Case Studies
26 Indicted in Drug Distribution Investigation
“Babubhai “Bob” Patel, 49 (pictured), a Canton pharmacist, was the beneficial owner and controller of some 26 pharmacies statewide (referred to in the indictment as “the Patel Pharmacies”). Babubhai Patel concealed his ownership and control over many of the Patel Pharmacies through the use of straw owners. The indictment alleges that Babubhai Patel would offer and pay kickbacks, bribes, and other inducements to physicians, in order to induce those physicians to write prescriptions for patients with Medicare, Medicaid, and private insurance, and to direct that those prescriptions be presented to one of the Patel Pharmacies for billing. In exchange for their kickbacks and inducements, the medical professionals would write prescriptions for the patients, and bill the relevant insurers for services supposedly provided to the patients, without regard to the medical necessity of those prescriptions and services. The physicians would direct the patients to fill their prescriptions at one of the Patel Pharmacies. There, according to the indictment, Babubhai Patel and his pharmacists would bill insurers, including Medicare, Medicaid, and private insurers, for dispensing the medications, despite the fact that the medications were medically unnecessary and/or never provided. Patients were recruited into the scheme by patient recruiters, who would pay kickbacks and bribes to patients in exchange for the patients’ permitting the Patel Pharmacies (and the physicians associated with Patel) to bill their insurance for medications and services that were medically unnecessary and/or never provided.”
Miami Man Indicted for Healthcare Fraud in Gainesboro, Tennessee
On September 23, 2010, Yennier Capote-Gonzalez of Miami, Florida, was indicted in the Middle District of Tennessee in Nashville for engaging in health care fraud, money laundering, and aggravated identity theft. Mr. Capote-Gonzalez established a phantom infusion clinic, Gainesboro Ultimate Med Services in Gainesboro, Tennessee (pictured), in order to submit fraudulent Part C claims to WellPoint and CIGNA for J-codes using legitimate numbers of an unsuspecting Medicare provider and beneficiaries. The total amount billed by Mr. Capote-Gonzalez to WellPoint and CIGNA was $205,965. The total amount paid by CIGNA Health Plan was $38,116.
WellPoint Plan had no monetary loss.