23 Michigan residents charged in $61.5 million Medicare fraud schemes
(CBS DETROIT) - Twenty-three Michigan residents were charged in connection with two fraud schemes involving Medicare, totaling more than $61.5 million.
On Tuesday, the Justice Department unveiled charges for 13 of the 23 people, which included healthcare fraud, conspiracy to commit healthcare fraud, conspiracy to defraud the U.S. through payment and receipt of illegal healthcare kickbacks, money laundering, receipt of illegal healthcare kickbacks, and payment of illegal healthcare kickbacks.
Federal court documents show Walid Jamil, 62, and Jalal Jamil, 69, of Oakland County, owned and operated multiple home health agencies in Metro Detroit, submitting about $50 million in fake home healthcare claims.
They allegedly bribed other co-conspirators to recruit patients who did not need home healthcare or qualified for it. They also entered quid pro quo relationships with physician clinics to obtain information to fraudulently bill Medicare, receiving $43 million.
"The alleged actions of these defendants is an astonishing abuse of our health care system," U.S. Attorney Dawn N. Ison said in a press release. "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."
Federal officials say the Jamils employed Oakland County resident Carol Ibrahim, 45, and Wayne County resident Delanie Jackson, 48, who allegedly made illegal payments to patient recruiters and submitted fake claims to Medicare. Ibrahim was also a straw owner at the agencies.
Another employee, Wayne County resident Ibrahim Sammour, 62, was working as a registered nurse and allegedly billed Medicare for home healthcare 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 the Jamils to refer them Medicare beneficiaries for home healthcare services that were billed.
In another scheme, court documents show Radwan Malas, 43, of Oakland County, operated Infinity Visiting Physician Services PLC and allegedly ordered his physicians to certify patients referred by the Jamils. Malas billed Medicare more than $11.5 million for services that were not provided, including 60-minute patient visits, and services not medically necessary, such as B-12 and Toradol injections.
The DOJ says those unnecessary services at Infinity were provided by physicians Alejandro Mataverde, 79, Cornelius Oprisiu, 82, and nurse practitioner Shafiq Rehman, 59.
Officials say Malas also demanded physicians to order the highest-reimbursing urine drug test for patients.
Michael Molloy, 50, of Integra Lab Management LLC, which provided the urine tests, allegedly paid the salary of Infinity employees and made monthly payments to Malas in exchange for orders for urine drug testing. Molloy and his co-owners submitted about $2.8 million in claims to Medicare, receiving more than $730,000.
One of the people who agreed to have their salary paid by Molloy as a kickback was medical assistant Montaha Hgeige, 39, of Wayne County.
Ten other people, whose identities were not initially released, were also charged for their involvement in the scheme.