Case 1:11-cr-00742-DLI Document 1 Filed 10/31/11 Page 1 of 9 PageID #: 1
EAG: SMH
F.#2011R01808
GC 'f ., ' ?.01t
UNITED STATES DISTRICT COURT
EASTERN DISTRICT OF NEW YORK
- - - X
UNITED STATES OF AMERICA
I N D I C T M E N T
- against -
Cr. No.
{T. 18, U.S.C., 982 {a) (7),
982(b), 1347, 2 and 3551 et
EMMA POROGER, D.O.,
~-)
Defendant.
- - - - - - - - X
THE GRAND JURY CHARGES:
INTRODUCTION
At all times relevant to this Indictment, unless
otherwise indicated:
I.
Background
A.
The Medicare Program
1.
The Medicare program
(~Medicare")
was a federal
health care program providing benefits to individuals aged 65 and
over and to certain disabled persons.
Medicare was administered
by the Centers for Medicare and Medicaid Services, a federal
agency under the United States Department of Health and Human
Services.
An individual who received benefits under Medicare was
referred to as a Medicare
~beneficiary."
The physician who
provided a service to a beneficiary or ordered that a service be
provided to a beneficiary was referred to as a
physician."
~rendering
Case 1:11-cr-00742-DLI Document 1 Filed 10/31/11 Page 2 of 9 PageID #: 2
2.
Medicare was a ''health care benefit program,u as
defined by Title 18, United States Code, Section 24(b).
3.
Medicare provided coverage under several
components, including hospital insurance ("Part Au)
1nsurance ("Part Bu).
and medical
Medicare Part B covered the costs of
physicians' services and outpatient care, including diagnostic
tests.
Medicare Part B covered these costs only if, among other
requirements, they were medically necessary and ordered by a
physician.
4.
A medical provider certified to participate 1n
Medicare, whether a clinic or an individual, was assigned a
provider identification number
("PIN")
for billing purposes.
medical provider rendering a service was required to use its
assigned PIN when submitting a claim for reimbursement to
Medicare.
5.
Each medical provider was permitted to submit
claims to Medicare only for services actually rendered and was
required to maintain patient records verifying the provision of
services.
6.
To receive reimbursement for a covered serv1ce from
Medicare, a medical provider was required to submit a claim,
either electronically or in writing.
The claim had to include
information identifying the medical provider, the rendering
physician, the patient and the services rendered.
By submitting
Case 1:11-cr-00742-DLI Document 1 Filed 10/31/11 Page 3 of 9 PageID #: 3
the claim, the provider certified, among other things, that the
services were rendered to the patient and were medically
necessary.
7.
Medicare provider claims included "billing codes,"
which were numbers that referred to specific descriptions of
medical services provided to beneficiaries.
Medicare reimbursed
medical providers a set fee based on the billing codes.
B.
The Defendant and Her Medical Clinic
8.
North Austin Medical, PC ("North Austin") was a New
York State professional corporation doing business at 68-60
Austin Street, Suite 209, Forest Hills, New York.
was certified to participate in Medicare.
North Austin
It purported to
provide, among other things, IV vitamin infusion therapy, sleep
studies, nerve conduction tests and duplex scans to Medicare
beneficiaries.
9.
The defendant EMMA POROGER, D.O., was a Doctor of
Osteopathy and the Medical Director and Chief Executive Officer
of North Austin.
II.
The Fraudulent Scheme
10.
From approximately October 2006 to March 2010,
the defendant EMMA POROGER, D.O., together with others, executed
a fraudulent scheme in which North Austin submitted false and
fraudulent claims for medical services that were never provided
to beneficiaries and were not medically necessary.
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11.
As part of the fraudulent scheme, the defendant
EMMA POROGER, D.O., repeatedly prescribed medically unnecessary
services and tests, including IV vitamin infusion therapy, sleep
studies, nerve conduction tests and duplex scans, for Medicare
beneficiaries at North Austin.
Through North Austin, the
defendant and others then submitted, and caused the submission
of, false and fraudulent claims to Medicare seeking reimbursement
for these medically unnecessary services and tests.
12.
As a further part of the fraudulent scheme, the
defendant EMMA POROGER, D.O., and others submitted, and caused
the submission of, false and fraudulent claims to Medicare
seeking reimbursement for services and tests that were never
provided.
13.
From approximately November 2006 to March 2009,
the defendant EMMA POROGER, D.O., and others caused North Austin
to submit approximately $13 million in claims to Medicare for
services that were prescribed and/or rendered solely by the
defendant EMMA POROGER, D.O.
million for these claims.
Medicare paid approximately $4.4
Medicare deposited all such
reimbursements into North Austin's bank account, established by
the defendant.
14.
The defendant EMMA POROGER, D.O., then dispersed
monies from the North Austin bank account she controlled to
herself and others.
Case 1:11-cr-00742-DLI Document 1 Filed 10/31/11 Page 5 of 9 PageID #: 5
COUNTS ONE THROUGH FOURTEEN
(Health Care Fraud)
15.
The allegations contained in paragraphs 1 through
14 are realleged and incorporated as if fully set forth in this
paragraph.
16.
On or about the dates identified below, within the
Eastern District of New York and elsewhere, the defendant EMMA
POROGER, D.O., together with others, did knowingly and willfully
execute, and attempt to execute, a scheme and artifice to defraud
Medicare, and to obtain, by means of materially false and
fraudulent pretenses, representations and promises, money and
property owned by, and under the custody and control of,
Medicare, in connection with the delivery of and payment for
health care benefits, items and services, as indicated below:
Count
Claim
Number
ONE
43110718
4074290
TWO
4 3110720
0060160
THREE
43110730
50788 90
FOUR
43110733
1068430
Aggrox.
Claim
Date
Descrigtion
of Services
(Billing
Code)
Aggrox.
Amount
Billed
La. B.
6/7/2007
EDTA
treatment
(J3520)
$50
Y.O.
6/18/2007
EDTA
treatment
(J3520)
$50
10/17/2007
EDTA
treatment
(J3520)
$50
11/6/2007
EDTA
treatment
(J3520)
$50
Medicare
Beneficiary
R.I.
Y.R.
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Count
Claim
Number
Aggrox.
Claim
Date
Descrigtion
of Services
(Billing
Code)
Aggrox.
Amount
Billed
FIVE
43110829
6074180
Li. B.
10/1/2008
EDTA
treatment
(J3520)
$50
SIX
431108 03
9092420
Y.O.
1/26/2008
Sleep Study
(95810)
$1,500
SEVEN
43110813
4132920
Li. B.
4/28/2008
Sleep Study
(95810)
$1,500
EIGHT
43110813
4132950
La. B.
4/28/2008
Sleep Study
(95810)
$1,500
NINE
43110729
0054550
Y.R.
9/27/2007
EEG for
Epileptic
(95957)
$500
TEN
43110803
9092420
Y.O.
1/26/2008
EEG for
Epileptic
(95957)
$500
ELEVEN
43110813
4132920
Li. B.
4/28/2008
EEG for
Epileptic
(95957)
$500
TWELVE
43110813
4132410
L.K.
5/1/2008
EEG for
Epileptic
(95957)
$500
THIRTEEN
43110722
7071700
La. B.
7/16/2007
Intravenous
Infusion
(90765)
$150
FOURTEEN
4 3110805
2064690
1/22/2008
Intravenous
Infusion
(90765)
$150
Medicare
Beneficiar_y
Li. B.
(Title 18, United States Code, Sections 1347, 2 and
3551 et ...g.)
,.
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CRIMINAL FORFEITURE ALLEGATION
defendant
17.
The
United
States
that
upon conviction
hereby
of the
gives
offenses
notice
to
the
charged
ln
the
Indictment, the government will seek forfeiture in accordance with
Title 18, United States Code, Section 982 (a) (7), which requires any
person convicted of such offenses to forfeit any property, real or
personal, that constitutes or is derived, directly or indirectly,
from gross proceeds traceable to the commission of the offenses,
including,
but not
limited to,
sum of money in United States
currency, in an amount to be determined at trial.
18.
If any of the above-described forfeitable property,
as a result of any act or omission of the defendant:
a.
cannot
be
located upon
the
exercise
of
due
diligence;
b.
has been transferred or sold to, or deposited
with, a third party;
c.
h.as been placed beyond the jurisdiction of the
d.
has been substantially diminished in value; or
e.
has been commingled with other property which
court;
cannot be divided without difficulty;
it is the intent of the United States, pursuant to Title 18,
United States Code, Section 982(b), to seek forfeiture of any
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other property of the defendant up to the value of the
forfeitable property described in this forfeiture allegation.
(Title 18, United States Code, Sections 982 (a) (7) and
982 (b))
A TRUE BILL
~p?#
FORE PERSON
LORETTA E. LYNCH
UNITED STATES ATTORNEY
EASTERN DISTRICT OF NEW YORK
~k ~
\M;y I~
6-r S/AH "(p41rruM~
HANK BOND WALTER
DEPUTY CHIEF
CRIMINAL DIVISION, FRAUD SECTION
UNITED STATES DEPARTMENT OF JUSTICE
Case 1:11-cr-00742-DLI Document 1 Filed 10/31/11 Page 9 of 9 PageID #: 9
FORM DBD-34
No. _ _ _ _ __
Action: _ _ _ _ _ __
JUN" 85
UNITED STATES DISTRICT COURT
EASTERN District of NEW YORK
CRIMINAL Division
THE UNITED STATES OF AMERICA
vs.
EMMA POROGER, D.O.,
Defendant
INDICTMENT
Filed in open court this _________________ day,
of_ __________ "' _ A" D" 20 ____ _
------------------------------GITk
Bail, $
Sarah M. Hall, USDOJ Trial Attorney/(202) 549-5864
Case 1:11-cr-00742-DLI Document 1-1 Filed 10/31/11 Page 1 of 1 PageID #: 10
