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Post date: November 3 2016

A.G. Schneiderman Announces Arrest Of Clinic Operator For Allegedly Defrauding Medicaid By Offering Sham Substance Abuse Treatment

News from Attorney General Eric T. Schneiderman

FOR IMMEDIATE RELEASE
November 3, 2016

New York City Press Office / 212-416-8060
Albany Press Office / 518-473-5525
nyag.pressoffice@ag.NY.gov
Twitter: @AGSchneiderman

A.G. SCHNEIDERMAN ANNOUNCES ARREST OF CLINIC OPERATOR FOR ALLEGEDLY DEFRAUDING MEDICAID BY OFFERING SHAM SUBSTANCE ABUSE TREATMENT  

Natalia Dochim Allegedly Induced Patients Into Bogus Substance Abuse Treatment, Then Pocketed Millions Of Dollars 

Schneiderman:  It Is Despicable To Use The Medicaid Program To Take Advantage Of Those Suffering From Addiction

NEW YORK—Attorney General Eric T. Schneiderman today announced the arrest of Natalia Dochim, 39, of Nyack, New York and charges against her two companies, Miromedical P.C. (“Miromedical”) and Ferrara Medical Care, P.C. (“Ferrara”). In papers filed in New York City Criminal and New York State Supreme Courts, Bronx County, prosecutors allege that Dochim, Miromedical, and Ferrara, submitted claims for reimbursement for substance abuse treatment services to Medicaid and to MetroPlus, a state-funded managed care organization (“MCO”), when they were not certified to provide such services and for medical services allegedly rendered to Medicaid Fraud Control Unit (“MFCU”) undercover investigators that never occurred.  Dochim was arrested yesterday on charges of Grand Larceny in the First, Second and Fourth Degrees; Health Care Fraud in the Second Degree; and Money Laundering in the Second Degree. If convicted on all charges, Dochim faces up to 25 years in prison. In addition to today’s arrests, the Attorney General’s Medicaid Fraud Control Unit filed an asset forfeiture and False Claims Act lawsuit against Dochim, Miromedical, Ferrara and others, freezing the defendants’ assets and seeking over $7.7 million dollars in damages plus penalties. MFCU also executed search warrants today at Dochim’s businesses located at 903 Sheridan Avenue in the Bronx and at 2364 and 2738 Frederick Douglass Boulevard in Manhattan.

“It is despicable to use the Medicaid program to take advantage of those suffering from addiction,” said Attorney General Schneiderman. “New York is suffering through a serious opioid epidemic, and sham substance abuse services only deepen this crisis. Those who attempt to line their own pockets on the backs of those in need will be caught.”

“To prey on the most vulnerable New Yorkers for personal gain is appalling”, said Department of Social Services Commissioner Steven Banks.  “We will continue our longstanding partnership with the office of the State Attorney General to identify suspicious activity that can lead to fraud and to ensure that those responsible are brought to justice as quickly as possible.”

Prosecutors allege that Dochim, aided by co-conspirators in her employ, lured Medicaid patients to Miromedical and Ferrara by paying kickbacks and offering prescriptions of Suboxone, a narcotic drug used to treat opioid addiction.  Once recruited, patients at Miromedical and Ferrara, prosecutors allege, encountered a façade of a substance abuse treatment program. Medically appropriate and necessary medical histories were not always obtained, physicals were not taken, initial counseling did not occur, and there was a complete lack of appropriate follow-up and monitoring. Subsequently, all patients were treated the same: mandated to enroll in one particular MCO (MetroPlus), sent to a purported “detox” program, and prescribed Suboxone at the maximum dosage in lieu of legitimate substance abuse treatment.  If actually provided, prosecutors allege, the so-called “detox” treatment that patients were required to obtain was, according to the claims submitted by Miromedical and Ferrara, merely vitamin injections, which is not an approved treatment for opioid addiction. 

Thereafter, prosecutors charge, Dochim, through Miromedical and Ferrara, submitted claims to MCOs and to Medicaid that bore little to no resemblance to the medical services actually rendered. Prosecutors allege services such as spirometry, a pulmonary function test, and allergy testing, were routinely billed but never provided.  Patient “recruiters” working inside Miromedical and Ferrara, it is alleged, also openly offered to buy back patient’s Suboxone prescriptions for cash.

Relying on the accuracy of substance abuse treatment claims submitted by Dochim, prosecutors allege that Medicaid managed care insurance paid over $1.7 million, and that Medicaid directly paid over $190,000, to Dochim, Miromedical and Ferrara, funds which they were not entitled and which Dochim is alleged to have then laundered through various shell companies.

Grand Larceny in the First Degree is a Class B felony with a maximum sentence of incarceration of twenty-five years.  Grand Larceny in the Second Degree, Health Care Fraud in the Second Degree, and Money Laundering in the Second Degree are each Class C felonies with a maximum period of incarceration of fifteen years.  Grand Larceny in the Fourth Degree is a Class E felony with a maximum period of incarceration of four years. Dochim was arraigned yesterday where bail was set at $250,000 cash over $100,000 bond.

The Attorney General would like to thank the New York City Human Resources Administration (“HRA”), notably the work of HRA’s Medicaid Provider Investigations and Audit Unit, and the New York State Office of Alcoholism and Substance Abuse Services for their partnership and valuable assistance throughout the investigation. In addition, the Attorney General thanks the United States Department of Health and Human Services-Office of the Inspector General and the New York State Office of the Medicaid Inspector General Dennis Rosen, MFCU’s partners in combatting fraud against the Medicaid program. The Attorney General also thanks Medicaid managed care plans MetroPlus and Healthfirst for their cooperation in this investigation.

The investigation was led by Senior Investigator Albert Maiorano and Investigators David Ryan and Julie Clancy with the assistance of Supervising Investigators Dominick DiGennaro and Michael Casado under the supervision of Deputy Chief Investigator Kenneth Morgan. Audit support was provided by Principal Auditor-Investigator Patricia Iemma and Auditor-Investigator Coleman Williams under the supervision of MFCU NYC Chief Auditor Thomasina Smith.

The criminal case is being prosecuted by Special Assistant Attorneys General Erin Kelsh and David Arias with the assistance of MFCU NYC Regional Director Christopher M. Shaw. Thomas O’Hanlon is MFCU’s Chief of Criminal Investigations-Downstate. The civil case is being handled by Special Assistant Attorneys General David Abrams, Gerri Gold and Elizabeth Silverman with the assistance of MFCU Civil Enforcement Chief Carolyn Ellis. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney.   

The charges filed in this case are accusations. The defendants are presumed innocent until proven guilty in a court of law.

 

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