It was announced that Dr. Antonieta Abarientos and Dr. Crispin Abarientos will pay an amount of $4,927,903 in a civil settlement agreement with both federal and state governments for the violation of the False Claims Act. The announcement came from the U.S. Attorney John H. Durham, Special Agent in Charge Brian C. Turner of the New Haven Division of the Federal Bureau of Investigation, Special Agent in Charge Phillip Coyne of the U.S. Department of Health and Human Sciences and Connecticut Attorney General William Tong. The two assailants were evidenced to have built allegations against them for violating the False Claims Act, and a large amount of money they were ordered to pay was for falsification of documents under the operations of the Middlesex Rheumatology in Middletown. The husband and wife duo operated the medical practice, specializing in both the diagnosis and treatment of autoimmune diseases, arthritis and other related diseases. While Dr. Crispin Abarientos was the primary physician at their Middletown practice, Dr. Anotieta Abarientos had a stake as part-owner of the operation.
Investigations against the two revealed that Dr. Crispin would prescribe medications to patients coming up to his practice, significantly prescribing Remicade which is injected into patients, commonly being used to treat rheumatoid arthritis. The prescriptions would be submitted as a claim to the Connecticut Medicaid for said medication for the patients it was prescribed to. Once Medicaid received the claim, the government agency would send payment to the Caremark Massachusetts Specialty Pharmacy, located in Massachusetts. This agency would then deliver the prescribed quantity of the medication Remicade, sending it directly to the Middlesex Rheumatology practice with no out-of-pocket cost to the operation itself. This practice made it easier for the duo to falsify prescriptions and alter documentation to receive aid without having had it delivered to patients, and under patients’ names.
According to the False Claims Act allegation made against the two, the Abarientos submitted claims to Medicaid to deliver the medications to Middlesex Rheumatology of Remicade, claims that were made under the information of the Middlesex Rheumatology patients, when those patients were not, in fact, being treated with Remicade. The two doctors were well aware of this fact, and falsified documents to represent wrongful information. The defendants would then go on to infuse the wrongfully received medication into the patients receiving aid from Medicare, or the patients covered by the Connecticut State Employees Health Plan.
They would then proceed to submit reimbursement claims for the medication to the aforementioned insurance programs, thereby collecting the profits for themselves and their Middlesex Rheumatology practice. Remicade to those insurance programs, and keep the profits for himself and the practice. As per the investigations and the federal law agencies deep-diving into the evidence presented against the two, these operations are an exact representation of healthcare fraud, committed by thousands across the country and accosted by many law enforcement agencies. The two defendants were thus ordered to pay the amount of 4,927,903 in order to cover the claims they had submitted to the Medicaid program through their unsuspecting patients’ information. The aforementioned claims were submitted from September 2013 till January 2018, thereby the two defendants pleaded guilty to one count of healthcare fraud. It was also revealed that Dr. Crispin Abarientos had pleaded guilty to another federal case, wherein he committed healthcare fraud and was charged with 37 months imprisonment.
The Medicare and Medicaid programs were developed with the spirit of helping patients in receiving the best healthcare, but cases such as these are an affront to the healthcare professionals who care for their patients. Not only do these cases cause major monetary damage to the taxpayer, but put lives at risk by submitting false claims for medication that could be used elsewhere. U.S. Attorney Durham reiterated the fact that transparent billing for services is crucial, and physicians must take extra care in billing their services if they participate in the Medicare and Medicaid programs.
This case was one of many where the government assistance programs were used to profit off of unsuspecting patients in a violation of their information. There are countless healthcare professionals who suffer from the consequences regarding the reputation of healthcare practices. If you or anyone you know is interested in knowing the legalities of healthcare fraud or would like to know how to avoid cases such as the above, feel free to contact the Healthcare Fraud Group on 888-402-4054 for any legal assistance required.