R&V and Robert Saul were charged with 48 counts of healthcare fraud, six counts of mail fraud, 47 counts of paying illegal kickbacks for Medicare referrals and three counts of obstruction of justice. Others charged in the case include Lisa Burnett (charged with 11 counts of receiving illegal kickbacks for Medicare referrals) and Carol Mason (charged with 27 counts of receiving illegal kickbacks for Medicare referrals). Susan Landolf was charged by Information with one count of receiving kickbacks for Medicare referrals and one count of healthcare fraud, and Debra Stallings was charged by Information with one count of healthcare fraud, according to the release.
According to the indictment, R&V Medical Supplies, Mr. Saul and Ms. Saul paid kickbacks to various persons to provide referrals to R&V for the provision of DME to healthcare benefit program beneficiaries, including Medicare beneficiaries. These referral sources allegedly worked in physician offices or social service or healthcare agencies and had access to confidential beneficiary information such as names, dates of birth, social security numbers and healthcare insurance providers, according to the release. It is alleged that the amounts paid were based on the amounts and types of DME ordered for each particular beneficiary, with power wheelchairs garnering the highest kickback payments. The indictment alleges that the referral fees were usually not paid until R&V received reimbursement from the applicable healthcare benefit program for the DME that was ordered as a result of the referral.
The indictment alleges that beneficiary information obtained by defendant R&V through these kickback payments was verified by Mr. Saul, Ms. Saul or an R&V employee to ensure that the beneficiary was covered by a healthcare benefit program and to determine the scope of available coverage. Based on the available coverage, Mr. Saul or Ms. Saul allegedly determined the type of DME to order for each beneficiary, according to the release. In addition to developing business through the payment of kickbacks to outside referral sources, the Sauls allegedly reviewed R&V’s files and ordered additional DME for healthcare benefit program beneficiaries whom R&V had previously supplied.
According to the indictment, the additional DME was ordered without regard to medical necessity and was based solely on the beneficiaries’ available insurance coverage. It is alleged that, at the request of R&V, Mr. Saul and Ms. Saul, employees of R&V drew up the necessary physician approval paperwork, such as physician orders, product descriptions, letters of medical necessity, and face-to-face examination pages, based on the type of DME to be ordered for each beneficiary and the beneficiary’s particular healthcare benefit program. Allegedly, on hundreds of occasions beginning in or about March 2007, Mr. Saul forged or caused others to forge physician signatures on the supporting physician approval documents.
The defendants then allegedly submitted, and caused to be submitted, fraudulent claims for reimbursement for DME to health care benefit programs, including Medicare and IBC that, among other things, were supported by false and fraudulent representations that physicians had ordered and approved the DME.
Additionally, the indictment states that Mr. Saul employed various tactics to attempt to cover up and conceal the fraudulent claims, including the following:
- Mr. Saul allegedly attempted to confuse beneficiaries as to the origin of the DME ordered on their behalf by falsely telling them, among other things, that the City of Philadelphia was giving out free medical supplies that they were qualified to receive, or that their physicians had approved them for DME at no cost to the patient;
- Mr. Saul allegedly instructed referral sources at physicians’ offices to try to intercept phone calls from the patients whom they had referred in order to prevent them from getting through to the physician and further instructed these referral sources to assure the patients that they were authorized to receive the equipment, which was being provided at no cost to the patient;
- Mr. Saul allegedly conducted a review of R&V’s files in an attempt to remove and replace forged physician approval documents after the relevant claims had already been submitted and reimbursed; and
- Mr. Saul allegedly instructed defendant R&V’s employees to lie to federal agents if questioned about the illegal kickbacks and forgeries.
If convicted, Mr. Saul faces a maximum possible sentence of five years imprisonment for conspiracy, 10 years imprisonment for each count of healthcare fraud, 20 years imprisonment for each count of mail fraud, five years imprisonment for each count of paying illegal kickbacks, and 20 years imprisonment for each count of obstruction of justice. If convicted, Ms. Saul faces a maximum possible sentence of five years imprisonment. If convicted, Ms. Burnett and Ms. Mason each face maximum possible sentences of five years imprisonment for each count of receiving illegal kickbacks. If convicted, Ms. Landolf faces a maximum possible sentence of 15 years imprisonment. If convicted, Ms. Stallings faces a maximum possible sentence of 10 years imprisonment.
Read the DOJ’s release on Robert and Sheila Saul (pdf).
