Several doctors were among defendants charged in Los Angeles and Orange County with participation in health care fraud schemes that often targeted the U.S. military’s managed care program, federal officials announced Wednesday.
A psychiatrist, a pharmacist and an occupational therapist were also charged in cases involving more than $125 million in fraudulent billings submitted to publicly funded health care programs such as Medicare and the military’s Tricare.
Over the course of a few years, Tricare paid hundreds of millions of dollars for medications dispensed to “patients” across the nation, typically for creams that supposedly treated minor pain, scars, erectile dysfunction or “general wellness,” according to the U.S. Attorney’s Office.
In one of the cases, John Garbino, 46, a marketer who lives in Dana Point, was charged with receiving illegal kickbacks after referring prescriptions to compounding pharmacies that filled the prescriptions and billed Tricare, according to prosecutors.
As a result, a Palmdale pharmacy received more than $46 million from Tricare in only six months, while a Corona pharmacy took in nearly $6 million over the same six-month period, officials allege.
Garbino allegedly received illegal kickbacks of as much as 65 percent for referring prescriptions to the pharmacies, according to a criminal complaint that alleges that one of the pharmacies dramatically increased its claims to Tricare for filling prescriptions formulated to achieve the highest possible reimbursement rates.
In another case, Dr. Donald Woo Lee, 50, a physician who had offices in Temecula and Mira Loma, allegedly submitted nearly $12 million in fraudulent bills to Medicare for unnecessary “vein ablation” surgery, prosecutors said.
In a separate case, Dr. Kain Kumar, 52, of Encino, who operated a medical clinic in Palmdale, was arrested Monday after being named in a superseding indictment that charges him with one count of conspiracy to pay and receive illegal health care kickbacks and four counts of receiving illegal health care kickbacks.
Kumar and four others allegedly participated in a kickback conspiracy at a La Verne home health agency, Star Home Health Resources. The owners of Star allegedly paid illegal kickbacks in exchange for home health referrals, prosecutors said.
“Those who commit fraud targeting health care funding get rich on the backs of American taxpayers who watch their premiums go up,” said Deirdre Fike, assistant director in charge of the FBI’s Los Angeles field office. “Anyone who identifies suspicious billing practices or unlawful activity by a provider should contact a member of the Medicare Fraud Strike Force.”
— Wire reports