Untitled1
IN THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF
GEORGIA
ATLANTA DIVISION UNITED STATES OF AMERICA, : : Plaintiff, : : v. :
CIVIL ACTION NO. : $2,128,826.81 IN UNITED STATES : CURRENCY, : :
Defendant. :
VERIFIED COMPLAINT FOR FORFEITURE
COMES NOW the United States of America, Plaintiff in the
above-styled
civil action, and files this Verified Complaint for Forfeiture
pursuant to 18 U.S.C.
§ 981(a)(1)(C). In support of this Complaint, Plaintiff states as
follows:
I. INTRODUCTION
A. Parties
1. On January 15, 2016, Federal Bureau of Investigation (FBI)
Special Agent
Megan Perry (SA Perry) seized $2,128,826.81 in United States funds
from
Wells Fargo bank account number X-2996 (Account X-2996; full
account
number redacted), (the “Defendant Funds”), pursuant to a seizure
warrant
issued on January 15, 2016, by the Honorable Magistrate Judge Linda
T.
Walker of the Northern District of Georgia.
Case 1:16-cv-00382-MHC Document 1 Filed 02/09/16 Page 1 of 13
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2. Wells Fargo Account X-2996 was held in the name of Peggy
Teague
Anderson (Anderson).
3. Anderson resides in Newton County, Georgia, a place within
the
jurisdiction and venue of this Court.
4. Anderson operates a business known as D&D Medical Supplies
and
Services (D&D Medical).
5. D&D Medical is located in Covington, Newton County,
Georgia.
6. Anderson, through D&D Medical, owned and operated a durable
medical
equipment and medical supply business.
B. Jurisdiction, and Venue
7. The Defendant Funds are within the jurisdiction and venue of
this Court,
and will remain within the Northern District of Georgia in an
account
maintained by the United States Marshal’s Service.
8. This Court has jurisdiction over this case pursuant to 28 U.S.C.
§§ 1345 and
1355.
9. Venue is proper in this Court pursuant to 28 U.S.C. §§ 1355 and
1391.
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C. Legal Basis For Forfeiture
10. 18 U.S.C. § 981(a)(1)(C) provides that any monies that
constitute or are
derived from proceeds traceable to theft or embezzlement in
connection
with health care in violation of 18 U.S.C. § 669 are subject to
seizure and
forfeiture to the United States.
II. FACTS SUPPORTING FORFEITURE
11. Blue Cross and Blue Shield (BCBS) requires that all labs,
medical
equipment providers, home care providers, and medical
specialty
pharmacies enter into an Ancillary Provider Agreement (APA) in
order to
become a member of the BCBS network of medical providers.
12. After a provider enters into an APA, BCBS will add the provider
to their
list of in-network providers and the provider can then provide
services to
BCBS members. BCBS will reimburse the medical provider for
covered
services that the provider renders to BCBS members.
13. An APA requires that after the provider treatment, a BCBS
member must
submit a request for reimbursement of the cost of the treatment to
BCBS.
14. An APA also grants BCBS the right to recover overpayments made
to a
provider for a variety of reasons, including payments that were
made in
error or that were inaccurate for any reason.
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15. On or about April 25, 2011, Anderson d/b/a D&D Medical
entered into an
APA with BCBS.
16. Anderson, through D&D Medical, operated a durable medical
equipment
and medical supply business that provided supplies to
Medicaid,
Medicare, and privately insured patients.
17. After providing medical supplies or services to a BCBS member,
D&D
Medical was required to submit reimbursement requests directly to
BCBS.
18. On May 18, 2015, Anderson submitted the following claims
for
reimbursement to BCBS:
Claim Number Date of Service Amount 26151403632800 8/21/2014
$2,445.61 26151403841300 9/21/2014 743.42 26151403841000 10/21/2014
743.42 26151403633400 12/21/2014 743.42 26151403841700 1/1/2015
1,357.95 26151403840800 2/1/2015 743.42 26151403634500 3/1/2015
743.42 26151403604000 4/1/2015 743.42 26151403632700 5/1/2015
743.42 26151403633500 11/12/2014 743.42 Total due on all 10 claims
$9,750.92
19. Under the terms of the APA contract, D&D Medical was
entitled to receive
a total of $9,750.92 in reimbursement on the ten claims
Anderson
submitted to BCBS.
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20. After BCBS received the ten claims from Anderson, the claims
were
entered into BCBS’s computer system.
21. BCBS’s computer system generated and mailed a reimbursement
check to
D&D Medical in the amount of $3,384,736.83.
22. Anderson received the $3,384,736.83 check from BCBS.
23. Anderson knew, or should have known, that the check BCBS sent
to D&D
Medical represented a substantial overpayment and, pursuant to the
APA,
should have contacted BCBS.
24. On June 4, 2015, Anderson endorsed the $3,384,736.83 check from
BCBS
and deposited the funds into Wells Fargo account X-3657.
25. Wells Fargo Account X-3657 was held in the name of Peggy
Anderson
d/b/a D&D Medical Supplies and Services.
26. A computer error resulted in BCBS issuing a reimbursement check
to D&D
Medical in the amount of $3,384,736.83 instead of $9,750.92.
27. In August 2015, BCBS became aware of the computer error and
resulting
overpayment.
28. On August 11, 2015, BCBS began efforts to recoup the
overpayment.
29. BCBS made numerous telephone calls to telephone numbers
Anderson
provided on her application forms for the APA.
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30. When a representative from BCBS called the telephone numbers
provided
by Anderson in the APA, an automated message stated either that
the
number had been disconnected or the recipient could not accept the
call.
31. On August 12, 2015, BCBS sent refund requests to a fax number
associated
with Anderson and received confirmations of successful
transmissions.
Copies of those requests were also mailed to Anderson through the
United
States Postal Service (USPS).
32. On August 18, 2015, BCBS Lead Investigator John Houston
(Investigator
Houston) called 678-658-XXXX and spoke with an individual who
refused
to provide her name. Houston asked the person on the phone if he
could
speak with Anderson in regard to a three million dollar overpayment
issue
and he was told that a message would be provided to Anderson.
Houston
left his name and contact information with the individual.
33. On August 24, 2015, Investigator Houston called 678-658-XXXX
and left a
voicemail message requesting a return call.
34. On August 24, 2015, Investigator Houston mailed letters to
Anderson at
her home and at her business address via USPS certified mail. The
letters
read as follows:
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Ms. Anderson, The Special Investigations Unit (SIU) has been tasked
with looking into a matter that involves and overpayment to you in
the amount of $3,384,736.83. Anthem, Blue Cross Blue Shield of
Georgia (BCBSGa), sent you the check in error dated May 29, 2015,
in regard to ten (10) claims that you submitted by facsimile. It
appears from a review of the check that the check was either cashed
or deposited and your name was used to endorse the instrument. The
claims that you submitted were for a total billed amount of
$9,750.92 for services related to one of our members for services
in 2014 and 2015. The check that was sent to you contained the
wrong payment amount and we are seeking a return of the funds
immediately. Associates with Anthem BCBSGa have made numerous
attempts to contact you including SIU Lead Investigator John S.
Houston. During one instance, LI Houston reached a person who
answered “D&D” yet when asked, that individual refused to
provide him with her name. Messages have been left for you but none
have been returned. As you are aware, you are contracted with
Anthem BCBSGa and as such, certain duties and responsibilities on
your part were agreed to as part of that contract. Please contact
me as soon as possible at [redacted] or via email at [redacted], so
that we may discuss the recovery of these funds. Sincerely, John S.
Houston, Lead Investigator, Anthem, Central States, Special
Investigations Unit
35. One of the certified letters sent to Anderson was returned to
BCBS on
August 29, 2015, marked “Return to Sender / Refused / Unable
to
Forward.” The envelope was unopened and “refused” was written on
it.
36. The second certified letter sent to Anderson was returned to
BCBS on
September 20, 2015, marked “Return to Sender / No Mail Receptacle
/
Unable to Forward.” The envelope had been opened.
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37. On August 26, 2015, Investigator Houston called 678-658-XXXX
and spoke
with an individual who identified herself as Anderson.
Investigator
Houston explained that he was calling in regard to a three million
dollar
overpayment that had been made in error. Anderson advised that she
had
received prior contact regarding the matter and had gotten letters
in the
mail. Anderson told Investigator Houston that she was “taking care
of it”
and then told Investigator Houston to stop calling her and stop
sending
letters. Anderson then hung up the phone.
38. On September 21, 2015, BCBS called 678-658-XXXX and left a
voicemail
message.
39. On October 13, 2015, BCBS called 678-658-XXXX and left a
voicemail
message requesting the status of the refund requests.
40. On October 14, 2015, BCBS attempted to send ten refund requests
via fax
but the fax number was no longer in service. The requests were
instead
mailed to Anderson via USPS.
41. On December 28, 2015, Houston sent an email four different
email
addresses that BCBS had on file for Anderson. The email read as
follows:
Ms. Anderson, would you please call me as soon as possible
regarding our need to recoup an overpayment amount that we
discussed previously. I have made attempts to call you
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and have left messages. I have also sent letters to you regarding
the same issue. Thank you
42. Investigator Houston received an automated email response from
two of
the email addresses stating that those email addresses were
non-existent
and that the addressee was unknown.
43. Investigator Houston did not receive an email response from
Anderson or
anyone else.
44. At no point did Anderson or any other person or entity return
any portion
of the erroneously paid funds to BCBS.
45. BCBS contacted the FBI after Anderson’s failure to respond to
the various
attempts at recouping the funds.
46. During the investigation, FBI agents determined that Anderson
held two
separate accounts at Wells Fargo bank, Account X-3657 held in the
name of
Peggy Anderson d/b/a D&D Medical Supplies and Services, and
Account
X-2996 held in the name of Peggy Teague Anderson.
47. On June 1, 2015, Anderson had a balance of $4,297.81 in Account
X-3657
and $60.90 in Account X-2996.
48. On June 4, 2015, Anderson endorsed the BCBS check in the amount
of
$3,384,736.83 to D&D Medical Supplies Services and deposited
that check
into Account X-3657.
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49. On June 5, 2015, Anderson made two separate transfers of
$900,000.00 each
from Account X-3657 into Account X-2996.
50. On June 8, 2015, Anderson made a payment of $119,543.81 from
Account
X-2996 to Ocwen Loan Servicing in satisfaction of the outstanding
balance
of the mortgage on her residence.
51. On June 17, 2015, Anderson transferred $999,999.00 from Account
X-3657
to Account X-2996.
52. Between June 8, 2015, and November 4, 2015, Anderson withdrew
cash
and wrote checks in the amount of $72,000.00 from Account X-3657
and
$45,000 from Account X-2996.
53. On January 7, 2016, Anderson withdrew $476,000.00 from Account
X-3657
and closed the account.
54. On January 13, 2016, Account X-2996 had a balance of
approximately
$2,100,000.
55. On January 15, 2016, at a Wells Fargo bank branch in Atlanta,
Georgia, SA
Perry executed a seizure warrant issued in the Northern District of
Georgia
authorizing the seizure of up to 3,374,985.91 from Account
X-2996.
56. At the time that SA Perry executed the warrant, the balance of
Account
X-2996 was $2,128,826.81.
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57. Wells Fargo immediately froze the $2,128,826.81 and began the
process of
issuing a check to the United States Marshals Service.
58. On or about February 8, 2016, SA Perry received a check from
Wells Fargo
bank in the amount of $2,128,826.81.
59. The $2,128,826.81 composes the Defendant Funds.
III. CONCLUSION
60. Based on the foregoing, the Defendant Funds are subject to
forfeiture
pursuant to 18 U.S.C. § 981(a)(1)(C), as property that constitutes
or is
derived from proceeds traceable to theft or embezzlement in
connection
with health care, in violation of 18 U.S.C. § 669.
WHEREFORE, Plaintiff prays:
(1) That the Court forfeit the Defendant Funds the United States
of
America;
(2) That the Court award Plaintiff the costs of this action;
and
(3) That Plaintiff have such other and further relief as the Court
deems
just and proper under the facts and circumstances of this
case.
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This 9th day of February, 2016.
Respectfully submitted, JOHN A. HORN UNITED STATES ATTORNEY /s/ G.
Jeffrey Viscomi G. JEFFREY VISCOMI ASSISTANT U.S. ATTORNEY Georgia
Bar No.: 289074 75 Spring Street, S.W., Suite 600 Atlanta, GA 30303
Telephone: (404) 581-6036
[email protected]