Doctors, pharmacists and an attorney are among dozens of defendants charged in Southland health care fraud schemes that collectively attempted to bilk public and private insurance programs out of more than $660 million, federal authorities in Los Angeles announced Thursday.
The defendants are among hundreds charged across the United States in cases that cumulatively allege $2 billion in bogus billings. The nationwide sweep includes charges against 165 doctors, nurses and other licensed medical professionals who allegedly participated in health care fraud schemes.
In the Los Angeles area, most of the defendants were charged for taking part in schemes to defraud Medicare and other health insurance programs. The cases allege health care fraud and kickback scams involving surgeries, compounded drugs, home health services, Medicare Part D prescription drugs and hospice care.
“Health care fraud schemes cost Americans billions of dollars every year through higher premiums and tax money stolen from public programs, such as Medicare,” First Assistant U.S. Attorney Tracy L. Wilkison said. “There is an incredible array of scams, some of which involve services that are simply never provided, and some of which use complicated and sophisticated ruses to conceal illegal acts, such as bribes.”
In one of the cases, prosecutors unsealed charges against nine new defendants in operation “Spinal Cap,” which they say targets a long-running spinal surgery kickback swindle that generated nearly $1 billion in fraudulent claims to federal, state and private insurers.
The alleged scheme — spearheaded by Michael Drobot, the previously convicted former owner of Pacific Hospital in Long Beach — involved more than $40 million in illegal kickbacks paid to doctors and other medical professionals in exchange for referring thousands of patients who received surgeries and other services at Pacific Hospital.
The U.S. Attorney’s Office said that in the new “Spinal Cap” cases announced Thursday, three surgeons and two chiropractors were among those facing federal charges in Santa Ana:
— Daniel Capen of Manhattan Beach, 68, an orthopedic surgeon, has agreed to plead guilty to conspiracy and illegal kickback charges. Capen accounted for $142 million of Pacific Hospital’s claims to insurers, on which the hospital was paid $56 million;
— Timothy Hunt, 53, of Palos Verdes Estates, another orthopedic surgeon who referred spinal surgery patients to Capen and other doctors, has agreed to plead guilty to a conspiracy charge involving his receipt of illegal kickbacks stemming from various financial relationships with Pacific Hospital and related entities;
— George William Hammer, 65, of Palm Desert, the former chief financial officer of the physician management arm of Pacific Hospital, has agreed to plead guilty to tax charges based on the fraudulent classification of illegal kickbacks in hospital-related corporate tax filings;
— Lauren Papa, 52, of Tarzana, a chiropractor, has agreed to plead guilty to a conspiracy charge involving her receipt of illegal kickbacks to refer patients to a neurosurgeon with the understanding that the neurosurgeon would perform the surgeries at Pacific Hospital;
— Tiffany Rogers, 53, of Palos Verdes Estates, an orthopedic surgeon, was named in an indictment unsealed Wednesday in connection with receiving illegal kickbacks to refer patients for spinal surgeries at Pacific Hospital;
— Brian Carrico, 64, of Redondo Beach, a chiropractor — along with Performance Medical & Rehab Center Inc., which was partially owned by Carrico; and One Accord Management Inc., which Carrico wholly owned — were charged in connection with the receipt of illegal kickbacks to influence the referral of patients to Pacific Hospital.
An indictment unsealed Wednesday alleges that the defendants and other co-conspirators were responsible for $80 million in claims submitted to the federal workers’ compensation program and were paid $56 million in connection with patients that Performance Medical referred to Pacific Hospital.
— William Parker, 64, of Redondo Beach, was charged in a separate indictment unsealed Wednesday in connection with the same kickback scheme involving Carrico and his companies.
With the new cases being filed in “Spinal Cap,” the fraudulent claims related to this scheme now span a 15-year period and total more than $950 million, prosecutors said.
In a separate case, an indictment unsealed Wednesday outlines a conspiracy that was responsible for more than $250 million in fraudulent claims for prescriptions that were filled by compounding pharmacies in Southern California and elsewhere.
The indictment charges Irena Shut, 41, an attorney who lives in Hidden Hills, with paying kickbacks to two podiatrists to authorize prescriptions written on pre-printed prescription pads designed to maximize insurance payments, regardless of the medical need for an expensive compounded formulary for each “patient.”
The charged podiatrists, Domenic Signorelli, 51, of Irvine, and Robert Joseph, 51, of Huntington Beach, along with several other unnamed co-conspirator doctors, allegedly received kickbacks for “writing” the prescriptions. Once the prescriptions were filled, members of the conspiracy submitted fraudulent claims to federal, state and private insurers for the compounded drugs, prosecutors said.
In yet another case, seven people were named in an indictment alleging multiple health care fraud conspiracies in which the owner of two pharmacies submitted claims to Medicare and Medi-Cal for expensive, brand-name prescription drugs that were never dispensed to patients.
Instead, the drugs were provided to co-conspirators to sell to third parties, thereby generating a profit from each prescription drug twice — first from the reimbursement from Medicare or Medi-Cal, and second from the sale of the prescription drugs diverted to the black market, the U.S. Attorney’s Office alleges.
The defendants named in that indictment are:
— Irina Sadovsky, 48, of Woodland Hills, the owner and pharmacist-in-charge of Five Star and Ultimate pharmacies;
— Yigal Keren, 36, of Los Angeles, who owns and operates transitional housing centers;
— Mikhail Khanukhov, 38, of Sherman Oaks, the manager at Five Star and Ultimate pharmacies;
— Shahriar “Michael” Kalantari, 51, of Los Angeles, who was a marketer;
— Andrei Sotnikov, 47, of Northridge, a marketer;
— Nida Rosales, 62, of Bellflower, a marketer; and
— Juan Carlos Enriquez, 31, of Van Nuys, a pharmacy technician and marketer.
The indictment alleges that Sadovsky paid kickbacks to marketers in exchange for patient referrals from facilities that treated Medicare and/or Medi-Cal patients. Sadovsky also paid kickbacks directly to Medicare beneficiaries in exchange for filling their prescriptions at Five Star Pharmacy, prosecutors allege.
Five Star and Ultimate Pharmacies were collectively paid more than $54 million by Medicare and Medi-Cal between January 2014 and September 2017, according to the U.S. Attorney’s Office.