Disbarred Attorney Sentenced to Prison for Her Role in $28.3 Million Medicare Fraud Scheme
|U.S. Department of Justice August 07, 2014|
WASHINGTON—A disbarred Florida attorney was sentenced in federal court in Tampa, Florida today to serve 70 months in prison in connection with her role in a $28.3 million Medicare fraud scheme involving false claims for physical and occupational therapy services.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney A. Lee Bentley III for the Middle District of Florida, Acting Special Agent in Charge Reginald France of the Health and Human Services Office of Inspector General (HHS-OIG) region including all of Florida and Special Agent in Charge Paul Wysopal of the FBI’s Tampa Field Office made the announcement. The sentence was imposed by U.S. District Judge Susan C. Bucklew of the Middle District of Florida.
Margarita Grishkoff, 60, of Charlotte, North Carolina, formerly of southwest Florida, pleaded guilty on Jan. 24, 2014, to conspiracy to commit health care fraud. In addition to serving a prison term of 70 months, Grishkoff was sentenced to serve three years of supervised release and ordered to pay $14,424,856 in restitution, jointly and severally with her co-conspirators.
Grishkoff admitted as part of her guilty plea that she and her co-conspirators submitted approximately $28.3 million in fraudulent reimbursement claims to Medicare through physical therapy clinics throughout Florida from 2005 through 2009. Medicare paid approximately $14.4 million on those claims.
According to court documents, Grishkoff, a former attorney who was disbarred in Florida in 1997, was vice president and director for a Delaware holding company known as Ulysses Acquisitions Inc. Through Ulysses Acquisitions, Grishkoff purchased comprehensive outpatient rehabilitation facilities and outpatient physical therapy providers, including West Coast Rehab Inc. in Fort Myers, Florida; Rehab Dynamics Inc. in Venice, Florida; Polk Rehabilitation Inc. in Lake Wales, Florida and Renew Therapy Center of Port St. Lucie LLC in Port St. Lucie, Florida, to gain control of these clinics’ Medicare provider numbers.
Grishkoff and her co-conspirators paid kickbacks to patient recruiters and clinic owners to obtain identifying information of Medicare beneficiaries and physicians. Grishkoff and her co-conspirators then used this information to create and submit false claims to Medicare through the clinics Ulysses Acquisitions purchased. These claims sought reimbursement for therapy services that were not legitimately prescribed and not actually provided.
Also according to court documents, Grishkoff and her co-conspirators used the clinics they controlled to submit false reimbursement claims to Medicare on behalf of clinics owned by others, in exchange for a percentage of the Medicare reimbursement received. These Miami-based therapy clinics included Hallandale Rehabilitation Inc., Tropical Physical Therapy Corporation, American Wellness Centers Inc. and West Regional Center Inc. Grishkoff and her co-conspirators kept approximately 20 percent of the money Medicare paid on these claims and paid the other 80 percent of the fraud proceeds to the co-conspirator clinic owners.
Grishkoff further admitted that after falsely billing Medicare through Ulysses Acquisitions, and in order to disassociate herself from the clinics, Grishkoff and her co-conspirators arranged sham sales of the clinics to nominee or straw owners, all of whom were recent immigrants to the United States with no background or experience in the health care industry.
The case is being investigated by HHS-OIG and the FBI and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Florida. The case is being prosecuted by Trial Attorneys Christopher J. Hunter and Andrew H. Warren of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Simon A. Gaugush of the Middle District of Florida.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Team (HEAT), go to: www.stopmedicarefraud.gov.