DETROIT—Eighteen individuals were charged in court documents unsealed today and yesterday in the Eastern District of Michigan for their participation in a series of separate Medicare fraud schemes involving home health and psychotherapy services, announced the Department of Justice, the Department of Health and Human Services (HHS), the FBI and the HHS Office of Inspector General (HHS-OIG).
According to court documents unsealed today and yesterday in U.S. District Court in Detroit, the separate schemes allegedly involved a total of more than $28 million in fraudulent claims submitted to Medicare for services that were medically unnecessary and/or never provided. Fifteen of the defendants were arrested this morning, one defendant was arrested in July 2011, and two defendants remain at large. In addition, law enforcement agents today executed search warrants at 11 locations and seizure warrants of 28 bank accounts related to the alleged fraud schemes.
Including these charges, Medicare Fraud Strike Force operations in Detroit have charged a total of 138 individuals in cases involving approximately $148 million in fraudulent billings to Medicare.
“Today we have charged physicians, nurses, clinic owners and other medical professionals for submitting millions of dollars in false claims to Medicare,” said Assistant Attorney General Lanny A. Breuer of the Criminal Division. “According to court documents, these defendants paid kickbacks to beneficiaries and others, and falsified medical documents in order to deceive the Medicare program. As our strike force efforts have consistently shown, we will not allow criminals to steal from government health care programs.”
“Health care providers should be aware that the days of stealing from Medicare with impunity are over,” said U.S. Attorney Barbara McQuade of the Eastern District of Michigan. “We are relentlessly investigating and prosecuting those who seek to profit from false claims for services that are medically unnecessary or, in some instances, not provided at all.”
“Health care fraud affects every American,” said FBI Special Agent in Charge Andrew G. Arena. “As Americans live longer, health care costs are expected to rise. The FBI, together with its federal, state, and local partners, is working aggressively to pursue health care fraud criminals and bring them to justice.”
“The Medicare Fraud Strike Force in Detroit continues to demonstrate a concentrated and sustained effort in combating health care fraud,” said Lamont Pugh III, HHS-OIG Special Agent in Charge of regional operations. “The Office of Inspector General will continue to work with our strike force partners to focus a spotlight on those who attack the Medicare program and ensure that they are held accountable.”
“These arrests are good news for American taxpayers and a powerful warning to health care ripoff artists,” said Donald M. Berwick, M.D., Administrator of the Centers for Medicare & Medicaid Services. “In this instance, the system worked as it should: Medicare detected suspicious behavior and got the information quickly to law enforcement for appropriate follow-up. Together with our law enforcement partners, we helped minimize the theft of taxpayer dollars and maximize criminal consequences to thieves. CMS will continue to relentlessly pursue fraudsters across the country and aggressively feed leads to our law enforcement partners.”
Fourteen individuals are charged in one indictment with conspiracy to commit health care fraud for their roles in a $14 million scheme to defraud Medicare by submitting fraudulent claims for home health care services. The defendants include three physicians, four clinic owners and managers, two clinic employees, one nurse, and four physical therapists and physical therapy assistants. According to court documents, the conspiracy was operated out of multiple home health agencies located in Livonia, Mich., including Physicians Choice Home Health Care LLC, First Care Home Health Care LLC, Quantum Home Care Inc. and Moonlite Home Care Inc.
In a separate complaint unsealed today, a physician and two other individuals are charged with health care fraud and the submission of false claims in connection with an approximately $11.5 million scheme to defraud the Medicare program. The scheme allegedly involved false billings for individual and group psychotherapy services at two clinics located in Detroit, Quality Recreation and Rehabilitation Inc. and Procare Rehabilitation Inc. According to court documents, the defendants billed Medicare for services that were medically unnecessary and/or never provided.
In another indictment unsealed yesterday, the owner of a medical clinic located in Southfield, Mich., was charged with conspiracy to commit health care fraud, health care fraud and identity theft for a scheme allegedly involving $2.9 million in fraudulent billings to Medicare. According to court documents, the clinic owner is alleged to have used the identities of Medicare providers and beneficiaries to bill for psychotherapy services that were medically unnecessary and never performed.
Defendants charged include: Gerald R. Funderburg Jr., 31, of Southfield, Mich.; Marcus Jenkins, 49, of Farmington Hills, Mich.; Elizabeth Jenkins, 47, of Farmington Hills; Dr. Alphonso Berry, 50, of Orchard, Mich.; Tausif Rahman, 36, of Canton, Mich.; Zahir Yousafzai, 41, of Canton, Mich.; Javed Rehman, 48, of Farmington Hills; Muhammad aka "Sib" Ahmad, 33, of Ypsilanti, Mich.; Jawad Ahmad, 41, of Ypsilanti, Mich.; Dr. Dwight Smith, 58, of Detroit; Dr. Paul Kelly, 74, of Bath, Mich.; Rehan Khan, 38, of Canton, Mich.; Nabeel Shaikh, 29, of Wixom, Mich.; Janaki Chettiar, 36, of Farmington Hills; Jigar Patel, 27, of Madison Heights, Mich.; Anthony Parkman, 40, of Southfield; Hetal Barot, 28, of Canton; and Srinivas Reddy aka "Dr. Reddy", 35, of Bloomfield Hills, Mich.
The charges were announced by Assistant Attorney General Breuer of the Criminal Division, U.S. Attorney McQuade of the Eastern District of Michigan, Special Agent in Charge Arena of the FBI’s Detroit Field Office and Special Agent in Charge Pugh of the HHS-OIG Office of Investigation.
The cases are being prosecuted by Trial Attorneys Gejaa T. Gobena and Catherine K. Dick of the Criminal Division’s Fraud Section. The investigations were conducted jointly by the FBI and HHS-OIG, as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Eastern District of Michigan and the Criminal Division’s Fraud Section.
Since their inception in March 2007, the strike force operations in nine districts have charged more than 1000 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
Indictments and criminal complaints contain merely charges and defendants are presumed innocent until proven guilty.