It seems that every year about this time, the Department of Justice announces a major arrest of hundreds of Medicare fraud perpetrators. Though the name of the investigative and arresting task force changes with the administration in Washington, this year is no different, with the announcement last that the DoJ arrested over 400 people, including doctors, nurses, and licensed medical professionals — and a few home health providers — for their roles in fraud schemes involving about $1.3 billion in false Medicare billings.
The law that brought us HIPAA also created the Health Care Fraud and Abuse Control Program. Under Obama's Attorney General and HHS Secretary, the effort became known as H.E.A.T., the Health Care Fraud Prevention & Enforcement Action Team. Today, when all things Obama must be erased and forgotten, the administration simply calls it the Medicare Fraud Strike Force.
Cities where last week's arrests took place included all the usual suspects plus a couple of surprises. Miami, Chicago, Detroit, Brooklyn, Los Angeles and Houston were joined this time by Fort Wayne, Indiana and Providence, Rhode Island. Most of last week's arrests, according to most reports we found in national and local print media, involved physicians accused of over-prescribing pain medications, primarily Purdue Pharma's OxyContin and OxyCodone, the morphine-related drugs that Purdue once told physicians are non-addictive when absorbed by extreme pain.
The Medicare Fraud Strike force organized this latest investigation and arrests. Over the years, it has charged more than 3,500 defendants with false billings totaling more than $12.5 billion since its creation in 2007.
In the Chicago area, however, federal authorities also arrested the owners of a Glendale Heights-based home health care business. The charges that prompted their arrest last Thursday allege that Zosima Victuelles, Mylene Masiclat and Maribel Cabrera, the owners of Sure Care, paid Dr. Yaseen Odeh, Dr. Mohammad Raza Khan and others more than $435,000 in kickbacks and bribes for the referral of Medicare beneficiaries to Sure Care, authorities said. The five professionals face a combined 28-count indictment on conspiracy to offer and pay, and to solicit and receive, kickbacks and bribes for the referral of Medicare beneficiaries. There were several other arrests throughout Illinois.
FBI agents raided multiple medical offices inside Detroit's historic Fisher Building in the New Center area. Employees in the area reported that offices tied to companies Tri-County Medical and Nat Lab were among those targeted. A DHHS news release described a "notable case" involving Mashiyat Rashid of Oakland County — owner or operator of Tri-County Network — and his alleged co-conspirators.
The Detroit network of companies "allegedly engaged in illegal kickbacks and billing for medically unnecessary joint injections, drug screenings and home health services," according to the news release. The indictment said the alleged conspiracy dates back to December 2008.
"The case was initiated based upon proactive data analysis, which identified one of Rashid's companies as one of the nation's top providers for joint injections that billed at a volume per patient that is not medically necessary or advisable," according to the news release. The seven people charged are Mashiyat Rashid, Yasser Mozeb, Joseph Betro, Tariq Omar and Mohammed Zahoor of Oakland County; Abdul Haq of Washtenaw County; and Spilios Pappas of Ohio.
Within the larger case, five healthcare providers in Brooklyn and Queens were charged for phony Medicare bills totaling more than $100 million, prosecutors say. Defendants Wael Bakry, Abraham Demoz, Victor Genkin, Mayura Kanekar, and Alexander Khavash, allegedly paid kickbacks to Brooklyn ambulance drivers for patient referrals.
Criminal complaint charges were also filed against Brooklyn resident Xiaoliang Zhang of Elmhurst United Medical, P.C. for submitting $27 million worth of Medicare and Medicaid claims for unnecessary — or fake — physical therapy services.
Three of the total suspects – Victor Genkin, Xiaoliang Zhan, and Vadim Alekseyev – hailed from Brooklyn. Another defendant, physical therapist Wael Bakry, once ran a clinic on Ocean Avenue and Avenue U.
The latest total of defendants and false claims far surpassed last year's healthcare fraud take-down. Hundreds of federal agents with the FBI and Health and Human Services-Office of Inspector General were deployed to make the arrests. In South Florida alone, the roughly 80 newly charged defendants were accused of submitting more than $140 million in fraudulent claims to Medicare and private insurance companies for home visits, managed care and prescription drugs that were either not necessary or provided, according to the U.S. attorney's office in Miami.
“Patients are being denied the quality of care that they deserve, doctors are turning a blind eye to their oaths, and taxpayer money is being diverted into the pockets of the greedy,” said Acting U.S. Attorney Benjamin Greenberg.
Attorney General Peter F. Kilmartin joined the party by introducing six Rhode Islanders arrested as part of the joint state and federal crackdown.
A Fort Wayne doctor and two local pharmacists have been indicted on 10 counts of conspiracy, distributing a controlled substance and conspiracy to commit health care fraud. The Department of Justice also hinted at more arrests to come. Dr. James E. Ranochak and pharmacists Brent A. Losier and Charles H. Ringger were named in a federal indictment issued in June and unsealed this week.
©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. firstname.lastname@example.org