Individuals Plead Guilty in Two Detroit Medicare Fraud Cases

WASHINGTON—Four individuals pleaded guilty today in Detroit for their roles in a $14 million Medicare fraud scheme. In a separate case, the owner of a Detroit psychotherapy clinic also pleaded guilty today for his role in a $3 million Medicare fraud scheme.

The guilty pleas were announced by the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Curtis Mallory, 38, Theodore Haile, 33, Maira Suleman, 31, and John Thomas, 33, each pleaded guilty before U.S. District Judge Denise Page Hood of the Eastern District of Michigan to one count of conspiracy to commit health care fraud. Gerald R. Funderburg Jr., 32, pleaded before U.S. District Judge Stephen Murphy in the Eastern District of Michigan to one count of health care fraud.

According to court documents, Mallory, Haile, Suleman, and Thomas participated in a fraud scheme at two Oakland County, Mich., home health agencies, Patient Choice Home Care Inc. and All American Home Care Inc. Mallory and Haile were patient recruiters for the home health agencies and admitted to paying kickbacks to Medicare beneficiaries in exchange for the beneficiaries’ Medicare information and signatures on therapy documents. The owners and operators of Patient Choice and All American paid Mallory and Haile for each patient they recruited, and then billed Medicare for physical therapy services that were medically unnecessary and never provided.

Thomas was a physical therapist for Patient Choice and All American and admitted that he was paid to fabricate therapy documents at the home health agencies for patients who did not receive and/or did not need the services billed by the agencies to Medicare. According to court documents, Suleman was the office manager at Patient Choice. Suleman admitted that she oversaw data entry at Patient Choice and designed various systems to facilitate the entry of false billing data into electronic databases used to bill Medicare. Suleman also admitted that she worked with recruiters and physical therapists to collect and maintain pre-signed visit forms used by the therapists to fabricate false therapy visit documents.

According to court documents in the separate case against Funderberg, from November 2006 to April 2011, Funderberg knowingly used the Medicare information of approximately 476 beneficiaries, without their consent, to bill Medicare for psychotherapy services purportedly rendered by his company, Funderburg Clinical and Community Services Inc. (FCCS). These services were medically unnecessary and/or were never provided. To implement the scheme, Funderburg admitted that he obtained the Medicare information of licensed social workers without their knowledge and used this information at FCCS to claim that these social workers provided individual and group psychotherapy sessions.

Funderburg admitted that he caused FCCS to submit approximately 4,658 claims to Medicare, totaling approximately $3.3 million, for psychotherapy and related services that were not provided and/or were not medically necessary.

Sentencing for Mallory, Haile, Suleman and Thomas is scheduled for April 19, 2012. Sentencing for Funderberg is scheduled for June 8, 2012. Each defendant faces a maximum penalty of 10 years in prison and a $250,000 fine.

Today’s pleas were 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 (HHS-OIG) Chicago Regional Office.

The cases are being prosecuted by Assistant Chief Gejaa T. Gobena and Trial Attorney William Kanellis of the Criminal Division’s Fraud Section. The cases were investigated by the FBI and HHS-OIG, and were 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 their inception in March 2007, the strike force operations in nine districts have charged more than 1,160 individuals who collectively have falsely billed the Medicare program for more than $2.9 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is 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 Stopmedicarefraud.gov.