Corpus Christi Doctor Convicted in Connection with Fraudulent Health Care Billing Scheme

CORPUS CHRISTI, TX—Dr. Roque Joel Ramirez, 49, of Robstown, has entered a plea of guilty to mail fraud in connection with his scheme to defraud Medicare and Medicaid through fraudulent billings, announced United States Attorney Kenneth Magidson and Texas Attorney General Greg Abbott.
Ramirez, a licensed physician in Texas since 1997 and owner of Health Resolutions Inc., was indicted by a federal grand jury on October 9, 2013, in a scheme to defraud Medicare and Medicaid through fraudulent billings. He was set for trial this morning but opted to enter a guilty plea to one count of mail fraud for using the United States Postal Service (USPS) for the purpose executing his scheme. His medical office in Corpus Christi is now closed.
Ramirez admitted he knowingly and willfully engaged in a scheme to defraud Medicare and Texas Medicaid and submitted false and fraudulent billings for medical services he did not provide. He also admitted he committed mail fraud by using USPS to receive payment on the fraudulent bills.
Court documents indicated that Ramirez knowingly and willfully engaged in the scheme from May 2008 through December 2011 by submitting fraudulent billings for physician services he did not provide. Thousands of false and fraudulent bills were submitted, according to the charges. Ramirez billed for medical services he claimed he personally provided to patients who had actually died prior to the dates of his claimed services. He also submitted bills claiming he personally provided services to patients at his clinic when he was actually overseas or in another state. Some of the bills also indicated he would have personally worked more than 24 hours in a single day. Court documents also alleged that when he provided medical services to Medicare and Medicaid patients in nursing homes, he would send fraudulent bills claiming he had seen the patients in private residences in order to collect the higher fees paid for house calls.
Senior U.S. District Judge Hayden Head, who accepted the guilty plea, has set sentencing for May 15, 2014, at which time Ramirez faces up to 20 years in federal prison and a $250,000 maximum fine. He was permitted to remain on bond pending that hearing.
The investigation was conducted by the FBI, U.S. Department of Health and Human Services-Office of Inspector General, and the Texas Attorney General’s Medicaid Fraud Control Unit. Assistant United States Attorney (AUSA) Robert D. Thorpe, Jr. and Special AUSA Rex G. Beasley are prosecuting.

Patient Recruiter Pleads Guilty in Connection with $13 Million Health Care Fraud Scheme

Pavel Zborovskiy, 57, of Brooklyn, New York, pleaded guilty today to conspiracy to pay and receive illegal health care kickbacks in connection with a $13 million health care fraud and money laundering scheme.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Loretta E. Lynch of the Eastern District of New York, Assistant Director in Charge George Venizelos of the FBI’s New York Field Office, and Special Agent in Charge Thomas O’Donnell of the U.S. Department of Health and Human Services’ Office of Inspector General (HHS-OIG) made the announcement.
Zborovskiy pleaded guilty before U.S. District Judge Nina Gershon of the Eastern District of New York and is the sixth defendant to plead guilty in connection with the scheme. At sentencing on May 28, 2014, Zborovskiy faces a maximum penalty of five years in prison and a fine of more than $2.5 million.
According to court documents, from 2010 to 2012, Zborovskiy, working through an ambulette company, recruited patients to attend a Brooklyn clinic called Cropsey Medical Care PLLC. An ambulette is a vehicle that is licensed by New York State’s Medicaid program to transport beneficiaries to and from medical facilities when such transportation is medically necessary. Zborovskiy’s ambulette company transported the patients he had recruited to and from Cropsey Medical and billed Medicaid for such transportation. Once Zborovskiy’s beneficiaries were transported to Cropsey Medical, Zborovskiy and others paid such beneficiaries cash kickbacks to induce them to continue to attend the clinic and to receive medically unnecessary physical therapy, diagnostic testing, and other services. Such purported medical services were then billed by Cropsey Medical to Medicare and Medicaid.
According to court documents, from approximately November 2009 to October 2012, Cropsey Medical submitted more than $13 million in claims to Medicare and Medicaid, seeking reimbursement for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy, and diagnostic tests.
The case was investigated by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and U.S. Attorney’s Office for the Eastern District of New York. The case is being prosecuted by Trial Attorney Sarah M. Hall of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Shannon Jones of the Eastern District of New York.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are 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 www.stopmedicarefraud.gov.