Twenty-Three Individuals Charged in $61.5 Million Medicare Fraud Schemes

Court documents were unsealed this week charging 23 Michigan residents for their alleged involvement in two illegal schemes to defraud Medicare of more than $61.5 million by paying kickbacks and bribes and billing Medicare for unnecessary medical services that were never provided.

“As alleged, the defendants and their co-conspirators repeatedly paid illegal bribes and kickbacks so they could submit claims for medically unnecessary home health services throughout the Detroit metropolitan area, exposing patients to needless physician services and drug testing and costing Medicare tens of millions of dollars,” said Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division. “As these actions demonstrate, we will work tirelessly to tackle complex, illegal schemes that take advantage of vulnerable populations and defraud federal programs of taxpayer dollars meant to provide health care to millions of Americans.”

United States v. Jamil, et al.

According to court documents, Walid Jamil, 62, and Jalal Jamil, 69, both of Oakland County, owned and operated several home health agencies in the Detroit metropolitan area. They allegedly concealed their ownership interest in these agencies using straw owners – including family members and other associates – and submitted approximately $50 million in fraudulent home health care claims to Medicare. Specifically, Walid and Jalal Jamil allegedly paid bribes to other co-conspirators to recruit patients in violation of the Federal Anti-Kickback Statute. These patients did not need home health care, did not qualify for home health care under Medicare rules, and in many instances were not actually provided the care for which Medicare was billed. Walid and Jalal Jamil allegedly entered into quid pro quo relationships with physician clinics to receive the necessary information to fraudulently bill Medicare. Based on their fraudulent claims, Walid and Jalal Jamil received more than $43 million from Medicare, which they misappropriated for their personal benefit.

“The alleged actions of these defendants is an astonishing abuse of our health care system,” said U.S. Attorney Dawn N. Ison for the Eastern District of Michigan. “By allegedly submitting fraudulent claims and paying illegal kickbacks, these defendants looted Medicare in order to line their own pockets at great cost to taxpayers. My office is grateful for the continued work of the Health Care Fraud Strike Force to root out corrupt medical professionals.”

Carol Ibrahim, 45, of Oakland County, and Delaine Jackson, 48, of Wayne County, were employed by one or more of the Jamil home health agencies and operated these agencies at the direction of Walid Jamil. They each allegedly made illegal payments to patient recruiters and submitted false claims to Medicare. Ibrahim was also allegedly a straw owner of one of the Jamil home health agencies.

Ibrahim Sammour, 62, of Wayne County, was a registered nurse employed by the Jamil home health agencies. Sammour is alleged to have fraudulently billed Medicare for home health services he never provided and falsely certified patients as “homebound.”

Mary Smelter-Bolton, 69, of Oakland County, and Cass Hawkins, 52, of Wayne County, were allegedly recruiters paid by various Jamil home health agencies to refer them Medicare beneficiaries for home health services that were then billed to Medicare, even though the claims were not eligible for reimbursement.

United States v. Malas, et al.

According to court documents, beginning in at least February 2015, Radwan Malas, 43, of Oakland County, operated Infinity Visiting Physician Services PLC (Infinity) as a home visiting physician company and allegedly ordered the physicians he employed to certify patients referred by Walid Jamil and Jalal Jamil for medically unnecessary home health services. He then allegedly billed Medicare for services that were never actually provided to these patients – including 60-minute complex patient visits – and for services that were not medically necessary – including B-12 and Toradol injections. Malas also allegedly demanded that physicians in his office order the highest-reimbursing urine drug test for patients, which was medically unnecessary, but for which Malas allegedly received a referral fee from the laboratory that processed the samples.

As part of this scheme, the defendants billed Medicare over $11.5 million in fraudulent claims for which they were paid nearly $4 million, which they misappropriated for their personal benefit. Malas is also alleged to have laundered the misappropriated funds by conducting illegal financial transactions.

“At the FBI, we swear an oath to protect the American people,” said Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division. “Fraudsters look to orchestrate their schemes at the cost of our health care systems, patients, and taxpayers. The FBI and our law enforcement partners remains dedicated to investigating and bringing to justice those who seek to exploit our U.S. healthcare system at the expense of its patients.”

Alejandro Mataverde, 79, of Oakland County, Cornelius Oprisiu, 82, of Livingston County, both physicians, and Shafiq Rehman, 59, of Wayne County, a licensed nurse practitioner, were employed by Infinity. They allegedly provided medically unnecessary services to Medicare beneficiaries or submitted claims to Medicare for medical services that were not provided to the patients.

“Those who attempt to defraud Medicare often do so at the risk of compromising the integrity of federal health care programs and disregarding the health and wellbeing of patients,” said Special Agent in Charge Mario Pinto of the Department of Health and Human Services Office of Inspector General (HHS-OIG). “HHS-OIG is proud to work alongside our law enforcement partners to protect federal health care programs and hold bad actors accountable for their actions.”

Michael Molloy, 50, of Wayne County, was co-owner of Integra Lab Management LLC (Integra), which processed the high-reimbursing and allegedly medically unnecessary urine tests submitted by Infinity. Molloy and his co-owners allegedly paid the salary of Infinity employees and made monthly payments to Malas in exchange for the physician orders for the medically unnecessary urine drug testing. As a result of the illegal kickbacks, Integra submitted approximately $2.8 million in fraudulent claims to Medicare and was paid more than $730,000.

Montaha Hogeige, 39, of Wayne County, was a medical assistant employed by Infinity who allegedly agreed to receive her salary from Integra as an illegal kickback to Infinity in exchange for physician orders for high-reimbursing urine drug testing.

“Medicare is designed to provide vital government funded services to our people. It is not a slush fund for thieves and fraudsters,” said Acting Special Agent in Charge Charles Miller of the IRS Criminal Investigation (IRS-CI) Detroit Field Office. “IRS-CI will work tirelessly with our law enforcement partners to investigate those who illegally target our Medicare program for personal financial gain.”

The charges alleged in the indictments against these defendants for their alleged participation in these schemes are described in the following table:

Ten other individuals were also charged by criminal information for their alleged participation in the fraud schemes.

The FBI Detroit Field Office, HHS-OIG, and IRS-CI are investigating the cases.

Trial Attorney Shankar Ramamurthy of the Criminal Division’s Fraud Section is prosecuting the cases.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, comprised of 15 strike forces operating in 25 federal districts, has charged more than 5,000 defendants who collectively have billed federal health care programs and private insurers more than $24 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at https://www.justice.gov/criminal-fraud/health-care-fraud-unit.

An indictment and an information are merely allegations. All defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

https://www.justice.gov/opa/pr/twenty-three-individuals-charged-615-million-medicare-fraud-schemes