WASHINGTON—A Michigan resident pleaded guilty today for his role in a $13.8 million Detroit-area home health care fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).
Nabeel Shaikh, 30, of Wixom, Michigan, pleaded guilty today to one count of conspiracy to commit health care fraud before U.S. District Judge Gerald E. Rosen of the Eastern District of Michigan. At sentencing, Shaikh faces a maximum penalty of 10 years in prison and a $250,000 fine.
According to information contained in plea documents, Shaikh purported to be a physical therapy assistant with a limited license who provided physical therapy services to homebound Medicare beneficiaries. In fact, Shaikh had a forged physical therapy assistant’s degree and no medical license. Beginning in approximately January 2009, Shaikh was paid to falsify medical documentation for two home health agencies, known as Physicians Choice Home Health Care LLC and Quantum Home Care Inc., each of which billed and received payments from Medicare for home health care services that were never rendered.
According to court documents, Shaikh paid kickbacks and bribes to Medicare beneficiaries in order to obtain the beneficiaries’ Medicare information, which was then used to bill Medicare for home health services that were never provided. Shaikh created evaluations, therapy revisit notes, and other medical documentation memorializing purported physical therapy for patients he did not see or treat. Shaikh and his co-conspirators had Medicare beneficiaries pre-sign forms and visit sheets that were later falsified to make it appear that the beneficiaries had received home health services when, in fact, they had not. Shaikh knew that the documents that he signed would be used to support false claims to Medicare for home health services.
From approximately January 2009 through September 2011, Medicare paid approximately $900,430 to Physicians Choice and Quantum for fraudulent physical therapy claims based on falsified files and notes signed by Shaikh.
Overall, between approximately July 2008 and September 2011, Physicians Choice, Quantum, and two other fraudulent home health care agencies involved in the conspiracy, known as First Care Home Health Care LLC and Moonlite Home Care Inc., were paid approximately $13.8 million in fraudulent home health claims by the Medicare program for services that were medically unnecessary and/or never rendered.
Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division, U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade, Acting Special Agent in Charge of the FBI’s Detroit Field Office Edward J. Hanko, and Special Agent in Charge Lamont Pugh, III of the HHS Office of Inspector General, Chicago Regional Office.
This case was prosecuted by Trial Attorney Catherine K. Dick of the Criminal Division’s Fraud Section with assistance from Trial Attorney Niall M. O’Donnell. It 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, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,330 defendants who have collectively billed the Medicare program for more than $4 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with 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.