rather take a nice pill.

Anonymous said...

Throw the damn book at them!

Anonymous said...

Just legalize marijuana.

Anonymous said...

Point of reference. The Attorney General is charged with prosecuting MEDICAID fraud, not Medicare or Tricare; and, he does a damn good job with it. Everything in this case is federal. There's nothing Jim Hood can do or could have done.

Albert Schweitzer said...

Scum like this needs to pay a high price for this behavior.
Lock them up for a VERY long time.

Rod Knox said...

Well Doctors are ENTITLED to 7 figure incomes and they take advantage of every opportunity to do so. All the waste fraud and abuse will be blamed on baby mamas in the end so just move on.

Anonymous said...

I see a loyal Hood fan has joined the comments here. Please explain how Hood does a "damn good job" with prosecuting Medicaid fraud when 3/4s of his cases deal with personal care assistants mistreating, abusing or mishandling patients in nursing homes??? Not to say that those cases don't need prosecuting, too, but they are not in the mainstream of Medicaid fraud and a large number of actual fraud cases either never get indicted in the first place or the indictment gets dismissed on the way to the courthouse with a civil settlement or probation sentences.

Anonymous said...

3:37 specific facts please.

Anonymous said...

Point Of Reference @ 10:12 is the pointy headed AG himself, the same guy who has a problem 'prosecuting family'.

Anonymous said...

@4:06 - The best evidence is the lack thereof: find me a recent AG Hood press release regarding Medicaid fraud charges -- not the patient abuse ones, but actual fraud charges, involving a prison sentence.

Anonymous said...

As for civil settlements of Medicaid fraud indictments, take a look at the entry on this very blog on February 21, 2019, where the AG announced he had "settled" an indictment based on a civil resolution of the case in Hinds County.

Anonymous said...

General Hood, Esq. has been running for governor for six years. Ain't got no time to be prosecutin'. A plate will only hold so much.

Anonymous said...

You ain't seen medicaid and medicare insurance (and related patient) abuse til you get into investigating nursing homes.

But General Hood has no oversight of Nursing Ho....Wait!

And usually the medical doctor who oversees/signs off on medical issues at nursing homes (via his nurse practitioner) also owns the Hospice outfit that the nursing home will call in at the appropriate time. But, that's an entirely different discussion. Like the coroner owning the funeral home.



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