Former Owner of Los Angeles Medical Clinic Management Company Mikran “Mike” Meguerian Indicted by a Federal Grand Jury Alleging a $13 Million Medicare Fraud Scheme

October 1, 2013

The Federal Bureau of Investigation on September 30, 2013 released the following:

“WASHINGTON—The former owner of a Los Angeles medical clinic management company has been indicted for his role in a $13 million scheme to defraud Medicare.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney André Birotte, Jr. of the Central District of California, and Assistant Director in Charge Bill L. Lewis of the FBI’s Los Angeles Field Office made the announcement.

Mikran “Mike” Meguerian, 36, of Glendale, California, was indicted in the Central District of California on one count of conspiracy to commit health care fraud and five counts of health care fraud, each of which carries a maximum penalty of 10 years in prison upon conviction. Meguerian was arrested on September 26, 2013, and the indictment was unsealed following his initial appearance in federal court on September 27, 2013.

According to court documents, Meguerian owned Med Serve Management, a medical clinic management company located in Van Nuys, California. From approximately 2006 through February 2009, he allegedly engaged in a conspiracy to commit health care fraud, in part through the operation of Med Serve. According to court documents, Meguerian oversaw several medical clinics that generated prescriptions and other medical documents for medically unnecessary power wheelchairs and other durable medical equipment (DME). Meguerian and his co-conspirators then sold the prescriptions to DME supply companies, knowing that the prescriptions were fraudulent. Court documents allege that, based on these fraudulent prescriptions, the DME supply companies then submitted false and fraudulent claims to Medicare.

Court documents allege that fraudulent prescriptions from Meguerian’s clinics were instrumental in generating approximately $13.6 million in fraudulent claims to Medicare, and Medicare paid approximately $7.6 on those claims.

The charges and allegations contained in the indictment are merely accusations, and the defendants are presumed innocent unless and until proven guilty.

The case was investigated by the FBI and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Central District of California. This case is being prosecuted by Trial Attorneys Fred Medick and Blanca Quintero of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.”

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Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

Federal Crimes – Detention Hearing

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To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


“Florida Health Care Medical Director and Six Therapists Arrested for Alleged Roles in $63 Million Fraud Scheme”

July 17, 2013

The U.S. Department of Justice’s Office of Public Affairs on July 16, 2013 released the following:

“The former medical director at defunct health provider Health Care Solutions Network (HCSN) and six therapists were arrested today, accused of conspiring to fraudulently bill Medicare and Florida Medicaid more than $63 million.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney for the Southern District of Florida Wifredo A. Ferrer; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office, made the announcement after the indictment was unsealed following the arrests.

The former HCSN medical director, Roger Rousseau, 71, of Miami, was indicted on July 11, 2013, and charged with conspiracy to commit health care fraud and two counts of health care fraud. In addition, six therapists from Miami – Doris Crabtree, 61; Angela Salafia, 65; Liliana Marks, 46; Ruben Busquets, 49; Alina Fonts, 47; and Blanca Ruiz, 59 – were also charged in the same indictment with conspiracy to commit health care fraud. Fonts was also charged with two counts of health care fraud, and Crabtree, Salafia, Marks and Busquets were each charged with two counts of making false statements related to health care matters. The indictment also seeks forfeiture of proceeds from the alleged healthcare fraud offenses.

According to the indictment, HCSN purported to provide intensive mental health treatment to Medicare and Medicaid beneficiaries in Miami and Hendersonville, N.C., from approximately 2004 through 2011 for purported mental health services that were not medically necessary and often never provided. The indictment also alleges that in Miami, HCSN paid kickbacks to assisted living facility owners and operators who, in exchange, referred beneficiaries to HCSN. In total, HCSN is alleged to have fraudulently billed Medicare and Medicaid approximately $63.7 million, from which HCSN allegedly received payments totaling approximately $28 million.

Rousseau served as the medical director for HCSN in Florida, and the indictment alleges that he routinely signed what he knew to be fabricated and altered medical records without ever reviewing the materials, and, in most instances, without ever meeting with the patient. The indictment also alleges that Crabtree, Salafia, Marks, Busquets, Fonts and Ruiz fabricated HCSN medical records to support false and fraudulent claims for partial hospitalization program services that were not medically necessary and were not provided.

The charges and allegations contained in the indictment are merely accusations, and the defendants are presumed innocent unless and until proven guilty.

The case is being investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. The case is being prosecuted by Fraud Section Trial Attorney Allan J. Medina.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.”

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Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

Federal Crimes – Detention Hearing

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To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


“Medicare Fraud Strike Force Charges 89 Individuals for Approximately $223 Million in False Billing”

May 14, 2013

The Federal Bureau of Investigation (FBI) on May 14, 2013 released the following:

“WASHINGTON— Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 89 individuals, including doctors, nurses, and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billing.

Attorney General Holder and Secretary Sebelius were joined in the announcement by Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, FBI Assistant Director Ron Hosko, Inspector General Daniel R. Levinson of the HHS Office of Inspector General (HHS-OIG), and Deputy Administrator and Director of Centers for Medicare and Medicaid Services (CMS) Center for Program Integrity Peter Budetti.

This coordinated takedown was the sixth national Medicare fraud takedown in strike force history. In total, almost 600 individuals have been charged in connection with schemes involving almost $2 billion in fraudulent billings in these national takedown operations alone. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

Since their inception in March 2007, strike force operations in nine locations have charged more than 1,500 defendants who collectively have falsely billed the Medicare program for more than $5 billion. In addition, CMS, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

The joint Department of Justice and HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. Approximately 400 law enforcement agents from the FBI, HHS-OIG, multiple Medicaid Fraud Control Units, and other state and local law enforcement agencies participated in the takedown.

“Today’s announcement marks the latest step forward in our comprehensive efforts to combat fraud and abuse in our health-care systems,” said Attorney General Holder. “These significant actions build on the remarkable progress that the HEAT has enabled us to make—alongside key federal, state, and local partners—in identifying and shutting down fraud schemes. They are helping to deter would-be criminals from engaging in fraudulent activities in the first place. And they underscore our ongoing commitment to protecting the American people from all forms of health care fraud, safeguarding taxpayer resources, and ensuring the integrity of essential health-care programs.”

“The Affordable Care Act has given us additional tools to preserve Medicare and protect the tens of millions of Americans who rely on it each day,” said Secretary Sebelius. “By expanding our authority to suspend Medicare payments and reimbursements when fraud is suspected, the law allows us to better preserve the system and save taxpayer dollars. Today we’re sending a strong, clear message to anyone seeking to defraud Medicare: you will get caught and you will pay the price. We will protect a sacred trust and an earned guarantee.”

The defendants charged are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes, and money laundering. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, primarily home health care, but also mental health services, psychotherapy, physical and occupational therapy, durable medical equipment (DME), and ambulance services.

According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and often never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries, and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers so that the providers could then submit fraudulent billing to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners, and others charged are accused of conspiring to submit a total of approximately $223 million in fraudulent billing.

“We have made it part of our core mission at the Department of Justice to hold accountable those who steal from the Medicare program to line their own pockets,” said Acting Assistant Attorney General Raman. “There are Medicare fraudsters in prisons across the country—some who will be there for decades—who can attest to our determination, and our effectiveness.”

“We all feel the effects of health care fraud,” said FBI Assistant Director Hosko. “It leads to higher health care costs and makes it harder for seniors and those who are ill to get the care they need. The FBI and our law enforcement partners are committed to preventing and prosecuting health care fraud at all levels. But we need the public’s help. Take the time to be aware of fraud and call law enforcement if you see anything suspicious included in the billings to your insurance, Medicare, or Medicaid or have any unusual encounters with health care providers. We can work together to ensure your hard-earned dollars are used to care for the sick and not to line the pockets of criminals.”

“Taxpayers expect us to work harder and smarter, and that is exactly what happened across the nation today,” said HHS Inspector General Levinson. “In addition to the work of my agents and other federal, state, and local law enforcement officials, investigators from nine other IG offices joined us today. Working together we can break down silos, pool expertise, reduce costs, and the successful result speaks for itself.”

“Today’s takedown is the result of dedicated commitment to working with our law enforcement partners to root out fraud in the Medicare program,” said CMS Program Integrity Deputy Administrator Budetti. “This collaboration has been strengthened by the Affordable Care Act, which provided CMS with the tools it needs to stop the flow of money while working to rid our programs of fraud, waste, and abuse.”

In Miami, a total of 25 defendants, including two nurses, a paramedic, and a radiographer, were charged today and yesterday for their participation in various fraud schemes involving a total of $44 million in false billings for home health care, mental health services, occupational and physical therapy, DME, and HIV infusion. In one case, three defendants were charged for participating in a $20 million home health fraud scheme involving a home health agency, Trust Care Health Services. Court documents allege that the defendants bribed Medicare beneficiaries for their Medicare information, which was used to bill for home health services that were not rendered or that were not medically necessary. According to court documents, the lead defendant spent much of the money from the scheme and purchased multiple luxury vehicles, including two Lamborghinis, a Ferrari, and a Bentley.

Eleven individuals were charged by the Baton Rouge Strike Force. Five individuals were charged today, including two doctors, in New Orleans by the Baton Rouge Strike force for participating in a different $51 million home health fraud scheme. According to court documents, the defendants recruited beneficiaries, offering cash and other incentives in exchange for their Medicare information, which was used to bill medically unnecessary home health services. The Baton Rouge Strike Force also announced a superseding indictment and an information charging six individuals, including another doctor, with over $30 million in fraud in connection with a community mental health center called Shifa Texas. These charges come on top of charges brought against the owners and operators of Shifa Baton Rouge, a related community mental health center which is at the center of an alleged $225 million scheme charged in an earlier indictment.

In Houston, two individuals, a nurse and a social worker, were charged today with fraud schemes involving at total of $8.1 million in false billings for home health care. The defendants, who are brother and sister, allegedly used patient recruiters to obtain Medicare beneficiary information that they then used to bill for services that were not medically necessary and not provided.

Thirteen defendants were charged in Los Angeles for their roles in schemes to defraud Medicare of approximately $23 million. In one case, three individuals allegedly billed Medicare for more than $8.7 million in fraudulent billing for DME. According to the indictment, the defendants allegedly paid illicit kickbacks to patient recruiters to bribe beneficiaries to participate in the scheme. Once the individuals provided their Medicare information to recruiters, doctors and medical clinics conspiring with the defendants allegedly wrote prescriptions for medically unnecessary power wheelchairs, which they sold to the defendants for illegal kickbacks.

In Detroit, 18 defendants, including two doctors, a physician’s assistant, and two therapists, were charged for their roles in fraud schemes involving approximately $49 million in false claims for medically unnecessary services, including home health, psychotherapy, and infusion therapy. In one case, three individuals were charged in a $12 million scheme where they allegedly held themselves out to be licensed physicians—which they were not—and signed prescriptions for drugs and documents about purported psychotherapy they provided.

In Tampa, nine individuals were charged in a variety of schemes, ranging from pharmacy fraud health care-related money laundering. In one case, four individuals were charged for their alleged roles in establishing and operating four supposed healthcare clinics in Tampa, Florida—Palmetto General Health Care Inc., United Healthcare Center Inc., New Imaging Center Inc., and Lord Physical Rehabilitation Center Inc.—which they allegedly used to steal more than $2.5 million from Medicare for surgical procedures that were never performed. The defendants allegedly billed Medicare for surgical procedures used to treat patients with high blood pressure by collapsing veins in the legs, but they did not actually perform the procedures.

In Chicago, seven individuals were charged, including two doctors, with a variety of health care fraud schemes.

In Brooklyn, New York, four individuals, including two doctors, were charged in fraud schemes involving $9.1 million in false claims. In one case, three additional individuals were allegedly involved in what is now alleged to be a $15 million scheme where massages by unlicensed therapists were billed to Medicare as physical therapy. Six defendants were previously charged in the scheme.

The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams comprised of attorneys from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices for the Southern District of Florida, the Eastern District of Michigan, the Eastern District of New York, the Southern District of Texas, the Central District of California, the Middle District of Louisiana, the Northern District of Illinois, and the Middle District of Florida; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.

An indictment is merely a charge and defendants are presumed innocent until proven guilty.

To learn more about HEAT, go to http://www.stopmedicarefraud.gov.”

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Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

Federal Crimes – Detention Hearing

Federal Mail Fraud Crimes

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To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


Physician Pleads Guilty to Conspiracy to Commit Health Care Fraud Violation

October 10, 2012

The Federal Bureau of Investigation on October 10, 2012 released the following:

“NEW ORLEANS— Dr. Jack Voight, age 81, of Metairie, Louisiana pleaded guilty yesterday before U.S. District Court Judge Lance M. Africk to conspiracy to commit health care fraud, announced U.S. Attorney Jim Letten.

According to the second superseding indictment, Voight participated in a criminal organization for the purpose of fraudulently billing Medicare and Medicaid. Patients went to the medical clinics for medical tests that were not performed and not medically necessary. Patients were moved between the various clinics to repeatedly perform the same unnecessary tests. According to the superseding bill of information and indictment, the doctors, including Voight, gave the patients prescriptions for drugs, usually narcotics, for their cooperation.

Thereafter, bills for the false and unnecessary services were submitted to Medicaid and Medicare by a third party medical claims processing and billing company that worked with other New Orleans-area clinics that have already entered guilty pleas.

Count 32 of the superseding indictment carries a possible maximum sentence of 10 years’ imprisonment. Sentencing for Voight has been set for January 10, 2012.

Artem Gasparyan, Anahit Petrosyan, Vadim Mysak, Daria Litvinova, Ernestine Girod, Anna Aivazova, Aram Khlgatian, Jo Ann Girod; and the medical clinics, Health Plus Consulting Inc., Saturn Medical Group, New Millennium Medical Group, Inc.; and the biller, Solo Lucky Claims Processing Inc., have already pleaded guilty and most are awaiting sentence.

The investigation was conducted by special agents of the Federal Bureau of Investigation; the U.S. Department of Health and Human Services, Office of Inspector General; and the Louisiana Department of Justice, Medicaid Fraud Control Unit. The case is being prosecuted by Assistant U.S. Attorneys Patrice Harris Sullivan, G. Dall Kammer, and Jordan Ginsberg.”

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Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

Federal Crimes – Detention Hearing

Federal Mail Fraud Crimes

Federal Crimes – Appeal

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To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


Houston-Area Physician and Local Businessman Charged in an Alleged Diagnostic Testing Fraud Scheme

May 24, 2012

The Federal Bureau of Investigation (FBI) on May 24, 2012 released the following:

“HOUSTON— Dr. Donald Gibson, II, 56, of Sugarland, Texas, and Sunday Joseph Edem, 53, of Richmond, Texas, have been arrested for health care fraud and conspiracy to commit health care fraud relating medically unnecessary diagnostic testing and physical therapy, United States Attorney Kenneth Magidson announced today.

Both defendants were arrested without incident this morning and are expected to make an initial appearance tomorrow before U.S. Magistrate Judge Mary Milloy.

According to the indictment, returned Thursday, May 17, 2012, and unsealed today upon their arrests, Gibson ordered, prescribed, and authorized medically unnecessary diagnostic tests and other procedures, which included allergy tests, pulmonary function tests, vestibular tests, urodynamic tests, and physical therapy, among others. These services were then billed to Medicare and Medicaid for payment under Gibson’s billing number.

From January 2007 through January 2012, Gibson allegedly caused more than $19.4 million in medical claims to the Medicare and Texas Medicaid Programs. As a result, Medicare deposited approximately $8.5 million into a bank account owned and controlled by Gibson.

The indictment also alleges Edem operated medical clinics under the names of other individuals to conceal his financial interest in the businesses. Edem and Gibson allegedly conspired with one another to cause the submission of false claims to the Medicare and Medicaid programs and share in the proceeds. Gibson and Edem paid patient recruiters for referring Medicare/Medicaid beneficiaries, according to the indictment, and also paid Medicare beneficiaries for showing up at the medical clinics.

This case is the result of a joint investigation involving multiple federal and state agencies, including agents and investigators of the Railroad Retirement Board, Secret Service, Drug Enforcement Administration, FBI, the Texas Attorney General’s Medicaid Fraud Control Unit, and U.S. Department of Health and Human Services-Office of Inspector General. Special Assistant U.S. Attorney Justin Blan and Assistant U.S. Attorney Andrew Leuchtmann are prosecuting this case.

An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless convicted through due process of law.”

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Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

Federal Crimes – Detention Hearing

Federal Mail Fraud Crimes

Federal Crimes – Appeal

————————————————————–

To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


Federal prosecutors claim Houston doctor was go-to man for fraud

May 23, 2012

The Houston Chronicle on May 22, 2012 released the following:

“By Terri Langford

A Houston physician accused of Medicare fraud prescribed costly home health care to hundreds of patients who didn’t need it – the majority of whom he never examined – resulting in more than $5.2 million in phony Medicare claims, according to federal data presented to jurors Tuesday.

In an unflattering snapshot of the home health care industry, the case brought by the government against Dr. Ben Echols aims to show he easily was able to sign off on home health care prescriptions for 352 patients and that the nation’s Medicare system, a $700 billion-plus behemoth, relies on an honor system where doctors and home health care agencies police their own claims.

Echols’ attorney, Connie Williams, insists his client has done nothing against the law or Medicare rules.

“He’s a good doctor. I think a lot of people in the community love him,” Williams said of his client. “However, he’s not the best manager in world.”

Echols’ signature was found on the patients’ plans of care forms, also known as a “485” form, paperwork needed by home health care companies before they can submit a claim for their services to Medicare.

The forms never make it to Medicare claims officials.

The home health care agencies and doctors keep them in their files in case a claim is questioned.

All of the requests for home health care for the 352 patients in question came from two home health care companies: Family Healthcare Services and Houston Compassionate Care.

Owners pleaded guilty

The owners of Family Healthcare, Clifford Ubani and Princewill Njoku, have already pleaded guilty to one count of conspiracy to commit health care fraud, one count of conspiracy to pay kickbacks and 16 counts of payment of kickbacks to Medicare beneficiary recruiters.

A record kept by Family Healthcare and recovered from a storage facility by federal investigators showed how the company went to Echols after patients’ own physicians rejected Family Healthcare’s request to provide services. The company dubbed the record, a “Re-Bill Doctor Log.”

However, most of the patients – 204 – were referred by Echols for home health care services from Compassionate Care, the same company that paid him $103,400 to serve as “medical director,” a position that requires him to make sure the company is following proper health care protocol.

Nurse indicted

The signature on the payments to Echols was that of Valnita Turner, a registered nurse with Compassionate Care.

Turner was indicted this month in the nation’s largest Medicare fraud sweep and is accused of conspiracy to disclose health information, conspiracy to commit health care fraud and five counts of health care fraud.

The second day of testimony in Echols’ trial, in U.S. District Judge Sim Lake’s court room, focused on how the two companies outmaneuvered Medicare through unsophisticated paperwork sleights-of-hand.

In one example, Family Healthcare Services tried to get a patient in Crockett, 120 miles from Houston, approved by his hometown physician for home health care.

The doctor’s office in Crockett faxed their denial back to Family Healthcare Services.

“He wasn’t home-bound,” testified nurse practitioner Toni McDonald, who worked for the doctor in Crockett. “He was driving.”

Not long after the denial, that same patient’s request for home health care was approved by Echols.

But Family Healthcare submitted paperwork to Medicare, under the Crockett physician’s Medicare number, not Echols’, according to testimony from U.S. Health and Human Services Office of Inspector General agent Korby Harshaw.

Rules tightened

A year ago, the Centers for Medicare and Medicaid Services (CMS) tightened home health care rules because too many doctors were approving patients for home health care without seeing the patient.

Of the 352 patients approved for home health care services by Echols, 200 did not have an office visit with him beforehand.

And at least one patient he approved for care got it for 2½ years before he was seen by the physician.

As Echols left the courthouse Tuesday he declined comment, then added, “Except to say I am not the monster you think I am.””

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Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

————————————————————–

To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.


Twenty-Two Detroit-Area Residents Charged in Nationwide Medicare Fraud Strike Force Takedown

May 3, 2012

The Federal Bureau of Investigation (FBI) on May 2, 2012 released the following:

Total of 107 Defendants Charged in Seven Cities for Approximately $452 Million in False Billing

DETROIT—Twenty-two Detroit-area residents were charged today for their roles in psychotherapy, home health care, and infusion therapy schemes to submit more than $58 million in false billing to Medicare, announced the Departments of Justice and Health and Human Services. Including these charges, Medicare Fraud Strike Force operations in Detroit have charged a total of 164 individuals in cases involving approximately $244 million in fraudulent billings to Medicare.

The charges in Detroit are part of a nationwide takedown by Medicare Fraud Strike Force operations in seven cities that led to charges against 107 individuals for their alleged participation in schemes to collectively submit more than $452 million in fraudulent claims to Medicare. This takedown involved the highest amount of false Medicare billing in a single takedown in strike force history.

“The results we are announcing today are at the heart of an administration-wide commitment to protecting American taxpayers from health care fraud, which can drive up costs and threaten the strength and integrity of our health care system,” said Attorney General Eric Holder. “We are determined to bring to justice those who violate our laws and defraud the Medicare program for personal gain. As today’s takedown reflects, our ongoing fight against health care fraud has never been more coordinated and effective.”

United States Attorney for the Eastern District of Michigan Barbara L. McQuade stated, “A disturbing new trend we are seeing is the exploitation of adults in foster care. Providers bill Medicare for home health and psychotherapy services for disabled adults that are unnecessary or not provided.”

“Those who seek to steal from Medicare and exploit the system will be vigorously pursued and brought to justice,” stated Special Agent in Charge of the FBI’s Detroit Division Andrew G. Arena. “These arrests are the result of a tremendous amount of hard work by FBI and HHS-OIG agents.”

“Today’s indictments and arrests in the areas of home health care, psychotherapy, or infusion therapy fraud demonstrate that HHS-OIG agents will untangle even the most complex fraud schemes and hold those responsible accountable for their criminal actions,” said Lamont Pugh III, Special Agent in Charge of the Department of Health & Human Services Office of Inspector General for the Chicago Region, which includes Detroit. “Through collaboration with our law enforcement partners, HHS-OIG will bring to justice those who waste Medicare’s limited resources and prevent the most vulnerable members of our society from receiving vital health care services.”

Court documents unsealed today in the Eastern District of Michigan charge defendants including owners and operators of companies, social workers, office employees, and patient recruiters with submitting fraudulent claims for services that were never rendered. Eighteen of the defendants were either arrested this morning or will be self surrendering this week and four defendants remain at large. In addition, law enforcement agents today executed search warrants at nine locations and seizure warrants of 14 bank accounts related to the alleged fraud schemes. The following charges were unsealed:

United States v. Rahman, et al.

Five individuals were charged in a superseding indictment with conspiracy to commit health care fraud for their roles in a $13.8 million scheme to defraud Medicare by submitting fraudulent claims for home health care services. One of the defendants was also charged with conspiracy to pay or receive kickbacks to refer Medicare beneficiaries for the fraudulent services. The indictment alleges that the fraudulent claims were submitted by four home health agencies operating in Livonia, Michigan: Physicians Choice Home Health Care, LLC; First Care Home Health Care, LLC; Quantum Home Care, Inc.; and Moonlite Home Care, Inc.

The defendants charged in the superseding indictment are: Bilal Akbar, 49, formerly of Canton, Michigan; Joann Terrell, 49, of Detroit; Madhur Thawani, 27, of Auburn Hills, Michigan; Shahzad Mirza, 41, of Canton, Michigan; and Ankit Patel, 27, of Plymouth, Michigan.

United States v. Mehmood, et al.

Two individuals were charged in a superseding indictment with conspiracy to commit health care fraud for their roles in a $33 million scheme to defraud Medicare by submitting fraudulent claims for home health care services, as well as conspiracy to pay or receive illegal kickbacks. The indictment alleges that the fraudulent claims were submitted by four home health agencies operating in Ypsilanti, Michigan and Detroit, Michigan: Access Care Home Care, Inc.; Patient Care Home Care, Inc.; Hands On Healing Home Care, Inc.; All State Home Care, Inc.

The defendants charged in the superseding indictment are: Badar Ahmadani, 45, of Ypsilanti Michigan and Falusic Ashford, 47 of Detroit, Michigan.

United States v. Sharma, et al.

Four individuals were charged in an indictment with conspiracy to commit health care fraud for their roles in a $23 million scheme to defraud Medicare by submitting fraudulent claims for home health care services and psychotherapy services. Three of the individuals were also charged with conspiring to pay or receive illegal kickbacks. The indictment alleges that the fraudulent claims were submitted by three home health agencies and an adult day care center. The home health agencies operating in Madison Heights, Michigan and Sterling Heights, Michigan are: Reliance Home Care, LLC; First Choice Home Health Care Services, Inc.; and Associates in Home Care, Inc. The adult day care center operating in Detroit Michigan is Haven Adult Day Care Center, LLC.

The defendants charged in the indictment are: Sachin Sharma, 36, of Shelby Township, Michigan; Dana Sharma, 29, of Shelby Township, Michigan; Abdul Malik Al- Jumail, aka “Tony,” 52, of Brownstown, Michigan; and Felicar Williams, 49, of Dearborn, Michigan.

United States v. English, et al.

Six individuals were charged in an indictment with conspiracy to commit health care fraud for their roles in a $2.8 million scheme to defraud Medicare by submitting fraudulent claims for psychotherapy services. Two of the defendants are also charged with additional health care fraud counts. The indictment alleges that the fraudulent claims were submitted by an adult day care center operating in Flint, Michigan: New Century Adult Day Program Services, LLC.

The defendants charged in the indictment are: Glenn English, 52, of Detroit, Michigan; Gregory Lawrence, 54, of Detroit, Michigan; Richard Hogan, 65, of Flint, Michigan; Donald Berry, 65, of Detroit, Michigan; Felicia Marsh, 44, of Detroit, Michigan; and Jamie Moreau, 34, of Davison, Michigan.

United States v. Thompson, et al.

Two individuals were charged in an indictment with conspiracy to commit health care fraud and additional counts of health care fraud for their roles in a $20 million scheme to defraud Medicare by submitting fraudulent claims for psychotherapy services. The indictment alleges that the fraudulent claims were submitted by two psychotherapy clinics and an adult day care center operating in Detroit, Michigan: TGW Medical, Inc.; Caldwell Thompson Manor, Inc. And P&C Adult Day Care Center, LLC.

The defendants charged in the indictment are: Louisa Thompson, 62, of Detroit, Michigan and Checarol Robinson, 41, of New Baltimore, Michigan.

United States v. Edwards, et al.

Two individuals were charged in an indictment with conspiracy to commit health care fraud and additional counts of health care fraud for their roles in a $3 million scheme to defraud Medicare by submitting fraudulent claims for psychotherapy services. The indictment alleges that the fraudulent claims were submitted by a psychotherapy clinic operating in Southfield, Michigan and Detroit, Michigan: Funderburg Clinical and Community Services, Inc.

The defendants charged in the indictment are: Sanyani Edwards, 32, of Taylor, Michigan and Angel Williams, 27, of Southfield, Michigan.

United States v. Raymond Arias

Raymond Arias, 40, of Troy, Michigan was charged in an indictment with six counts of health care fraud for his leading role in a $12.5 million scheme to defraud Medicare by submitting fraudulent claims for infusion therapy treatments. The fraudulent claims were submitted by Arias’s clinic Elite Wellness, LLC, operating in Westland, Michigan.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

The cases announced today are being prosecuted and investigated by Medicare Fraud Strike Force teams comprised of attorneys from the Fraud Section of the Justice Department’s Criminal Division and from the U.S. Attorney’s Offices for the Southern District of Florida, the Eastern District of Michigan, the Southern District of Texas, the Central District of California, the Middle District of Louisiana; the Northern District of Illinois, and the Middle District of Florida; and agents from the FBI, HHS-OIG, and state Medicaid Fraud Control Units.

The cases in the Eastern District of Michigan are being prosecuted by Assistant Chief Gejaa T. Gobena and Trial Attorneys Catherine K. Dick and William G. Kanellis of the Criminal Division’s Fraud Section, and Assistant United States Attorney Philip Ross of the U.S. Attorney’s Office for the Eastern District of Michigan.

An indictment is merely a charge and defendants are presumed innocent until proven guilty.”

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Douglas McNabb – McNabb Associates, P.C.’s
Federal Criminal Defense Attorneys Videos:

Federal Crimes – Be Careful

Federal Crimes – Be Proactive

Federal Crimes – Federal Indictment

Federal Crimes – Detention Hearing

Federal Mail Fraud Crimes

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To find additional federal criminal news, please read Federal Criminal Defense Daily.

Douglas McNabb and other members of the U.S. law firm practice and write and/or report extensively on matters involving Federal Criminal Defense, INTERPOL Red Notice Removal, International Extradition Defense, OFAC SDN Sanctions Removal, International Criminal Court Defense, and US Seizure of Non-Resident, Foreign-Owned Assets. Because we have experience dealing with INTERPOL, our firm understands the inter-relationship that INTERPOL’s “Red Notice” brings to this equation.

The author of this blog is Douglas C. McNabb. Please feel free to contact him directly at mcnabb@mcnabbassociates.com or at one of the offices listed above.