UNITED STATES OF AMERICA, : $2,128,826.81 IN UNITED STATES

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]

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UNITED STATES OF AMERICA, : $2,128,826.81 IN UNITED STATES