Archive for the tag 'fraud'

What a perfect photo for this article. (Source: Pedro Vezini/Flickr)

A recent report is raising questions about several local doctors who rank among the nation’s highest earners for Medicare claims, with many of them seeing the same patients thousands of times in just a few short months.

The doctors – occupational therapists, chiropractors and physical therapists – have been walking a quasi-legal line, sharing patients through a network in which they are seen, and billed, multiple times on the same day. One chiropractor and an occupational therapist had overlapping patients that were seen on the same day more than 11,000 times in 18 months, according to USA Today.

While referring patients to other doctors is common, a high frequency could indicated what experts call “churning” – cross-referring within a known network for financial gain and not medical need, and possibly for a kickback. The local network is also unusual because chiropractors, physical therapists and occupational therapists usually compete with one another, and would be unlikely to send referrals.

After reviewing Medicare data nationwide, USA Today found Southern Brooklyn docs stood out for their high referral rates. Here’s how they detailed the network:

The USA TODAY analysis found that six practitioners in Brooklyn all regularly saw the same patients, often treating each person dozens of times. Medicare paid the six a total of nearly $15 million in 2012, the only calendar year that payment data is publicly available. Additional practitioners also fed into and benefited from the referral network, but at smaller rates than the top half-dozen.

For example, physical therapist Wael Bakry and occupational therapist Victor Genkin, both part of the network, are the first and second biggest recipients of Medicare money in 2012 in their respective fields.

Medicare paid Bakry about $4.1 million for performing more than 184,000 procedures on 1,959 patients. Genkin brought in more than $2.3 million from seeing fewer than 1,200 patients.

According to Medicare’s data, over 18 months the two shared more than 700 clients, who saw both regularly — as many as 25 times each.

The top earning chiropractor in the nation, Brooklyn’s Alexander Khavash, was also a top referrer to Bakry and Genkin. According to the Medicare data, Bakry and Khavash shared more than 1,200 patients between them.

Often, but not always, the physical therapist and chiropractor saw patients back-to-back. One group of patients made a total of more than 17,000 visits to both doctors on the same day — an average of 13 times per patient — over an 18 month span.

The patients also regularly cycled through internist Abraham Demoz, who has used the same address as Genkin and Bakry. For example, Khavash saw 2,060 patients in 2012, according to the Medicare payment records. Demoz shared almost 1,800 of them with him over 18 months, the data show. Demoz and Genkin had about the same amount of patient overlap.

Mayura Kanekar is another Brooklyn provider who is part of the same circle.

Kanekar brought in nearly $3 million as the top Medicare-earning occupational therapist in the country in 2012. Occupational therapists work on people’s fine motor skills so they can perform daily tasks. Over the 18 months covered by Medicare’s referral data, a group of about 800 patients routinely visited both her and Khavash on the same day — seeing the two specialists back-to-back a total of 11,621 times.

None of the federal law enforcement officials USA TODAY interviewed would comment about whether any of the individuals are under investigation.

Some of those docs have also come up in other recent reports for their unusually high billing.

The USA Today report is lengthy and detailed – and a worthwhile read. Their reporters go to find the doctors at their listed medical offices, only to find abandoned storefronts or residential buildings. The look into the causes for the high rate of Medicare claims, and also address investigators’ challenges in finding and prosecuting such cases. Check it out, then feel sad.

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The MTA is warning E-ZPass users of a new e-mail phishing scam that has surfaced, in which digital con artists attempt to get at your private data by warning of phony unpaid tolls.

Phishing scams attempt to dupe users to send the scammer sensitive information, including usernames, passwords or banking information by masquerading as a trustworthy entity.

Scam artists are sending out official looking e-mails carrying the E-ZPass logo, often from an e-mail account that appears to be connected to the service. A screenshot of the e-mail is shown above, stating that the user has not paid for driving on a toll road and that previous invoices have not been responded to. It provides a link to download the invoice.

In reality, the E-ZPass Service Center does not send out e-mail invoices for payments. All bills are sent through the United States Postal Service. The e-mails are not authorized by E-ZPass, MTA Bridges and Tunnels or any other toll agency associated with the service.

The agency is advising customers not to open or respond such e-mail, and instead send them straight to the trash bin. If you think you may have a legitimate e-mail from E-ZPass and want confirmation before opening it, you can call the E-ZPass New York Customer Service Center at (800) 333-8655.

Source: DVIDSHUB/Flickr

The American Red Cross is coming under fire for refusing to disclose how it spent more than $300 million in funds raised for Superstorm Sandy relief, claiming that the information is a “trade secret.”

Investigative news outlet ProPublica has been fighting to get the independent relief organization to reveal how it spent donated funds on Sandy between the storm and February 2014, but the organization refuses to give a breakdown.

But the organization did fork over information to New York Attorney General Eric Schneiderman, who is investigating this and other charities – so ProPublica filed a public records request with his office to see what was handed over.

The site reports what happened next:

That’s where the law firm Gibson Dunn comes in.

An attorney from the firm’s New York office appealed to the attorney general to block disclosure of some of the Sandy information, citing the state Freedom of Information Law’s trade secret exemption.

The documents include “internal and proprietary methodology and procedures for fundraising, confidential information about its internal operations, and confidential financial information,” wrote Gabrielle Levin of Gibson Dunn in a letter to the attorney general’s office.

If those details were disclosed, “the American Red Cross would suffer competitive harm because its competitors would be able to mimic the American Red Cross’s business model for an increased competitive advantage,” Levin wrote.

The letter doesn’t specify who the Red Cross’ “competitors” are.

The Red Cross is a public charity and occupies a unique place responding to disasters alongside the federal government.

Some of the organization’s redaction requests were trivial: lines that simple read “American Red Cross,” or sections of letter stating they were willing to meet with the attorney general.

Those requests were denied by Schneiderman’s office, but others included information that the attorney general agreed was “proprietary and constitutes trade secrets,” such as “business strategies, internal operational procedures and decisions, and the internal deliberations and decision-making processes that affect fundraising and the allocation of donations.”

ProPublica has not yet received the documents from the attorney general, but the outlet says it will report on them when they do.

UPDATE (6:00 p.m.): Councilmember Mark Treyger, chairman of the Committee on Recovery and Resiliency, asked us to tack this on to the article, following the introduction (with Councilmember Ulrich) of a bill to create a monitor to oversee Sandy relief funding to prevent fraud.

“Citizens who donate to disaster relief efforts, including in the aftermath of Superstorm Sandy, have a right to know that their money is being used to help victims recover and rebuild. With so much funding at stake, and residents still in need of so much assistance, I remain concerned about the potential for misuse of relief funds, including by government agencies, contractors and private organizations. That’s why I worked with my colleague Council Member Eric Ulrich to introduce legislation this week establishing an independent monitor to investigate instances of waste, fraud and abuse in order to maximize the amount of aid delivered to impacted neighborhoods across New York City. To be clear, I am not accusing the Red Cross of any improper activity, but rather am reiterating the need for openness and transparency as the recovery effort moves forward.”

grimm2Congressman Michael Grimm, already in hot water over criminal charges that he evaded taxes and illegally employed undocumented immigrants, may have violated the internal ethics rules of the House of Representatives when he threatened to throw a reporter off a balcony in January.

The New York Times reports:

A one-page report by the office, a quasi-independent investigative body that serves almost like a grand jury, was released on Wednesday by the House Ethics Committee, the panel of lawmakers with the exclusive power to punish colleagues for ethical infractions.

The Office of Congressional Ethics, in a preliminary review, unanimously concluded in March that there was “substantial reason to believe that Representative Grimm threatened a reporter with bodily harm and engaged in a threatening or menacing act that created a fear of immediate injury,” which would violate local law in the District of Columbia as well as House ethics rules.

Grimm made headlines the night of the State of the Union when he was caught on camera threatening NY1 reporter Michael Scotto. He told the reporter he would “break him like a boy” and throw him off the balcony of the Capitol rotunda.

Scotto was interviewing him about a federal investigation into the congressman’s campaign fundraising that later led to criminal indictments of several Grimm associates. Grimm himself has so far escaped charges on that matter, but was slapped with a 20-count indictment alleging financial and employment improprieties in connection to a restaurant he operated before entering Congress.

The House panel will not investigate further at this time, setting it aside at the request of federal prosecutors.

The following is a press release from the MTA:

The Metropolitan Transportation Authority (MTA) is reminding customers that if they have lost an item on a train or bus, or at a station, they can submit a lost property claim free of charge and directly to the MTA online, by phone, or in person. There is no charge for submitting a lost property claim to the MTA’s lost and found offices.

Recently, MTA customers have complained that online searches have directed them to an official-looking website, www.lostpropertynyc.com, which asks for personal information, then uses that information to generate a bill to be paid online by credit card.

The website implies that it contacts the MTA on behalf of the customers seeking lost property. However, the MTA’s lost and found offices do not do business with lostpropertynyc.com or any other third party company claiming to act on behalf of people who have reported lost items. The MTA’s lost and found offices return lost items only to those claimants who can identify that they are the rightful owners of the property.

“Anyone looking to submit a claim for lost property needs to go through the MTA’s official website,” said MTA Police Chief Michael Coan. “There is no charge to submit a claim to any of the MTA’s lost and found units.”

The MTA Police Department has launched a criminal investigation into the website. Because the website is also soliciting information from taxi and airport customers, and the MTA has notified the New York City Taxi & Limousine Commission and the Port Authority of New York and New Jersey.

The MTA’s lost and found offices are accessible from this web page: http://web.mta.info/mta/lost_found.html

The MTA maintains three units that serve as repositories for personal items that are left on trains and buses, or at stations. MTA New York City Transit’s Lost Property Unit, located at the 34th Street-Penn Station stop on the ACE lines, handles items left on the New York City Subway, New York City Buses, and Staten Island Railway. MTA Long Island Rail Road has a lost and found office in Penn Station, and MTA Metro-North Railroad has a lost and found office at Grand Central Terminal.

In 2013, the MTA’s lost and found offices received 67,320 lost items, and returned 34,572 of them to their owners while fielding more than 73,000 queries about lost items from customers.

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Grimm

Congressman Michael Grimm faces a 20-count indictment for tax evasion and illegal employment practices stemming from a restaurant he operated before running for Congress, charges he said are because the nation’s commander-and-chief wants to see him gone.

Grimm made the allegations against the Obama administration on Tuesday before a gathering of Republican supporters rallying for gubernatorial candidate Rob Astorino. He also compared the United States to oppressive regimes in Iran and North Korea.

New York Observer reported on the statements:

“They change policy, they use regulation to legislate, they circumvent the Congress–this is now the norm for the Obama administration,” Mr. Grimm fumed at the Bay Ridge Manor in Bay Ridge, Brooklyn.

“And when you look and see why they come after me so hard, every day another negative story [against] the only Republican in New York City, it becomes obvious: they don’t want any opposition. This administration wants to do what it wants to do and they want you to forget about the America that you grew up in,” he said.

… “Sometimes I wake up in the morning and I’m not sure what country I’m living in,” he said. “Four Americans are killed and murdered in Benghazi–no one’s held accountable …. The IRS, arguably the most feared agency in our entire government targeting people because of their political views. Now this happens in Iran, this happens in North Korea, but this is the United States of America.”

The site reported that the statements “drew loud cheers.”

Grimm has long maintained that the investigation against him, which began as a probe into his 2010 campaign fundraising, was a “political witch hunt” by Democrats looking to see the city’s lone Republican congressman unseated. Prosecutors, however, have submitted paperwork to the court suggesting that Grimm’s own documents show he kept two sets of books and paid employees – some of which were undocumented immigrants – in cash to avoid taxes.

Grimm’s assertion that he is the subject of political retaliation has sparked snark from colleagues, including State Senator Diane Savino. The pol, whose district is largely within Grimm’s, let forth a tirade on Facebook about Grimm’s conspiracy theory back in April:

[G]et a grip folks, Mikey is not that important, he is no threat to the power structure, he is a slick talker with a nice resume who seems to be in trouble. he was not on track for greatness as a national leader, not on track to upset the national scene. Conspiracy, please….

Grimm pleaded not guilty to the charges.

Grimm

Congressman Michael Grimm kept a cell phone registered to his undercover, mob-connected FBI alter-ego years after leaving the job, and continued to use the phone while in Congress, according to a Daily News report.

The paper cites documents released by the U.S. Attorney earlier this week that outlines their evidence in their case against Grimm, who is accused of a $1 million tax fraud scheme, as well as illegal hiring and employment practices.

The paper reports:

Rep. Michael Grimm, who posed as a mobbed-up stockbroker named Michael (Mikey Suits) Garabaldi while working undercover for the FBI, kept his wise-guy alter ego even after entering Congress, newly unsealed federal documents show.

Grimm’s cell phone was listed under a “Michael Garibaldi of Centurian Consulting” as recently as 2012, when prosecutors sought a court order for permission to track all his calls, the documents show.

The embattled Staten Island Republican, who is now under federal indictment, used the phone as his primary number as recently as last year, and even received mail addressed to a Michael Garibaldi, a source told The Daily News.

Grimm, his spokesman and his lawyer did not respond to questions Wednesday about why he used the alias more than six years after leaving the FBI — and for at least two years after entering the U.S. House in January 2011.

The story also reveals the extent of the investigation into Grimm’s 2010 campaign fundraising. That investigation came to light shortly after it began in 2012, first noted by the New York Times, yet it was unclear how far-reaching it was. The new documents show that not only were Grimm’s phone lines were being monitored by authorities, but also that of gal pal Diana Durand, who has been indicted for her alleged role in funneling illegal funds to the Republican pol, and Grimm associates Ofer Biton and Ronn Torossian, who they believed, along with Grimm, has attempted to extort money from prominent Orthodox Rabbi Yosef Pinto.

Biton has also been arrested, and is cooperating in the government’s case against Grimm.

Grimm did not respond to the paper’s requests for comment, or those of the Staten Island Advance.

In fact, he appears to be dodging questions about the investigation, having made headlines yet again this week for jumping into a car and making a getaway from this FOX Detroit reporter:

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Grimm

Federal prosecutors have released documents outlining the government’s case against Congressman Michael Grimm, revealing that Grimm’s own texts and e-mails are being entered as evidence alongside testimony from former employees and business associates.

The Daily News reports:

The preliminary list of evidence includes emails between Grimm and a “Healthalicious manager,” “documents provided by a cooperat[ing] witness,” and “records provided by a Healthalicious employee.” Also listed are “text messages between Grimm and a cooperating witness.”

The list of evidence indicates a seemingly straightforward federal case. Prosecutors plan to prove Grimm maintained a false set of books and lied in financial filings. They will contrast the phony forms with material provided by cooperating witnesses, and with Grimm’s own statements in texts and emails.

Prosecutors are turning over an extensive list of financial documents. Those include years of tax, health and labor filings by Healthalicious and its parent company, Granny Sayz, records of Grimm’s personal finances, the restaurant’s accounts, bank account and credit card records and financial disclosure forms Grimm filed in Congress from 2009 to 2012.

Prosecutors are also offering as evidence the IRS 1040 forms filed by Bennett Ofraly, Grimm’s partner in the restaurant who prosecutors say has ties to the Gambino crime family, which Grimm once investigated while an FBI agent.

Grimm pleaded not guilty to the 20-count indictment alleging the local pol hid more than $1 million in sales at a business he owned to avoid paying taxes, as well as illegally employing undocumented immigrants.

The charges surround the operations of Upper East Side eatery Healthalicious, a venture he ran from 2007 to 2010. However, he’s also charged with perjury for lying to investigators about the business’ operations when he was questioned in 2013, while already serving in the House of Representatives.

It appears the case will not be resolved until after the November 4 elections, in which he faces a challenge from Democrat Domenic Recchia.

grimm

Congressman Michael Grimm has been barred from visiting the FBI’s New York field offices since he left the agency eight years ago, calling into question if the embattled representative left on good terms as he frequently claims.

The Grimm prohibition was discovered by DNAinfo, which reports:

Federal security personnel at the FBI’s headquarters in Lower Manhattan and a satellite office in Kew Gardens, Queens, posted Grimm’s photo inside their glass-enclosed stations in the event he showed up, sources said.

They were under orders to stop him and to immediately notify higher authorities on what further action to take, according to the sources.

“He is not permitted in our space,” one source told “On The Inside.”

“He is not welcome,” a former top FBI official said.

Grimm was hit with a 20-count indictment last Monday, alleging tax fraud and illegal hiring practices at an Upper East Side eatery he ran after his stint in the FBI, and before he ran for Congress. The U.S. Attorney’s office has suggested they’re also looking into potential campaign fundraising abuses.

The congressman often touts his military service record and his career at the FBI as qualifications on the campaign trail. In the law enforcement agency, he served as an undercover operative who penetrated the Gambino crime family, and also helped bring down a ring of white-collar criminals in 2003.

But his career was cut short in 2006, when he unexpectedly resigned. He has always said that he left on good terms to start a family.

The new revelations discovered by DNAinfo cast doubt onto those claims, though, with sources telling the outlet that Grimm was being investigated by the agency’s internal monitors for breach of protocol.

They report:

Sources said Grimm’s FBI identification picture was posted shortly after he resigned from the bureau in 2006 and it now hangs with about two dozen other ex-agents and federal employees.

“They are all employees who were fired, or they were under circumstances where they were forced out or felt they should leave, and all are no longer welcome back,” the former FBI official explained.

… Sources said Grimm, 44, was under internal scrutiny before he quit over allegations that he told a woman he met during a probe that he worked undercover — a violation of FBI protocol.

The FBI’s Office of Professional Responsibility was also questioning so-called “voucher” expenses he submitted in connection with his undercover roles.

The sources believe the pressure of the inquiry played a role in his decision to exit the FBI — an agency he often professed to love, his colleagues noted — without getting a pension because he didn’t serve 20 years.

A spokesperson for Grimm told DNAinfo that the congressman was “unaware” that he was not permitted in FBI offices, and had no idea why. The spokesperson also provided a 2012 letter on FBI letterhead stating that the former agent “resigned his post in good standing with the FBI.”

Source: Facebook

Congressman Michael Grimm continues to face fallout from the criminal charges levied against him on Monday, with New York Republican leadership seeking ways to kick him off the ballot, and the national party booting him from programs to aid his reelection bid.

Grimm turned himself in to authorities Monday morning to respond to a 20-count federal indictment alleging tax fraud, systematically hiring undocumented immigrants and hiding more than $1 million in revenue from the government during his time as a restaurant owner before he became congressman. Grimm pleaded not guilty, and is portraying the investigation as a “political witch hunt” to unseat New York City’s only Republican in Congress.

While the congressman vowed to continue his reelection campaign, where he faces an aggressive bid from former Councilman Domenic Recchia, it seems Republican leadership in both his home borough and in Washington are reconsidering their support.

The Wall Street Journal reports that Staten Island GOP leadership are looking for ways to boot Grimm from the ballot altogether:

The road to replacing the Staten Island congressman on the ballot is narrow and complicated because the deadline for a challenger to get on the ballot passed earlier in April. Election-law experts and Republican Party officials said the sole viable option under New York law appears to be to nominate the Staten Island congressman for another office, such as running for an open judge position.

… Potential GOP candidates to run in Mr. Grimm’s place include state Sen. Andrew Lanza and state Assemblywoman Nicole Malliotakis, a person familiar with the matter said.

The paper reports that a judgeship might be the only route available, but there are no open positions at the moment. Leadership told the paper that could change by September. A defense attorney who has worked on other federal tax evasion charges noted that it’s a tough rap to beat since the prosecution builds its case on documentation as opposed to witness testimony.

Meanwhile, in D.C., Grimm’s Republican colleagues are cooling on his prospects, according to the Daily News. He’s been removed from the National Republican Congressional Committee’s “Patriot Program,” which helps candidates in swing district raise money and receive other support from the national party. He’s also been dis-invited from a fundraiser, and House Speaker John Boehner declined to defend the Congressman when questioned about the case.

The change in fortune for one of the GOP’s more charismatic candidates has him speaking in the third person:

“There are people that don’t like Michael Grimm because Michael Grimm is outspoken,” Grimm said. “I’m a Marine. I don’t relent.”

The congressman also took his message straight to supporters, posting a somewhat lengthy update on Facebook yesterday thanking them for their continued support and claiming that the “trumped-up charges against me are false.”

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