CHICAGO—Two area physicians and three health clinic
co-owners are among seven defendants charged here with engaging in five
separate, unrelated health care fraud schemes to defraud the Medicare
program and/or private health insurers of millions of dollars, federal
law enforcement officials announced today.
Four of the five cases here are part of a nationwide takedown
by Medicare Fraud Strike Force operations in eight cities, announced
today by the Departments of Justice and Health and Human Services,
resulting in charges against 89 defendants, including doctors, nurses,
and other licensed medical professionals, for their alleged
participation in Medicare fraud schemes collectively involving
approximately $233 million in false billing.
In Chicago, the defendants were charged in two criminal complaints
and two informations filed today and yesterday, and an indictment that
was unsealed today following the arrest of one defendant in Miami. All
seven defendants were charged with health care fraud for allegedly
defrauding the Medicare program, or violating the anti-kickback statute,
which makes it illegal to offer, pay, solicit, or receive payments in
exchange for referrals of Medicare patients. The charges involve various
medical treatments and services, as well as durable medical equipment.
“Today’s announcement marks the latest step forward in our
comprehensive efforts to combat fraud and abuse in our health-care
systems,” said Attorney General Eric Holder. “These significant actions
build on the remarkable progress that the HEAT has enabled us to
make—alongside key federal, state, and local partners—in identifying and
shutting down fraud schemes. They are helping to deter would-be
criminals from engaging in fraudulent activities in the first place. And
they underscore our ongoing commitment to protecting the American
people from all forms of health-care fraud, safeguarding taxpayer
resources, and ensuring the integrity of essential health care
programs,” he added.
“Today’s charges are part of our continuing efforts not only to
deprive dishonest healthcare providers of their illegal profits but to
demonstrate to the broader medical services community that health care
fraud will be found out and prosecuted with all of our resources. In
short, we will not tolerate medical professionals and providers who
abuse our healthcare system,” said Gary S. Shapiro, United States
Attorney for the Northern District of Illinois.
Details of the Chicago cases follow:
United States v. Ankur Roy, Akash Patel, and Dipen Desai
Ankur Roy, Akash Patel, and Dipen Desai, who owned and operated
Selectcare Health Inc., which provided outpatient physical and
respiratory therapy in Park Ridge and Skokie, were charged with
submitting more than $4 million in false billings to Medicare between
March and July 2011. Each defendant was charged with six counts of
health care fraud in an indictment that was returned by a federal grand
jury last Wednesday and unsealed today.
Roy, 36, of Miami was arrested today in south Florida, while Patel,
33, of Morton Grove, and Desai, 33, of Chicago, will be ordered to
appear for arraignment on a later date in U.S. District Court in
Chicago.
According to the indictment, the defendants submitted false claims to
Medicare and Blue Cross Blue Shield on behalf of Selectcare patients
for respiratory therapy services that were never provided. The alleged
false billings sought reimbursement for services purportedly provided on
days that Selectcare’s sole respiratory therapist was not working; for
time periods in which the patients were not receiving care from
Selectcare; and for treatment seven days a week for three hours per day,
a schedule well in excess of any schedule prescribed for patients at
Selectcare.
Roy, Patel, and Desai used a third-party billing service to forward
the alleged false claims to Medicare, as well as to private insurers
such as Blue Cross if the patient had supplemental private insurance,
including insurance funded by labor union health and welfare plans.
Between March and July 2011, the defendants allegedly submitted
$4,009,094 in false billings for services that were purportedly provided
between April 2010 and April 2011, resulting in payments totaling
approximately $2,214,424 from Medicare and $320,881 from Blue Cross Blue
Shield. The indictment seeks forfeiture of $2,535,305 in alleged fraud
proceeds, including $446,974 in funds withdrawn by cashiers’ checks that
were seized by the FBI in July 2012.
The government is represented by Assistant U.S. Attorney Maureen
Merin. The case was investigated by the FBI, the U.S. Department of
Health and Human Services Office of Inspector General (HHS-OIG), and the
U.S. Department of Labor Office of Inspector General (DOL-OIG).
United States v. Cecilia Ibrahim
Dr. Cecilia Ibrahim, an internal medicine physician who operated
Sunrise Medical Center in Flossmoor, was charged with one count of
health care fraud for allegedly engaging in a $1.7 million Medicare and
private insurance false billing scheme.
Ibrahim, 50, of Frankfort, was charged in an information filed today
in U.S. District Court. She will be arraigned on a date to be
determined.
Between March 2006 and August 2009, Ibrahim allegedly submitted more
than 3,200 false claims to Medicare and Blue Cross Blue Shield using a
billing code for spinal decompression neuroplasty, a surgical procedure
that she did not perform, when she only performed intervertebral
differential dynamics therapy (IDD), a non-surgical procedure. As a
result, she allegedly caused a loss of at least $300,000 to Medicare and
$550,000 to Blue Cross Blue Shield. The indictment seeks forfeiture of
at least $882,500 in alleged fraud proceeds.
The government is represented by Assistant U.S. Attorney Samuel B.
Cole. The case was investigated by the FBI, HHS-OIG, and the Railroad
Retirement Board Office of Inspector General.
United States v. Ellyse Lamon
Elysse Lamon, an account executive at a company that sold durable
medical equipment, including back braces and transcutaneous electrical
nerve stimulation units, also known as tens units, was charged with one
count of health care fraud for allegedly engaging in a $350,000 Medicare
false billing scheme.
Lamon, 30, of Elmhurst, was charged in an information filed today in
U.S. District Court. She will be arraigned on a date to be determined.
Between October 2010 and May 2011, Lamon allegedly caused her company
to submit false claims to Medicare representing that a physician had
prescribed back braces and tens units when she knew that no physician
had done so and the items were not medically necessary. In order to
provide written support for the false claims, Lamon allegedly obtained
patient records without a physician’s permission and added false
information reflecting that a physician had ordered the equipment for
the patients. She allegedly forged doctors’ signatures on documents,
including false treatment records she created. Lamon further used
patient information she had inappropriately accessed at a pain medicine
center in Chicago to set up patient meetings where she falsely told
patients that doctors had prescribed the equipment for them, according
to the charges.
Lamon allegedly submitted false claims to Medicare totaling $352,685,
resulting in payment of at least $206,233 to her medical equipment
company. She allegedly profited from these false claims by receiving
increased commissions and other benefits from her company.
The government is represented by Assistant U.S. Attorney Kruti
Trivedi. The case was investigated by the FBI and is not part of the
Medicare Fraud Strike Force operation.
United States v. Nalini Ahluwalia
Dr. Nalini Ahluwalia was charged with one count of violating the
anti-kickback law for allegedly receiving $1,000 in exchange for
referring two patients to a home health care agency in August 2012.
Ahluwalia, 58, of Burr Ridge, was charged in a complaint filed today
in U.S. District Court. She will be ordered to appear on a date to be
determined.
According to the complaint, a confidential informant who worked at a
home health care company in Chicago, told agents that the confidential
informant had previously paid kickbacks to Ahluwalia of $400 to $500 per
patient in exchange for her referral of Medicare patients to the home
health care company.
On August 23, 2012, at the direction of agents, the confidential
informant met with Ahluwalia at the doctor’s office in Chicago and paid
her $1,000 for the two Medicare patient referrals in an exchange that
was reflected on an audio/video recording, according to the complaint
affidavit. In October 2012 and February 2013, the informant allegedly
made two additional $500 payments to Ahluwalia in exchange for Medicare
patient referrals.
The government is represented by Assistant U.S. Attorney Samuel B. Cole. The case was investigated by the FBI and the HHS-OIG.
United States v. Joseph Dickson
Joseph Dickson, the president and owner of JD Medical Consultants
Inc., a medical marketing company, was charged with one count of
violating the anti-kickback law for allegedly receiving $4,200 in
exchange for referring patients to a home health care agency in October
2012.
Dickson, 65, of Lansing, was charged in a complaint filed yesterday
in U.S. District Court. He will be ordered to appear on a date to be
determined.
According to the complaint, a confidential informant who owned a home
health care company in the Chicago area, told agents that the
confidential informant had previously paid kickbacks to Dickson, among
others, for referring Medicare patients to another home health care
company where s/he previously worked. Dickson was described as a “middle
man” who arranged the referral of patients from a physician to a home
health care company, and the confidential informant told agents that the
confidential informant had paid Dickson approximately $15,000 for
referring about 30 patients between 2006 and 2008.
On October 3, 2012, at the direction of agents, the confidential
informant met with Dickson at his office in Chicago and paid him $4,200
for seven Medicare patient referrals, at $600 each, in an exchange that
was reflected on an audio/video recording, according to the complaint
affidavit. In December 2012, the informant allegedly made an additional
$1,800 payment to Dickson in exchange for Medicare patient referrals and
re-certifications.
The government is represented by Assistant U.S. Attorney Joseph H.
Thompson. The case was investigated by the FBI and the HHS-OIG.
The charges in these cases carry the following maximum penalties on
each count: health care fraud—10 years in prison and a $250,000 fine, or
an alternate fine totaling twice the loss or twice the gain, whichever
is greater; and violating the anti-kickback statute—five years in prison
and a $250,000 fine. If convicted, the court must impose a reasonable
sentence under federal statutes and the advisory United States
Sentencing Guidelines.
The Medicare Fraud Strike Force began operating in Chicago in
February 2011 and consists of agents from the FBI and HHS-OIG working
together with prosecutors from the U.S. Attorney’s Office and the
Justice Department’s Fraud Section. The strike force is are part of the
Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint
initiative announced in May 2009 between the Department of Justice and
HHS to focus their efforts to prevent and deter fraud and enforce
current anti-fraud laws around the country.
Since their inception in March 2007, strike force operations in nine
locations have charged more than 1,500 defendants who collectively have
falsely billed the Medicare program for more than $5 billion. In
addition, the HHS Centers for Medicare and Medicaid Services, working in
conjunction with the HHS-OIG, are taking steps to increase
accountability and decrease the presence of fraudulent providers.
The nationwide takedown was announced today by Attorney General
Holder, HHS Secretary Kathleen Sebelius and other federal law
enforcement officials. Mr. Shapiro announced the Chicago charges with
Cory B. Nelson, Special Agent in Charge of the Chicago Office of the
Federal Bureau of Investigation; Lamont Pugh, III, Special Agent in
Charge of the Chicago Regional Office of the HHS-OIG; and James
Vanderberg, Special Agent in Charge of the Labor Department Office of
Inspector General in Chicago. The Railroad Retirement Board Office of
Inspector General assisted in the Ibrahim investigation.
The public is reminded that indictments, informations, and complaints
contain only charges and are not evidence of guilt. The defendants are
presumed innocent and are entitled to a fair trial at which the
government has the burden of proving guilt beyond a reasonable doubt.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.