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BENJAMIN B. WAGNER
United States Attorney
PHILIP A. FERRARI
Assistant U.S. Attorney
501 I Street, Suite 10-100
Sacramento, California 95814
Telephone: (916) 554-2744

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IN THE UNITED STATES DISTRICT COURT
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FOR THE EASTERN DISTRICT OF CALIFORNIA
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UNITED STATES OF AMERICA,

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Plaintiff,
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v.
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RAMANATHAN PRAKASH,
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Defendant.
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CASE NO.

CR S 08-0427 MCE

PLEA AGREEMENT

DATE: TBD
TIME: 9:00 am
COURT: Hon. Morrison C.
England, Jr.

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I.
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INTRODUCTION
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A.

Scope of Agreement:

The Superseding Indictment in this case

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charges the defendant with one count of conspiring to commit health
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care fraud, in violation of 18 U.S.C. 1349 and 1347, and three
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counts of individual executions of a scheme to commit health care
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fraud, in violation of 18 U.S.C. 1347.

This document contains the

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complete plea agreement between the United States Attorney's Office
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for the Eastern District of California (the "government") and the
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defendant regarding this case.

This plea agreement is limited to the

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United States Attorney's Office for the Eastern District of
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California and cannot bind any other federal, state, or local

prosecuting, administrative, or regulatory authorities.

B.

Court Not a Party:

The Court is not a party to this plea

agreement.

Sentencing is a matter solely within the discretion of

the Court, the Court is under no obligation to accept any

recommendations made by the government, and the Court may in its

discretion impose any sentence it deems appropriate up to and

including the statutory maximum stated in this plea agreement.

the Court should impose any sentence up to the maximum established by

If

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the statute, the defendant cannot, for that reason alone, withdraw

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his guilty plea, and he will remain bound to fulfill all of the

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obligations under this plea agreement.

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that neither the prosecutor, defense counsel, nor the Court can make

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a binding prediction or promise regarding the sentence he will

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receive.

The defendant understands

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II.

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DEFENDANT'S OBLIGATIONS

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A.

Guilty Plea:

The defendant will plead guilty to Count

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Twelve in the Superseding Indictment, charging a violation of 18

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U.S.C. 1347, Health Care Fraud.

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fact guilty of this charge and that the facts set forth in the

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Factual Basis For Plea attached hereto as Exhibit A are accurate.

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B.

The defendant agrees that he is in

Restitution: The Mandatory Victim Restitution Act requires

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the Court to order restitution to the victims of certain offenses.

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In addition to that restitution, the defendant agrees to pay full

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restitution to the following victims in the amounts below.

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Victim

Amount

Center For Medicare and Medicaid Services

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$302,770.46

Payment should be by cashier's or certified check made payable to the

Clerk of the Court.

to discharge any restitution obligation or any part of such

obligation in any bankruptcy proceeding.

C.

Defendant further agrees that he will not seek

Special Assessment:

The defendant agrees to pay a special

assessment of $100 at the time of sentencing by delivering a check or

money order payable to the United States District Court to the United

States Probation Office immediately before the sentencing hearing.

The defendant understands that this plea agreement is voidable by the

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government if he fails to pay the assessment prior to that hearing.

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If the defendant is unable to pay the special assessment at the time

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of sentencing, he agrees to earn the money to pay the assessment, if

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necessary by participating in the Inmate Financial Responsibility

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Program.

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III.

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THE GOVERNMENT'S OBLIGATIONS

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A.

Dismissals:

The government agrees to move, at the time of

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sentencing, to dismiss the remaining counts against this defendant in

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the pending Superseding Indictment.

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B.

Incarceration Range:

The government will recommend that

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the defendant be sentenced to the low end of the applicable guideline

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range for his offense as determined by the United States Probation

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Office.

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C.

Acceptance of Responsibility:

If the United States

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Probation Office determines that a three-level reduction in the

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defendant's offense level for his full and clear demonstration of

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acceptance of responsibility is appropriate under U.S.S.G. 3E1.1,

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the government will not oppose such a reduction and will so move
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under 3E1.1(b), so long as the defendant pleads guilty, meets with

and assists the probation officer in the preparation of the pre-

sentence report, is truthful and candid with the probation officer,

and does not otherwise engage in conduct that constitutes obstruction

of justice within the meaning of U.S.S.G 3C1.1, either in the

preparation of the pre-sentence report or during the sentencing

proceeding.

IV.

ELEMENTS OF THE OFFENSE

A.

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Elements of the Offense:

At a trial, the government would

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have to prove beyond a reasonable doubt the following elements of the

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offense to which the defendant is pleading guilty, Health Care Fraud:

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First, that there was a scheme or artifice to either (a) defraud

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a health care benefit program; or (b) obtain, based on material false

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or fraudulent pretenses, representations, or promises, money or

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property under the custody or control of a health care benefit

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program;

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Second, that the defendant knowingly and willfully executed, or

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attempted to execute the scheme with knowledge of its fraudulent

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nature and with specific intent to defraud, or that he knowingly and

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intentionally aiding and abetted others in executing or attempting to

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execute the scheme;

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Third, that the scheme was conducted in connection with the

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delivery of, or payment for, health care benefits, items or services;

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and

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Fourth, that the health care benefit program affected interstate

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commerce.

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V.

MAXIMUM SENTENCE

A.

Maximum Penalty:

The maximum sentence that the Court can

impose is ten years of incarceration, a fine of $250,000, a three

year period of supervised release and a special assessment of $100.

By signing this plea agreement, the defendant also agrees that the

Court can order the payment of restitution for the full loss caused

by the defendant's wrongful conduct.

restitution order is not restricted to the amounts alleged in the

The defendant agrees that the

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specific counts to which the defendant is pleading guilty.

The

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defendant further agrees that

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any present or future bankruptcy proceeding any restitution imposed

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by the Court.

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B.

he will not attempt to discharge in

Violations of Supervised Release: The defendant understands

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that if he violates a condition of supervised release at any time

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during the term of supervised release, the Court may revoke the term

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of supervised release and require the defendant to serve up to two

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additional years imprisonment.

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VI.

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SENTENCING DETERMINATION

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A.

Statutory Authority:

The defendant understands that the

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Court must consult the Federal Sentencing Guidelines (as promulgated

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by the Sentencing Commission pursuant to the Sentencing Reform Act of

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1984, 18 U.S.C. 3551-3742 and 28 U.S.C. 991-998, and as

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modified by United States v. Booker and United States v. Fanfan,

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543 U.S. 220 (VI), 125 S.Ct. 738 (2005)) and must take them into

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account when determining a final sentence.

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that the Court will determine a non-binding and advisory guideline

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The defendant understands

sentencing range for this case pursuant to the Sentencing Guidelines.

The defendant further understands that the Court will consider whether

there is a basis for departure from the guideline sentencing range

(either above or below the guideline sentencing range) because there

exists an aggravating or mitigating circumstance of a kind, or to a

degree, not adequately taken into consideration by the Sentencing

Commission in formulating the Guidelines.

understands that the Court, after consultation and consideration of

the Sentencing Guidelines, must impose a sentence that is reasonable

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The defendant further

in light of the factors set forth in 18 U.S.C. 3553(a).

B.

Stipulations Affecting Guidelines Calculation:

The

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government and the defendant agree that there is no material dispute

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as to the following sentencing guidelines variables and therefore

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stipulate to the following:

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1.

Base Offense Level: 6 (U.S.S.G. 2B1.1(a)(2)).

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2.

Specific Offense Characteristics:

a.

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Loss: In consideration for the defendants guilty

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plea, the government agrees that loss should be determined according

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to the benefits paid by Medicare on claims submitted by the Sacramento

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clinic, as described in the factual basis.

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exceeds $200,000, the offense level should be increased by 12

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(U.S.S.G. 2B1.1(b)(1)(H)).
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Because this amount

Sophisticated Means: The parties agree that a two-

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level enhancement for sophisticated means (U.S.S.G. 2B1.1(b)(9)) is

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appropriate.

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3.

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Acceptance of Responsibility:

See paragraph III(B)(2)

above.
4.

Departures or Other Enhancements or Reductions: With the

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exceptions expressly set forth above, both parties stipulate and agree

that they will not seek or argue in support of any other specific

offense characteristics, Chapter Three adjustments, or cross-

references.

government for a departure under U.S.S.G. 5K1.1, both parties

stipulate and agree not to move for, or argue in support of, any

departure from the Sentencing Guidelines, or any deviance or variance

from the Sentencing Guidelines under United States v. Booker, 543 U.S.

220, 125 S.Ct. 738 (2005).

With the express exception of a possible motion by the

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VII.

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WAIVERS

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A.

Waiver of Constitutional Rights:

The defendant understands

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that by pleading guilty he is waiving the following constitutional

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rights:

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already made; (b) to be tried by a jury; (c) to be assisted at trial

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by an attorney, who would be appointed if necessary; (d) to subpoena

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witnesses to testify on his behalf; (e) to confront and cross-examine

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witnesses against him; and (f) not to be compelled to incriminate

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himself.

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B.

(a) to plead not guilty and to persist in that plea if

Waiver of Appeal and Collateral Attack:

The defendant

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understands that the law gives him a right to appeal his conviction

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and sentence.

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right to appeal the conviction and the right to appeal any aspect of

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the sentence imposed in this case.

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to appeal any order of restitution the Court may impose.

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He agrees as part of his plea, however, to give up the

He specifically gives up his right

Regardless of the sentence he receives, the defendant also gives

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up any right he may have to bring a post-appeal attack on his

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conviction or his sentence.

He specifically agrees not to file a

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motion under 28 U.S.C. 2255 or 2241 attacking his conviction or

sentence.

If the defendant ever attempts to vacate his plea, dismiss the

underlying charge, or reduce or set aside his sentence, the government

shall have the right (1) to prosecute the defendant on the count to

which he pleaded guilty; and (2) to file any new charges that would

otherwise be barred by this plea agreement.

any or all of these options is solely in the discretion of the United

States Attorneys Office.

The decision to pursue

By signing this plea agreement, the

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defendant agrees to waive any objections, motions, and defenses he

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might have to the governments decision.

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to raise any objections based on the passage of time including, but

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not limited to, any statutes of limitation or any objections based on

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the Speedy Trial Act or the Speedy Trial Clause of the Sixth

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Amendment.

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C.

In particular, he agrees not

Waiver of Attorneys Fees and Costs:

The defendant agrees to

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waive all rights under the Hyde Amendment, Section 617, P.L. 105-119

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(Nov. 26, 1997), to recover attorneys fees or other litigation

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expenses in connection with the investigation and prosecution of all

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charges in the above-captioned matter and of any related allegations

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(including without limitation any charges to be dismissed pursuant to

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this plea agreement and any charges previously dismissed).

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VIII.

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ENTIRE PLEA AGREEMENT

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Other than this plea agreement, no agreement, understanding,

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promise, or condition between the government and the defendant exists,

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nor will such agreement, understanding, promise, or condition exist

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unless it is committed to writing and signed by the defendant, counsel

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for the defendant, and counsel for the United States.

IX.

APPROVALS AND SIGNATURES

A.

Defense Counsel:

I have read this plea agreement and have

discussed it fully with my client.

The plea agreement accurately and

completely sets forth the entirety of the agreement.

in my client's decision to plead guilty as set forth in this plea

agreement.

I concur

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DATED:

_____________________

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RONALD RICHARDS, ESQ.
Attorney for Defendant

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B.

Defendant:

I have read this plea agreement and carefully

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reviewed every part of it with my attorney.

I understand it, and I

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voluntarily agree to it.

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and fully understand my rights with respect to the provisions of the

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Sentencing Guidelines that may apply to my case.

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inducements have been made to me, other than those contained in this

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plea agreement.

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any way to enter into this plea agreement.

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with the representation of my attorney in this case.

Further, I have consulted with my attorney

No other promises or

In addition, no one has threatened or forced me in

Finally, I am satisfied

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DATED:

_____________________

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RAMANATHAN PRAKASH, Defendant

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C.

Attorney for United States:

I accept and agree to this plea

agreement on behalf of the government.

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DATED:

_____________________

BENJAMIN B. WAGNER
United States Attorney

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By:________________________
PHILIP A. FERRARI
Assistant U.S. Attorney

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EXHIBIT "A"
Factual Basis for Plea Plea
Beginning no later than March 7, 2006, and continuing through at
least March 23, 2007, the defendant Dr. Ramanathan Prakash
participated in a scheme to defraud Medicare, a healthcare benefit
program. Over this time period, Dr. Prakash and another physician
were associated with a health care clinic located at 9121 Folsom
Boulevard, Ste. A, in Sacramento, California. The clinic was owned
and operated by Vardges Egiazarian. While this clinic was in
operation, claims were submitted to Medicare relating to patients the
physicians did not treat, seeking reimbursement for procedures that
were either unnecessary or never performed.

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On March 7, 2006, Dr. Prakash signed a Medicare Enrollment

Application for the purpose of obtaining a Provider Identification
Number to bill Medicare for services to be rendered at the Sacramento
Clinic. In this application, Dr. Prakash agreed to abide by all
Medicare laws, regulations and program instructions. In addition, he
certified he understood the Medicare identification number issued to
him could only be used when billing for services he rendered, he would
not knowingly present or cause to be presented a false or fraudulent
claim for payment, and would not submit claims with deliberate
ignorance or reckless disregard of their truth or falsity. On May 17,
2006, Dr. Prakash established Washington Mutual checking account no.
XXXXXX3256. Vardges Egiazarian was a co-signer on this account.
Hundreds of claims were submitted to Medicare seeking
reimbursement for services allegedly performed at the Sacramento
clinic under Dr. Prakashs care. However, Dr. Prakash never treated a
single patient at the Sacramento clinic. Rather, as the Government
would prove at trial, the clinic was generally staffed by four other
individuals. Nazaret Salmanyan was employed as an ultrasound
technician. Zola Belov was tasked with drawing blood from patients
and performing EKG tests. Irina Giyenko was a receptionist who
performed administrative duties. Salmanyan, Belov and Giyenko were
all unlicensed. Sol Teitelbaum, M.D., actually saw some of the
patients at the clinic.
The clinics patients were recruited and transported to the
clinic by individuals serving as cappers. The cappers were paid
according to the number of patients that each brought to the facility.
Patients were required to provide identifying information, including
their Medicare eligibility number. Giyenko would check these numbers
to ensure that each patient was eligible to receive Medicarereimbursed services. No patient was required to make a co-payment.
Instead, the patients were paid, generally $100 per visit. Some were
given ultrasound examinations by Salmanyan, although he admitted that
on occasion he simply performed ultrasounds on himself and submitted
them under the guise that they pertained to a patient. Some gave
blood samples to Belov, although she admitted that on occasion she
substituted blood from other clinic employees and represented that the
samples were from patients. Many patients were seen by Dr.
Teitelbaum. Although a physician, Teitelbaum was not authorized to
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perform Medicare-reimbursed services at the clinic.

Some of the patient files were transported to Southern

California, and then to Dr. Prakash for review. Regardless of whether
Dr. Prakash signed off on the files, claims were submitted to Medicare
for reimbursement for services never performed by Dr. Prakash.
Medicare received claims totaling approximately $1,156,470.66 for
patients allegedly under the care of Dr. Prakash at the Sacramento
clinic. Medicare paid a total of approximately $302,770.46 on these
claims. From on or about July 7, 2006, through on or about February
2, 2007, at least approximately $40,000 was withdrawn from this
account through checks made out to Dr. Prakash.

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As an example of a particular execution of the scheme to defraud,

Medicare received claim number 540206353065680 seeking reimbursement
for various physical therapy procedures allegedly performed upon
beneficiary S.P. on December 19, 2006. Dr. Prakash signed forms
within a medical chart relating to S.P. indicating that various
services including physical therapy were provided to S.P. from
December 18 through December 26, 2006. In truth and in fact, S.P.
never had any contact with Dr. Prakash and never received any physical
therapy through the Sacramento Clinic, which did not offer that
treatment in any event. The above-referenced claim sought $610 in
reimbursement, and Medicare paid $131.45 on the claim.

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