Dozens Charged In Massive Texas Health Care Fraud Operation

Dozens of people, including doctors, have been charged in a large coordinated health care fraud enforcement operation in Texas that involved alleged Medicare fraud schemes and networks of "pill mill" clinics, according to the Department of Justice.

In a press release announcing the results of the investigation, the Department of Justice said the charges aggressively target schemes billing government insurance programs like Medicare, Medicaid as well as private insurance companies for prescription drugs that were not needed and often never purchased or distributed to the beneficiaries.

The DOJ said the charges also involve individuals contributing to the opioid epidemic, with a particular focus on medical professionals.

"As we continue to dedicate resources to battle healthcare and opioid fraud schemes in Texas and elsewhere, we are shining an inescapable light on dirty doctors, clinic owners, pharmacists, and others who may have long believed they could perpetrate their frauds behind closed doors," Brian A. Benczkowski, assistant attorney general for the DOJ's criminal division, said in a statement.

Below are the individuals charged and the allegations against them as detailed by the DOJ:

Northern District of Texas

• Dr. Brian Carpenter and Jerry Hawrylak were charged for their alleged participation in a scheme to defraud TRICARE through a compounding pharmacy located in Fort Worth, Texas. The case is being prosecuted by Trial Attorney Brynn Schiess of the Fraud Section.
• Leah Hagen and Michael Hagen were charged for their alleged participation in conspiracies to pay and receive kickbacks and launder money through Metro DME Supply and Ortho Pain Solutions, both durable medical equipment (DME) companies in Arlington, Texas. The case is being prosecuted by Trial Attorney Brynn Schiess.
• Nilesh Patel, Dr. Craig Henry and Bruce Henry were charged for their alleged participation in a scheme to defraud TRICARE through marketing company RxConsultants and a compounding pharmacy located in Fort Worth, Texas. The case is being prosecuted by Trial Attorney Carlos Lopez of the Fraud Section.
• Bruce Stroud and Bobbi Stroud were charged for their alleged participation in a scheme to defraud Medicare through New Horizons Durable Medical Equipment, Striffin Medical Supply and 4B Ortho Supply, all DME companies located in the Dallas/Fort Worth area of Texas. The case is being prosecuted by Trial Attorney Carlos Lopez.
• Jamshid Noryian, Dehshid Nourian, Christopher Rydberg, Leyla Nourian, Ashraf Mofid, Dr. Leslie Benson, Dr. Michael Taba and Ali Khavarmanesh were charged for their alleged participation in a scheme to defraud the Department of Labor-Office of Worker’s Compensation and Blue Cross Blue Shield and conspiracies to launder money and evade the payment of taxes through Ability Pharmacy, Industrial & Family Pharmacy and Park Row Pharmacy, all located in the Dallas/Fort Worth area of Texas. The case is being prosecuted by Assistant Chief Adrienne Frazior of the Fraud Section.
• Michael Charles Braddick, Kyle Martin Hermesch and Bioflex Medical were charged for their alleged participation in a scheme to defraud the Department of Labor-Office of Worker’s Compensation Programs. Bioflex Medical is located in Dallas, Texas. The case is being prosecuted by Special Assistant U.S. Attorney Jennifer Bray.
• Nehaj Rizvi was charged for his alleged participation in a scheme to defraud Medicare through Life Spring Housecall Physicians Inc., a company located in Dallas, Texas. The case is being prosecuted by Assistant U.S. Attorney Douglas Brasher.

Southern District of Texas

• Diana Hernandez, Kathy Hernandez, Hieu Troung, R.P.H., Clint Randall, Prince White, Charles Walton and Cedric Milbrurn were charged for their alleged participation in a scheme to unlawfully distribute and dispense controlled substance without a legitimate medical purpose through S&S Pharmacy of Houston, Texas. The case is being prosecuted by Trial Attorney Devon Helfmeyer of the Fraud Section.
• Franklin Nwabugwu, R.P.H. was charged for his alleged participation in a scheme to unlawfully distribute and dispense controlled substance without a legitimate medical purpose through Golden Pharmacy of Houston, Texas. The case is being prosecuted by Trial Attorney Devon Helfmeyer.
• Steven Inbody, M.D. and Hoai-Huong Truong were charged for their alleged participation in a scheme to unlawfully distribute and dispense controlled substance without a legitimate medical purpose. The case is being prosecuted by Trial Attorney Catherine Wagner.
• Ashley McCain, John Sims, Gregory Comer, Kesia Banks, Jacqueline Hill and Horace LeBlanc were charged for their alleged participation in a scheme to unlawfully distribute and dispense a controlled substance without a legitimate medical purpose through Continuous Medical Care and Rehabilitation. The case is being prosecuted by Assistant Deputy Chief Aleza Remis of the Fraud Section and Trial Attorney Devon Helfmeyer.

Eastern District of Texas

• Demetrius Cervantes, 44, of McKinney, Texas, Amanda Lowry, 39, of Sherman, Texas, and Lydia Henslee, 27, of Denison, Texas, were indicted for conspiracy to obtain information from a protected computer and conspiracy to unlawfully possess and use a means of identification. The case involves the breach of a health care provider’s electronic health record (EHR) system in order to steal protected health information and personally identifiable information belonging to patients of the provider. The information that was stolen from the provider was “repackaged” in the form of false and fraudulent physician orders and sold to DME providers and contractors. Within approximately eight months, the defendants obtained more the $1.4 million in proceeds from the sale of the stolen information. The proceeds of the offenses were traced and the following forfeitable assets were identified: a 2019 Land Rover Range Rover SC; a 2019 Dodge Durango; a 2018 Polaris RZR XP4 1000 EPS; a 2019 Can-Am Outlander 450; a 2019 Sea-Doo RXT-X 300 W; a 2019 Sea-Doo RXT-X 300 W; and a 2019 Karavan Sea-Doo Move. This case is being prosecuted by Assistant U.S. Attorneys Nathaniel C. Kummerfeld and L. Frank Coan.
• Joseph Valdie Kimble, 62, of Longview, Texas, pleaded guilty to health care fraud. Kimble operated Tiger EMS, a business providing non-emergency ambulance transport, mostly between skilled nursing centers and hospitals and dialysis centers. Ambulance providers may bill for ambulance services only if there is a demonstrated medical need, which requires that (a) the beneficiary be bed-confined, and it is documented that other methods of transportation are contraindicated; or (b) the beneficiary's medical condition is such that transportation by ambulance is medically required. Kimble disregarded medical necessity requirements and billed Medicare and Medicaid for ambulance services provided to patients for whom ambulance transport was not medically necessary. The plea agreement provides for an agreed sentence of 30 months in prison and $751,986.80 in restitution. This case is being prosecuted by Assistant U.S. Attorney Alan R. Jackson.

Western District of Texas

• Orlando Garcia-Moya, owner and president of Fleet Ambulance Co. in San Antonio (Fleet), and Melody Ann Villareal, emergency medical technician and Fleet supervisor, were charged for their roles in a scheme to defraud Medicaid by submitting over $2.5 million in fraudulent claims for non-emergency ambulance transportation that was never provided. As a result of the scheme, Fleet received over $1 million in Medicaid funds. The case is being prosecuted by Special Assistant U.S. Attorney Rex Beasley and Assistant U.S. Attorney John Kennedy.