Two Connecticut Physicians Pay over $4.9 Million to Settle False Claims Act Allegations
U.S. Attorney John H. Durham, Special Agent in Charge Phillip Coyne of the U.S. Department of Health and Human Services, Office of Inspector General, Special Agent in Charge Brian C. Turner of the New Haven Division of the Federal Bureau of Investigation, and Connecticut Attorney General William Tong today announced that DR. CRISPIN ABARIENTOS and his wife, DR. ANTONIETA ABARIENTOS, have entered into a civil settlement agreement with the federal and state governments in which they will pay $4,927,903 to resolve allegations that they violated the federal and state False Claims Acts.
Crispin and Antonieta Abarientos owned and operated Middlesex Rheumatology in Middletown, a medical practice that specialized in the diagnosis and treatment of arthritis, autoimmune diseases and related conditions. Crispin Abarientos was the treating physician at the practice and Antonieta Abarientos was a part owner of the practice.
One of the medications that Crispin Abarientos prescribed to his Middlesex Rheumatology patients was Remicade, an injectable prescription medication used to treat rheumatoid arthritis. When treating Medicaid patients with Remicade, Crispin Abarientos was required to submit a claim to Connecticut Medicaid for Remicade on behalf of each member patient. Medicaid then sent payment to Caremark Massachusetts Specialty Pharmacy in Massachusetts, which delivered the quantity of Remicade contained in the claim directly to Middlesex Rheumatology for the Medicaid patient without any out-of-pocket cost to the practice.
The government alleges that Crispin and Antonieta Abarientos submitted false claims to Medicaid for the delivery to Middlesex Rheumatology of Remicade that Crispin Abarientos represented was to be provided to his Medicaid patients, when he knew that those Medicaid patients were not being treated with Remicade. Crispin Abarientos then proceeded to infuse the fraudulently obtained Remicade he had obtained for free from Medicaid, into Medicare patients and patients covered by the Connecticut State Employees Health Plan, submit claims for reimbursement for the cost of the Remicade to those insurance programs, and keep the profits for himself and the practice.
To resolve the allegations under the federal and state False Claims Acts, Crispin and Antonieta Abarientos have agreed to pay $4,927,903, which covers claims submitted to the Medicaid program from September 2013 through January 2018, and claims submitted to the Medicare program and the Connecticut State Employees Health Plan from July 2013 through June 2017.
In a related federal criminal case, Crispin Abarientos pleaded guilty to health care fraud and, on October 30, 2019, was sentenced to 37 months of imprisonment.
“Physicians who participate in the Medicare and Medicaid programs must bill their services honestly, and the failure to do so increases the cost of health care for all of us,” said U.S. Attorney Durham. “Health care providers who submit false claims to federal health care programs face serious consequences.”
“We take very seriously our responsibility to safeguard taxpayers by eliminating fraud, waste and abuse in our public health care programs, and I appreciate the continued partnership with the Connecticut U.S Attorney’s Office to protect public funds,” HHS-OIG Special Agent in Charge Coyne.
“We will not tolerate medical professionals stealing precious dollars from our federal health care programs,” said FBI Special Agent in Charge Turner. “Together with our state and federal law enforcement partners, we will continue to swiftly investigate these schemes, to ensure that waste, fraud and abuse in our Medicaid program is uncovered and those responsible are punished accordingly.”
This matter was investigated by the Office of Inspector General for the Department of Health and Human Services and the Federal Bureau of Investigation. The case is being prosecuted by Assistant U.S. Attorney Richard M. Molot, and by Assistant Attorney General Michael Cole of the Connecticut Office of the Attorney General.
People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS or the Health Care Fraud Task Force at (203) 777-6311.