Monthly Archives: January 2012

Five Plead Guilty in Michigan Medicare Scam

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Last week, Maira Suleman and three other individuals plead guilty to a single count of conspiracy to commit health care fraud, as the result of their part in an alleged Medicare Fraud Scheme related to two home medical companies. Another man, Gerald Funderburg, also plead guilty in an unrelated Medicare Fraud case.

Suleman, Curtis Mallory, Theodore Haile, and John Thomas are scheduled to be sentenced on April 19, 2012 and each face up to ten years in prison and up to a quarter of a million in fines.

According to the plea agreement, the defendants Mallory, Suleman, and Haile were complicit in Medicare Fraud at All American Home Care Inc. and Patient Choice Home Care Inc.

All American Home Care and Patient Choice Home Care were incorporated, according to Michigan’s business database, in 2005 and 2007 respectively. They are involved with home health care.

As part of the plea agreement, Mallory and Haile stated they paid kickback to Medicare recipients, as part of their jobs as patient recruiters for these companies. In turn, the Medicare recipients information was used to submit fraudulent claims to Medicare for physical therapy that was either not preformed or was not medically required.

John Thomas admitted to creating false physical therapy documentation as part of his job as a physical therapist for both companies. This documentation was used to bill Medicare.

Maira Suleman is listed in the Articles of Incorporation for Patient Choice Home Care Inc. and stated in court that she was the office manager at this company. Another man, Hassan Akhtar, has ties to both companies, according to public business records.

Suleman admitted to helping facilitate the Medicare fraud by coordinating the collection and documentation of fabricated therapy forms, as well as preforming the actual submission of claims to Medicare for payment.

In the separate case, Gerald Funderburg admitted responsibility for illegally using information from around 500 different Medicare recipients, without their knowledge, in order to submit claims for mental health services that were not preformed in most cases.

Funderburg is listed as the sole owner of Funderburg Clinical and Community Services Inc( FCCS,) which was incorporated in 2006.

According to his plea agreement, admitted to submitting close to 5,000 fraudulent claims that were related to over $3 million billed to Medicare.

Funderburg is scheduled to be sentenced on June 8, 2012 and also faces up to ten years in prison and a $250,000 fine.

Another Guilty Plea in Miami American Therapeutic Corporation Medicare Scam

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Sandra Jimenez, who is 38 years old and from Miami, plead guilty yesterday as part of the ongoing American Therapeutic Corporation, or ATC, Medicare Fraud Scheme. She plead guilty to a single count of conspiracy to commit health care fraud and, according to the Department of Justice, was responsible for around $45 million in fraudulent Medicare claims.

As part of Jimenez’s guilty plea, she admitted responsibility for providing kickbacks to assisted living facility owners who provided, typically, unqualified patients for American Therapeutic Corporation’s(ATC) and the American Sleep Institutes'(ASI) partial hospitalization programs, or PHPs.

Jimenez’s worked as a Marketer for these companies, which according to her court statements, entailed locating business owners and those who worked at half-way houses or assisted living facilities, who would be able to refer Medicare patients to her employers partial hospitalization programs. The owners received kickbacks for each day their referred patients stayed in the PHP, which Jimenez has admitted to arranging.

In addition to her work with ATC and ASI, Jimenez also, as part of her guilty plea, admitted to a separate Medicare fraud scheme she was involved with, related to Priority Home Health. In this scheme, Jimenez and others that worked with the Miami based home medical agency, actively recruited Medicare recipients to their company who were not eligible to receive services from the company.

Jimenez sentencing is scheduled for the end of June, June 27, 2012, where should could face up to fifteen years in prison and up to a quarter of a million in fines.

The American Therapeutic Corporation and American Sleep Institute Medicare fraud scam is one of the largest in the company and relied on a large network of doctors, recruiters, and even Medicare recipients, who provided mostly ineligible Medicare patients to receive mental health services. These services would not qualify as partial hospitalization programs and were responsible for more than $200 million in Medicare fraud.

Many defendants have already been tried and convicted in Federal court for their part in this scam, with other trials set for the following months.

The defendants include a wide range of individuals, including those from the parent company, Medlink Professional Management Group Inc.

Owner of Medical Equipment Company Sentenced to 5 Years in Prison for Medicare Fraud

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Nnanta Felix Ngari, who is the owner of a medical equipment supply company in Louisiana, was sentenced to five years in prison for his part in a Medicare Fraud Scam yesterday, which was responsible for almost $5 million in Medicare fraud.

Ernest Payne, a patient recruiter for Ngari, was also sentenced to prison, receiving a slightly lower sentence of fifty-five months. Both men will also serve two years of probation and have been fined $2.5 million, although the fine will be split among others involved in the Medicare fraud.

Another man, a doctor named Sofjan Lamid who was paid kickbacks from Ngari, received three years probation, for his part in writing unnecessary prescriptions for medical equipment.

Ngari, and several of his co-defendents were convicted on August 16, 2011 and sentenced on January 12, 2012.

Ngari, is the owner of Unique Medical Solutions, LLC, which provided durable medical equipment for those on Medicare. Durable Medical Equipment includes things like wheelchairs, hospital beds, walkers, and other types of physical medical equipment that is typically covered by Medicare. For most types of home medical equipment, a doctor’s prescription is required to receive coverage and for some items, a more advanced certificate of medical necessity is needed.

Unique Medical Solutions focused on providing electric power wheelchairs to Medicare recipients, however, according to court documents, Ngari began to use his co-defendants, such as Payne, to get prescriptions for power chairs that were not required for medical reasons.

To help find Medicare recipients, Ngari began to hold regular health conferences at local churches and other public areas around Baton Rouge. Visitors to the health conferences that were on Medicare would often receive prescriptions for power chairs, written by doctors like Sofjan Lamid, who received kickbacks for their part in the scam.

According to the prosecuting attorney, this fraud scheme took place from between 2003 and 2009, resulting in over $4.5 million in fraudulent Medicare claims. Unique Medical Solutions received around half of this in payment from Medicare.

Broward County Florida Man Pleads Guilty in ATC Medicare Fraud Case

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Today, Barry Nash, who is the sixty-nine year old owner of a Halfway house in Broward County Florida, plead guilty to a single count of conspiracy to commit health care fraud for his part in a Medicare Fraud Kickback Scheme.

Nash’s guilty plea is related to the growing stack of guilty sentences associated with the American Therapeutic Corporation Medicare Fraud scam in Florida.

Nash is scheduled to be sentenced on March 8th, 2012, and faces up to ten years in prison, as well as a fine of up to a quarter of a million dollars.

Nash admitted to receiving kickbacks for funneling patients into a fraudulent mental health shell company operated by American Therapeutic Corporation(ATC) and American Sleep Institute(ASI,) who was related to American Therapeutic Corporation. According to the plea agreement, Nash was responsible for almost a million dollars in Medicare Fraud that was the direct result of patients from his halfway house being sent for treatment at ATC and ASI.

Nash is the most recent in a string of more than 9 individuals convicted of fraud related to ATC. The ATC and ASI fraud involved a large number of doctors, marketers, and even patients in Florida. These individuals received kickbacks for providing Medicare patients to American Therapeutic Corporation, which is related to Medlink Professional Management Group Inc.

Patients were supposed to receive mental health care and treatment, which included a partial hospitalization program(PHP,) but were typically ineligible or did not receive qualifying treatment. In all, the ATC and ASI fraud is believed to have been responsible for over $200 Million dollars in Medicare Fraud.

This prosecution is related to the Medicare Fraud Strike Force, which was formed five years ago to help fight Medicare Fraud. To date, the Health Care Fraud Prevention and Enforcement Action Team, also known as HEAT, and the Medicare Fraud Strike Force has helped prosecute over 1000 defendants, who are allegedly responsible for close to $3 Billion in Medicare Fraud.

AseraCare Hospice Accused of Enrolling Non-Terminal Patients into Hospice Care

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In a legal complaint published this week, the U.S. Department of Justice accused AseraCare, a national for-profit Hospice group, of making fraudulent Medicare Claims.

The Department of Justice contends that AseraCare defrauded the government of millions of dollars that was intended for patients who were terminally ill. Hospice care is covered by Medicare and is a type of Palliative, which is intended to address pain, stress, and other symptoms of those who are facing a terminal disease. Under Medicare, someone who has less than six months to live is eligible for this type of Medicare coverage, but it will prevent them from receiving other more standard treatments for their condition. This means that those receiving reimbursement for hospice care would not be eligible to also receive medications or treatments that are aimed at preventing death or other complications of their condition.

According to the complaint, AseraCare has, since 2007 at the earliest, claimed patients as terminally ill in order to receive payments from Medicare. These allegations were brought about by former employees of AseraCare, who created a whistle-blower lawsuit alleging that Medicare Fraud is prevalent nationwide. The original lawsuit was filed against Golden Gate National Senior Care LLC, who is related to Golden Living. AseraCare Hospice is owned by Golden Gate.

The Vice President of Golden Living, Blair Jackson, has denied these accusations, stating that they feel they have not violated any laws or regulations.