Posted On Monday, September 21, 2015
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On Friday, September 18, the medical biller for a Chicago-area visiting physician practice was sentenced to 45 months in prison, by U.S. District Judge Gary Feinerman of the Northern District of Illinois, for her role in a $4 million healthcare fraud scheme. Mary Talaga was convicted in May of this year following a jury trial on numerous charges relating to a billing scheme, including conspiracy to commit healthcare fraud. Ms. Talaga was also sentenced to pay approximately $1 million in restitution.
From 2007-2011, Talaga was the primary medical biller for Medicall Physicians Group, Ltd., a physician practice that visited patients in their home and prescribed home healthcare. The primary method of billing fraud that came to light at trial was the billing of Medicare for a service known as “Care Plan Oversight” or “CPO,” which would have indicated that the doctors had provided oversight of patient care plans. In fact, the doctors at Medicall rarely provided the service.
Talaga and her co-conspirators also billed Medicare for other services that were never provided, including services rendered to patients who were deceased, services purportedly provided by medical professionals no longer employed by Medicall and services purportedly provided by medical professionals who, based on billing records would have had to have worked over 24 hours per day. In all, the evidence presented at trial indicated that, through the period of the 5-year conspiracy, Medicall submitted bills to Medicare for more than $4 million in services never provided and Medicare paid more than $1 million on those claims.
Talaga’s co-conspirators, Rick Brown and Roger A. Lucero, Medicall’s former medical director, were also convicted in this matter. Brown was convicted as part of the same trial with Talaga, and has been sentenced to serve more than 7 years in prison. Lucero pleaded guilty and will be sentenced at a later date.
According to the government, since its inception in March 2007, the Medicare Fraud Strike Force, which investigated and prosecuted this case, has charged over 2,300 defendants who collectively have billed the Medicare program for over $7 billion.
Posted On Friday, September 18, 2015
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A securities broker pleaded guilty on Wednesday in the U.S. District Court in Trenton to a securities fraud conspiracy that profited from his use of material inside information stolen from the New York office of a global law firm. Contemporaneous with the plea, the government filed the criminal information detailing the charges, which also included one count each of securities fraud and tender offer fraud.
The case arises out of the defendant Vladimir Eydelman’s having trading on material non-public information from 2009-2013, while a broker at Oppenheimer & Co. and later at Morgan Stanley. The inside information was provided to him by his brokerage client, Frank Tamayo. According to the government, Tomayo obtained the inside information from a friend and former law school classmate, Steven Metro, who was the managing clerk of the New York office of Simpson Thacher and Bartlett, LLP. The inside information disclosed by Metro related to corporate transactions, including mergers and acquisitions or tender offers, in which the law firm represented a party or financial advisor to the transaction.
The government charged that Metro collected the inside information by scouring the law firm’s computer systems using search terms relating to corporate transactions, as well as client names and client-matter numbers. Metro would then pass on the information to Tamayo in meetings at restaurants and coffee shops in Manhattan, providing, among other things, the names and/or ticker symbols of the companies whose securities should be purchased, the general timing of the planned deals, and information related to how the deals would affect the issuer’s stock price once announced. After Tamayo received the inside information from Metro, Tamayo would meet with Eydelman and pass the information to him. According to the government, Tamayo would show Eydelman the paper or napkin on which Tamayo had written the ticker symbol of the company whose securities should be purchased. After Eydelman memorized the ticker symbol, Tamayo, in an apparent attempt at a bit of spy tradecraft, would then place the paper or napkin into his mouth and chew it until it was destroyed.
The government charged that, after receiving the inside information provided by Metro, Eydelman would purchase securities for himself, family members, friends and clients, including Tamayo. He would then quickly sell the shares and cover any positions once the relevant deal in each instance was publically announced and the stock price rose. The government estimates that by exploiting the information that Metro had stolen from the law firm, Eydelman and conspirators Metro and Tamayo netted more than $5.6 million in illicit profits.
Tamayo pleaded guilty to conspiracy and securities and tender offer fraud in September of 2014. Metro has maintained his plea of not guilty and is scheduled to go to trial on February 8, 2016.
Cyber hacking incidents have grabbed headlines recently, causing companies, healthcare institutions and professional service firms to reinforce their security from outside threats. This case, however, is a reminder that some of the most substantial threats to the security of a company’s sensitive information can come from within.
