That’s Crazy!!! – More Chronicles from the VA (CH 4)

Angry Wet ChickenHave you ever been so embarrassed by something that any mention seems to depress you?  I am in this position right now; the Department of Veterans Affairs (VA) – Office of Inspector General (VA-OIG) has released more investigation reports and analyses of the VA.  Analyses that should be cause for the most profound concern by congressional representatives, and instead, they act like nothing is wrong, nothing to see here, go away.  Well, I am too embarrassed to “go away,” and I demand action to clean house and curb this atrocious behavior!

Courage involves pain and is justly praised, for it is harder to face what is painful than to abstain from what is pleasant.” – Aristotle

Too often, I am left asking where the Federal Government Employees are and what their responsibility is in fraudulent schemes.  For example, we begin with a $50 Million scheme that had to have been suspicious to employees at Medicare, TRICARE, CHAMPVA, and many other health benefit programs.

  • Nicholas Defonte and Christopher Cirri, both of Toms River, New Jersey, and Pat Truglia of Parkland, Florida, pleaded guilty to conspiracy to commit healthcare fraud. Each defendant played a role in defrauding healthcare benefits by offering, paying, soliciting, and receiving kickbacks and bribes in exchange for completed doctors’ orders for durable medical equipment, specifically orthotic braces. The defendants then fraudulently billed Medicare, TRICARE, the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), and other healthcare benefit programs. Cirri, Defonte, and their conspirators owned and operated multiple call centers where they obtained prescriptions for compound medications and other medical products reimbursable by federal and private healthcare benefit programs. The defendants caused losses to Medicare, TRICARE, and CHAMPVA of approximately $50 million.VA 3

Next, we see another case where Federal employees should have been aware, vocal, and the problems fixed before the scheme turned three years old.

  • Matthew Camera of Erie, Pennsylvania, pleaded guilty to violating federal drug laws. From January 2017 to June 2020, while employed as the pharmacy chief at the VA medical center in Erie, he unlawfully obtained multiple dosage units of hydrocodone and oxycodone from pill bottles awaiting delivery to VA patients. Sentencing is scheduled for March 22, 2022.
  • Michael Nolan of Tampa, Florida, and Richard Epstein, of Aurora, Colorado, were sentenced in a conspiracy to defraud two federal health benefit programs, Medicare and the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). From October 2016 through April 2019, Epstein and Nolan ran a telemarketing company in Tampa called REMN Management LLC that targeted the elderly to generate thousands of medically unnecessary physicians’ orders for durable medical equipment and cancer genetic testing. Epstein and Nolan also created and operated Comprehensive Telcare LLC, a telemedicine company through which they illegally bribed physicians to sign the orders regardless of medical necessity. They then illegally sold the signed physicians’ orders to client-conspirators to support false and fraudulent claims submitted to Medicare and CHAMPVA. The conspiracy resulted in the submission of at least $134 million in fraudulent claims and approximately $29 million in payments. Nolan was sentenced to six years and six months in federal prison, followed by three years supervised release and was ordered to pay $2.1 million. Epstein was sentenced to five years and three months in federal prison, followed by three years supervised release and was ordered to pay $3 million. The court ordered Nolan, Epstein, and other conspirators to pay over $29 million in restitution.
  • Twenty people, including the two founders of Hertel & Brown Physical & Aquatic Therapy and 18 of its employees, were indicted in Erie County, Pennsylvania, of conspiracy to commit wire and healthcare fraud and healthcare fraud. According to the indictment, the defendants engaged in a multifaceted conspiracy from January 2007 to October 2021 that involved a range of fraudulent activities. These included allegedly using unlicensed technicians to provide therapy and then billing for the treatment as though licensed therapists had performed it, regularly billing for treatment using the name and credentials of physical therapists who were on vacation, recording, and billing for time that exceeded the actual treatment time, among several other allegations.
  • Robin Calef of Brockton, Massachusetts, pleaded guilty to one count of theft of public funds. Calef shared a bank account with her sister, a veteran receiving monthly benefits from the VA. Her sister passed away in 2006, and Calef failed to report her death to the VA. Through September 2017, Calef stole approximately $102,289 in VA funds from the shared bank account. Sentencing is scheduled for March 1, 2022.
  • Lisa Hoffman, a former pharmacy procurement technician at the East Orange VA Medical Center in New Jersey, pleaded guilty to theft of government property. From October 2015 to November 2019, Hoffman was responsible for ordering medication, including large quantities of HIV medication, for the center’s outpatient pharmacy. She stole approximately $10 million worth of HIV medication and sold it to Wagner Checonolasco of Lyndhurst, New Jersey. Hoffman is scheduled to be sentenced on March 9, 2022. Checonolasco previously pleaded guilty and is expected to be sentenced on December 15, 2021.
  • Thirteen defendants, including three compounding pharmacy owners, three physicians, two pharmacists, and three patient recruiters, pleaded guilty to a years-long, multistate scheme to defraud the Department of Labor’s Office of Workers’ Compensation Programs (OWCP) and TRICARE. The defendants submitted false and fraudulent claims to the OWCP and TRICARE for prescriptions for compounded and other drugs prescribed to injured federal workers and armed forces members. The defendants paid kickbacks to patient recruiters and physicians to persuade them to prescribe the drugs. Medications were selected based on the reimbursement amount and not on the patients’ needs. The drugs were then mailed to patients, even though they often never requested, wanted, or needed them. The defendants were indicted in June 2018 and are scheduled to be sentenced in February 2022.
  • Andrew Ziacik of New Kensington, Pennsylvania, was sentenced to one day of imprisonment followed by three years of supervised release and was ordered to pay $4,000. Between 2013 and 2017, Ziacik was an appointed federal fiduciary for his older brother, a service-disabled veteran. Ziacik was responsible for receiving his brother’s VA income and paying his brother’s debts. However, Ziacik admitted that he violated the terms of his fiduciary agreement by using the VA funds to purchase a Harley Davidson motorcycle, a diamond ring, and a GMC Sierra truck. As part of his sentence, Ziacik will pay restitution to his brother of $75,000.I-Care

When it comes to incompetence, neglect of duties, and abuse of veterans, the final entry in today’s chronicles of shame reflects blatant criminality, and repercussions and remunerations are only a small part of serving justice.  Never forget the following fact, “overpayments should have been considered an administrative error and the debt waived since veterans are not responsible for repaying overpayments that are found to be the result of administrative errors” [emphasis mine].  The VA-OIG investigation reflects the following:

        • April 2021, the VA Office of Inspector General (VA-OIG) discovered the VBA had incorrectly created a debt of about $210,000 for a veteran.
        • Because of the size of the debt and VA’s plan to withhold the veteran’s entire monthly compensation benefits (over $1,100), and given the veteran’s history of treatment for mental illness, a prior suicide attempt, and suicidal ideation, the VA-OIG review team promptly contacted VBA for corrective action.
        • When contacted by the veteran at four different VA offices, staff assured the veteran all was good, the overpayment was not his to pay, and it would be worked out administratively.

These are the investigation facts; to get this administrative error corrected, the problem had to percolate to the VA-OIG instead of any number of the checks and balances, quality assurance measures, and other in-house processes to catch the VBA from damaging a veteran.  The VBA failed!  How many hundreds of employees were responsible for this disaster and leadership failure?  When will those employees be held accountable?  The case presented is but one of thousands of cases every year where the VBA makes a mistake.  The veteran, their family, and the taxpayer are abused, robbed, cheated, and responsibility shirked and avoided by the employees.VA 3

Imagine for a moment, you wake up, got to the mailbox.  You find the VBA will take your monthly benefit, the money you need to live on because they made an error, but you have to pay for their mistakes unless a power greater than the local agency exerts sufficient force to correct the problem.  Assurances from the VBA are pie-crust promises, easily made, easily broken, and crumby!  The final statement in this charade from the VA-OIG is priceless.

VBA should consider steps to avoid this type of error in the future.”

Angry Grizzly BearSeriously, the VBA’s internal processes failed and would have continued failing if the VA-OIG had not stepped in and demanded immediate action on the veteran’s behalf!  How many other veterans are not so lucky; too many!  America, the shame of the VA is beyond the pale, and a complete reckoning and corrective action should be the action of Congress as the President refuses to clean house in the Executive Branch, the Legislative Branch MUST step up and do their constitutional duties!  The legislative and the executive branches must answer to us, the taxpayers and citizens, for the continual debacles displayed by recalcitrant and intransigent federal employees.  In front of real judges, real people must answer and be held accountable for the crimes of neglect of duty demonstrated!

© Copyright 2021 – M. Dave Salisbury
The author holds no claims for the art used herein, the pictures were obtained in the public domain, and the intellectual property belongs to those who created the images.  Quoted materials remain the property of the original author.

NO MORE BS: Speaking of Administration (Bureaucrats) in Government

I want to send congratulations to the US District Attorney’s Office – District of New Jersey; they have uncovered a fraud scheme worth $93 Million in kickback frauds, bribery, and theft of taxpayer monies; this is good news for the United States.  From me, you have my deepest thanks!

Some significant details are missing from this report, and I would expect these details to have been made public:

      1. How many of those charged were employees of Medicare, TRICARE, and CHAMPVA?
      2. How long was this scheme in place before discovery?
      3. How was this scheme discovered?
      4. Who was offered immunity from prosecution to turn traitor and open the doors to the scheme? Why?

One partial question was answered, “From March 2018 to October 2019, several conspirators withdrew money from the scheme approximately $1.6 Million.”  I guess this is as good a time as any to remind everyone that under the law, you are presumed innocent until proven guilty in a court of law.  Five people are charged in this case, where two others have admitted guilt, bringing the total of people involved to seven.

Some things might be slightly different from my time in government procurement, US Army, and US Navy.  I know that when you use the same provider more than two or three times in a single quarter of a fiscal year, someone should be asking a bunch of why questions and checking the contract.  Yet, to the best of my understanding of the case details as provided, this was not occurring.  Thus, more questions need to be raised:

      1. Who are the contracting officers in this case for the government agencies most affected by the fraud?
      2. Who are the supervisors of the contracting officers who allowed these abnormalities to exist without question?
      3. Who is reviewing the contracts to improve protection against fraud in the future?

Remember, no employment details were provided for those charged to see who was/is a government employee and who was/is not.  But, with Medicare, TRICARE, and CHAMPVA all involved, there should be a lot more details coming forth, and as of today (28 April 2021), there is nothing more available.  Bringing more questions to the front:

      1. Where is the media covering another government fraud case? Surely this should be of interest to every media outlet since the scheme covered at least some of President Trump’s tenure.  You would presume the media’s Trump Derangement Syndrome would have kicked-in to plaster this news nationwide.
      2. Where are the investigative reporters tasked with finding the details, rooting out the causes, and spurring politicians to action to “fix the government?”
      3. Where are the politicians, those who had to be notified about this case, in praising the DA’s office, clambering for justice for the taxpayer, and promising that these people involved will face stern justice? Or are these politicians silent because it doesn’t allow them to play a race/sex/gender card?

Healthcare fraud remains the number one issue for Medicare and the VA to tackle, as well as TRICARE, Tri-West, CHAMPVA, and every other government healthcare agency.  The problem lies in how the administrators do their jobs, affect policy, and scrutinize their employees.  Yet, every government healthcare fraud case leaves out the details of what the agencies will change to avoid future problems and prevent similar schemes.

      1. When will the heads of these government healthcare agencies be hauled in front of Congress to testify about healthcare fraud, and why they continue to refuse to follow the law laid down by Congress?
      2. When will Congress develop a spine and hold these bureaucrat administrators accountable for the failure of their agencies to protect the taxpayer from fraud, bribery, theft, and other healthcare scams that only make problems worse and cost billions in dollars annually?
      3. Where are the politicians who are sick to death of seeing fraud occur and not seeing action by those placed to head these organizations?

As an employee, two other employees and I signed a letter claiming that the processes being followed by the Emergency Department of the VA Hospital in Albuquerque, NM., were violating the Fraud, Waste, and Abuse of the government.  We proposed changes that would improve patient care, increase employee productivity, and increase the security of patient HIPAA information.  The HAS Administrator refused even to consider the letter, even with favorable approval from the supervisor.  I sent the letter to the hotline, the specific place every poster in government buildings tells people to contact when you witness fraud, waste, and abuse in government.  My answer was crickets!  Then, I was terminated from employment; that is how the VA administrators treat employees who try to raise the bar in performance and reduce fraud, waste, and abuse.  See, if you are not an employee, you cannot be a whistle-blower.  Nice loophole for administrators to employ to threaten, cajole, Quid Pro Quo, and protect themselves from accountability!

      1. When will the administrators be held accountable for the fraud, waste, and abuse experienced in their agencies?
      2. When will the taxpayer be vindicated and receive just consideration of rights and accountability for taxpayer dollars wasted, stolen, and debt increased without cause?

Please do not allow the tone of this article to produce a fraudulent thought; I have no problems with the government helping its citizens.  But I demand better accountability and responsibility from those few selected to lead the agencies involved.  I demand higher accountability from the politicians, who chose to run for office, and whose job it is to scrutinize the government!  I demand a complete and accurate accounting for my tax dollar, and this should not be a complex action for any government to make.  When fraud is your number one issue and has been since your agency was launched, I would expect some progress to have been made in processes, procedures, and standards by now, and I do not see any of this occurring!

© 2021 M. Dave Salisbury
All Rights Reserved
The images used herein were obtained in the public domain; this author holds no copyright to the images displayed.