11 defendants plead guilty in $300 million healthcare fraud case

DALLAS (CBSDFW.COM) – U.S. Lawyer for the Northern District of Texas Chad E. Meacham announced that on April 20, 2022, 11 defendants billed in a $300 million health care fraud scheme have pleaded guilty.

Ten defendants, together with two clinical medical practitioners, have been indicted on February 9, and an eleventh was charged on March 16.

Six of the initial 10 defendants – Laredo-centered inside medicine health care provider Eduardo Canova, household medicine medical professional Jose Maldonado, nurse practitioner Keith Wichinski, Dependable Labs cofounder Abraham Phillips, advertising agency owner Juan David Rojas, and marketing and advertising employee Laura Ortiz – submitted plea papers on February 11, just two days just after becoming indicted. The last defendant, Responsible Labs cofounder Biby Kurian, submitted plea papers on April 6 and entered her plea on April 13.  

“The swift resolution of this situation is a testament to both of those our business office and to the investigative companies that worked diligently to assure our circumstance was airtight,” reported U.S. Lawyer Chad Meacham. “We are not able to let physicians’ judgement to be clouded by financial concerns.”

“This proactive investigation determined an illegal kickback conspiracy that resulted in significant proof and a guilty plea from every single defendant,” explained Dallas FBI Particular Agent in Charge Matthew J. DeSarno. “I commend our partners and the Northern District of Texas for their meticulous do the job in unraveling the schemes perpetrated by these defendants, and for their get the job done to secure American taxpayers and the integrity of our healthcare technique.”

In accordance to court papers, the founders of multiple lab organizations, including Unified Laboratory Expert services, Spectrum Diagnostic Laboratory, and Dependable Labs LLC, compensated kickbacks to clinical experts for them to buy medically unwanted lab checks, the prices of which ended up then billed to Medicare and other federal healthcare courses.

The lab businesses disguised the kickbacks as legitimate transactions, like as health care advisor settlement payments, salary offsets, lease payments, and advertising commissions. Through marketers, they paid out out hundreds of thousands of dollars to doctors in return for lab examination referrals. The labs also paid portions of the doctors’ staff salaries and parts of their places of work leases primarily based on the quantity of checks they referred each and every month. In some scenarios, the entrepreneurs even manufactured immediate payments to the provider’s husband or wife. 

The health-related industry experts, which include Dr. Canova, Dr. Maldonado, and Wichinski, recognized the bribes and ordered thousands and thousands of dollars’ value of exams. In one circumstance, when the labs threatened one particular supplier that payments would stop if he didn’t refer far more checks, he right away enhanced his lab referrals, averaging in between 20 to 30 referrals per day.

In buy to disguise supplemental kickbacks applying a provider-ownership model, Jeffrey Madison, the founder of Spectrum and United, confident Reliable’s co-founders to covert Responsible into a medical professional-owned lab. Trusted presented physicians possession alternatives only if all those medical professionals referred an ample number of lab tests. In some conditions, they even compensated medical professionals in an effort and hard work to assure they would not mail samples to other labs.

As a final result of these kickbacks, laboratories controlled by the defendants were being ready to post a lot more than $300 million in billing to federal federal government healthcare courses.  

In plea papers, Dr. Maldonado admitted he acquired far more than $400,000 in kickbacks for buying a lot more than $4 million really worth of lab checks, and Dr. Canova admitted he obtained a lot more than $300,000 in kickbacks for ordering much more than $12 million really worth of lab exams.  

The defendants’ pleas ended up:

• Jeffrey Paul Madison, founder of Unified Laboratory Solutions and Spectrum Diagnostic Laboratory – conspiracy to shell out and get health care kickbacks and a substantive depend of spending and acquiring healthcare kickbacks (two counts)
• Mark Christopher Boggess, main functioning officer for Spectrum and Unified – misprison (concealment) of a felony
• Biby Ancy Kurian, co-founder of Responsible Labs, LLC – conspiracy to shell out kickbacks
• Abraham Phillips, co-founder of Trustworthy Labs, LLC – conspiracy to shell out kickbacks
• Dr. Jose Roel Maldonado, household drugs physician centered in Laredo – conspiracy to solicit and acquire unlawful kickbacks
• Dr. Eduardo Carlos Canova, internal drugs expert based in Laredo – conspiracy to solicit and acquire unlawful kickbacks
• Keith Allen Wichinski, board-qualified nurse practitioner dependent in San Antonio – conspiracy to solicit or get kickbacks
• David Michael Lizcano, operator of DCLH, a advertising agency engaged by Unified, Spectrum, and Reliable – conspiracy to pay back and acquire health care kickbacks and a substantive depend of paying out and acquiring healthcare kickbacks (two counts)
• Laura Ortiz, sister of David Lizcano and personnel at his internet marketing agency – conspiracy to pay out and acquire health care kickbacks
• Juan David Rojas, owner of Rojas & Associates, one more advertising business engaged by Unified, Spectrum, and Dependable – conspiracy to shell out and acquire healthcare kickbacks
• Sherman Kennerson, trader in Unified (billed by means of felony information and facts) – conspiracy to shell out kickbacks

 Madison and David Lizcano confront up to 15 years every single in federal jail, Kennerson, Ortiz, Phillips, Kurian, Dr. Maldonado, Dr. Canova, Wichinski, and Rojas every confront up to 5 many years. Boggess faces up to 3 years.

“The expeditious resolution of this matter is a testomony to the comprehensive investigation and beneficial collaboration involving investigative associates and prosecutors,” reported Miranda L. Bennett, Unique Agent in Cost for the Office environment of Inspector Standard of the U.S. Health and fitness and Human Providers. “We will go on working with our associates to secure federal health and fitness care programs and the beneficiaries who depend on these systems for therapy and care.”

“As the investigative arm of the DoD Office environment of Inspector General, the Defense Prison Investigative Assistance (DCIS) and our colleagues work tricky to maintain accountable those who undermine Federal health care packages this kind of as TRICARE, “claimed Performing Specific Agent in Charge Gregory P. Shilling of the DCIS Southwest Area Business. “Safeguarding TRICARE not only shields our warfighters, their families, and retirees, but it also preserves worthwhile taxpayer resources.”