2009 Award Winners

2009 Investigation of the Year
2009 Investigation of the Year: Honorable Mention
2009 Excellence in Public Awareness
2009 Investigative Excellence Award
2009 Medical Director

Investigation of the Year

United States of America v. Robert Ignasiak, Jr., M.D.

Presented to

United States Department of Justice
United States Attorney's Office
Northern District of Florida

United States Department of Justice
Federal Bureau of Investigation
Jacksonville Division

United States Department of Defense
Defense Criminal Investigative Service

Florida Office of the Attorney General
Medicaid Fraud Control Unit

Florida Department of Law Enforcement

Florida Department of Health
Special Investigations Unit

Florida Department of Financial Services

United States Department of Justice
Drug Enforcement Administration

United States Department of Justice
National Drug Intelligence Center

Walton County Sheriff's Office

A 2 ½ year investigation into the practice of a family physician in a small community of 1500 in northwestern Florida uncovered evidence of major over prescribing of controlled substances; drug overdoses requiring visits to area emergency rooms; the deaths of at least 8 persons; an increase in drug trafficking and drug related robberies; and patients traveling from as far away as Texas and Michigan to obtain their drugs. A 54-count indictment charged the physician with health care fraud, including two counts of unlawfully dispensing drugs resulting in death. After a 3-week trial, the doctor was convicted of 43 counts and sentenced to 292 months' imprisonment and a $250,000 criminal fine. In addition, property valued at $850,000 was forfeited.

Congratulations to:

AUSA Michelle M. Heldmyer
AUSA Benjamin W. Beard
Paralegal LeAynn Dunbar
U.S. Department of Justice
United States Attorney's Office, Northern District of Florida

Special Agent Victoria Harker
U.S. Department of Justice
Federal Bureau of Investigation, Jacksonville Division

Special Agent Luis Hernandez
Special Agent Jason Sargenski
U.S. Department of Defense
Defense Criminal Investigative Service

Investigator Melody Barnard
Investigator W. Taylor Wells
Florida Office of the Attorney General
Medicaid Fraud Control Unit

Sandra Fitzsimons, Law Enforcement Detective
Florida Department of Financial Services

Special Agent Kristen Cortes
Florida Department of Law Enforcement

Analyst Betty Irvine
U.S. Department of Justice
National Drug Intelligence Center

Investigator Harry F. Knight
Florida Department of Health, Special Investigations Unit

Diversion Agent Martin Ramirez
U.S. Department of Justice, Drug Enforcement Administration

Sergeant Will Curtis
Sergeant Marvin Willford
Walton County Sheriff's Office

2009 Investigation of the Year: Honorable Mention

United States of America v. All-Med Billing Corp.

Presented to

United States Department of Justice
United States Attorney's Office
Southern District of Florida

United States Department of Justice
Federal Bureau of Investigation
Miami Division

United States Department of Health and Human Services
Office of Inspector General
Office of Investigations, Miami Regional Office

TrustSolutions, LLC

This was a 5-year investigation of a billing company for the fraudulent submission of Durable Medical Equipment claims on behalf of its clients, DME suppliers. During the course of the investigation, 52 search warrants were obtained authorizing searches of the billing company's offices; a storage facility it maintained; the home of its owners; two check-cashing businesses that its clients used to cash reimbursement checks; and the business locations of a large number of its clients. As a result, almost 1000 boxes of records were seized. Over the course of the investigation, charges were brought against 29 individuals for health care fraud, money laundering and aggravated identity theft involving the submission of $419 million in fraudulent claims. Twenty eight individuals have been convicted (there is one fugitive). Among those convicted were the owners of the billing company who were sentenced to 14 years' imprisonment.

Congratulations to:

AUSA Christopher J. Clark
AUSA Marc Osborne
United States Department of Justice
United States Attorney's Office, Southern District of Florida

Special Agent Rolf O. Gjertsen
Special Agent Cesar Facio
United States Department of Justice
Federal Bureau of Investigation, Miami Division

Special Agent Jose Braniella
Special Agent Jesus Barranco
U.S. Department of Health & Human Services
Office of Inspector General
Office of Investigations, Miami Regional Office

2009 Excellence in Public Awareness

Presented to

Southern District of Florida
Health Care Fraud Team

Through numerous investigations and prosecutions involving over $2.5 billion in fraud committed against the Medicare program, a dedicated group of special agents and Federal prosecutors working together in the Southern District of Florida has charged over 750 individuals with health care fraud and identified vulnerabilities in program areas highly susceptible to fraud that, when corrected, saved hundreds of millions of dollars. Using a three-step process involving traditional long-term criminal investigative techniques; data analyses to identify fraud being committed in "real time;" and identifying assets for civil seizure, a model emerged which would later be adopted in other large metropolitan areas affected by massive health care fraud. The results achieved by this concentrated and coordinated approach generated extensive press coverage, both locally and on a national level, bringing the problem of health care fraud to the forefront for all to see.

Congratulations to:

2009 Investigative Excellence Award

Presented to

Medical Mutual of Ohio

A 5-year investigation into the fraudulent billing practices of a provider including: billing for services and supplies not rendered; exaggerated claims for infusion therapy; inflated professional services claims; up-coding; resubmission of previously paid claims; and submission of claims under an affiliated provider's number in an attempt to misrepresent the source of the claims resulted in an administrative settlement of $2.3 million and the identification of an additional $2.4 million in false claims. Even after the settlement was reached, the provider continued its deceptive billing practices. In addition to the monetary settlement noted above, Medical Mutual of Ohio's investigative activities resulted in cost avoidances of $3.5 million.

Congratulations to:

John Shoemaker
Manager, Financial Investigations

Kathy Schneeberger
Financial Investigator

Brianne Santoli
Associate Financial Investigator

Becky Radesic
Financial Investigator Analyst

2009 Medical Director Award

Presented to

Daniel S. Bowerman, DC, FACO, CPC
Medical Director, Chiropractic
Independence Blue Cross

The National Health Care Anti-Fraud Association is proud to honor Daniel S. Bowerman, DC, FACO, CPC, with the 2009 NHCAA Medical Director Award.

Dr. Bowerman has been a member of the Independence Blue Cross (IBC) Medical Director staff since 2001, where he currently serves as Medical Director of Chiropractic. In addition to providing support to the Independence Blue Cross investigations unit, he serves as a subject matter expert for the Contracting Department, Medical Policy Development, Internal Audit and the Provider Network Division. He also participates on multiple IBC committees including the Medical Cost Council and is Co-Chair of the Care Management and Coordination Medical Cost Action Program.

In reference to Dr. Bowerman's dedication to his job, IBC Senior Vice President of Health Services Richard L. Snyder, M.D. states, "He brings a keen focus on quality and the delivery of a high level of care to our members."

Dr. Bowerman has proven to be a valued supporter of NHCAA, sharing his breadth of knowledge with those working in the health care anti-fraud field. He has given generously of his time, serving as presenter for several NHCAA training programs and workshops, actively participating as a member of the NHCAA Education & Training Committee, and serving as Chair of the NHCAA Medical Director Advisory Group.

His passion as an educator extends well beyond his work with IBC and NHCAA. Dr. Bowerman has shared his knowledge as a presenter with many organizations including the National Insurance Crime Bureau, the International Association of Special Investigations Units and the Blue Cross Blue Shield Association. He is also recognized as an authority within the chiropractic academic community and serves as a postgraduate instructor/lecturer for several institutions including American Chiropractic Educational Services, Canadian Memorial Chiropractic College, Texas Chiropractic College and National College of Chiropractic.

Dr. Bowerman is a graduate of the Sherman College of Chiropractic Medicine. He completed a three-year advanced training program in chiropractic orthopedics at the National College of Chiropractic and is recognized as a Diplomate of the American Board of Chiropractic Orthopedics. In addition, he recently became a Certified Professional Coder through the American Academy of Professional Coders.

A Private-Public Partnership Against Health Care Fraud

2009 Award Winners

Platinum & Premier Supporting Members

A Private-Public Partnership Against Health Care Fraud

2009 Award Winners

Platinum & Premier Supporting Members

Twitter

Facebook

Resources