Medical Assistant Sentenced to 36 Months in Prison for His Role in a Fraudulent Home Health Scheme

WASHINGTON – A medical assistant was sentenced today to 36 months in prison for his role in a conspiracy to defraud the Medicare program, the Departments of Justice and Health and Human Services announced.  Guy Ross was also sentenced by U.S. District Judge Denise Page Hood in the Eastern District of Michigan to three years of supervised release following his prison term and was ordered to pay $472,623 in restitution.

Ross, 51, pleaded guilty in July 2010 to one count of conspiracy to commit health care fraud.   According to court documents, Ross received kickbacks from the owners and/or operators of two Detroit-area home health agencies, Patient Choice Home Healthcare Inc. and All American Home Care Inc., in exchange for referring home health patients to those entities.   Ross admitted to receiving $500 per patient, paid either by check or in cash, in exchange for providing co-conspirator Mohammed Shahab with Medicare beneficiary information for various patients he recruited.    After paying the kickbacks to Ross, Shahab, an owner of Patient Choice and All-American, billed Medicare for home health visits purportedly made to the beneficiaries recruited by Ross.   Ross referred 21 patients to Patient Choice and All American.   During the time Ross participated in the scheme, Patient Choice and All American submitted claims for $172,573 in improper benefits.  Shahab pleaded guilty in February 2010 to health care fraud charges in connection with this case.

According to court documents, Ross also admitted to engaging in a similar scheme with a home health agency called Visiting Nurses Services (VNS), a home health agency that purportedly provided physical therapy services.    Ross admitted he accepted money in exchange for providing patient referrals to VNS.    According to court documents, Ross referred approximately 80 patients to VNS and VNS submitted claims for $300,050 as a result of those referrals.  

In total, Ross’s kickback arrangements with Patient Choice, All American and VNS resulted in $472,623 in fraudulent billing to Medicare.   

Of the total restitution amount, Ross was ordered to pay $172,573 joint and several with co-defendants in the Patient Choice and All American scheme.

Today’s sentence was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (OIG) Chicago Regional Office.

The case was prosecuted by Trial Attorney Gejaa T. Gobena of the Criminal Division’s Fraud Section.  The case was 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 Eastern District of Michigan.

Since its inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 850 individuals and organizations that collectively have billed the Medicare program for more than $2.1 billion.  In addition, HHS’s 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.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov