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Medical Billing Fraud

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Page 49 of 52

January 9, 2015

Felix Gonzalez, owner of Miami-based home health care company AA Advanced Care Inc. pleaded guilty in connection with a $32 million Medicare fraud scheme. Specifically, Gonzalez admitted he and his co-conspirators operated AA Advanced for the purpose of billing Medicare for, among other things, expensive physical therapy and home health care services not medically necessary or not provided at all. He also admitted he paid kickbacks and bribes to patient recruiters in exchange for patient referrals, prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services. DOJ

December 17, 2014

Mark Morad and Dr. Divini Luccioni, both of Louisiana, pleaded guilty to their role in a $56M Medicare fraud scheme. According to court documents, Morad directed the scheme through multiple New Orleans-area companies he owned, including Interlink Health Care Services Inc.,Memorial Home Health Inc., Lakeland Health Care Services Inc., Lexmark Health Care LLC, and Med Rite Pharmacy Inc. Morad paid kickbacks to recruiters who canvassed New Orleans neighborhoods for Medicare beneficiary numbers, which Morad then used to bill Medicare for services that were not medically necessary or not provided. Dr. Luccioni admitted that he signed home health referrals and wrote DME prescriptions that were used to support these fraudulent billings. DOJ

October 22, 2014

Tayyab Aziz, founder of three Detroit-area home health agencies Prestige Home Health Services Inc., Royal Home Health Care Inc., and Platinum Home Health Services Inc. pleaded guilty for his role in a $22M home health care fraud scheme. Specifically, Aziz admitted he and his co-conspirators submitted fraudulent claims to Medicare for services that were medically unnecessary or never performed. They also submitted claims for services purportedly provided to Medicare beneficiaries who were recruited through illegal kickbacks paid to the patients and recruiters. DOJ

July 23, 2014

Elsa Ruiz, the owner and administrator of the Miami-based home health care agencies Professional Home Care Solutions and LTC Professional Consultants, pleaded guilty for her participation in a $74M Medicare fraud scheme. According to court documents, Ruiz and her co-conspirators operated the two companies for the purpose of billing Medicare for expensive physical therapy and home health care services that were either never provided or not medically necessary. DOJ

June 23, 2014

Cruz Sonia Collado, the owner and operator of Nestor’s Health Services, a now-defunct Miami home health care agency, pleaded guilty to a $6.5M million health care fraud scheme. According to the government, Collado and her co-conspirators operated Nestor for the purpose of billing Medicare for expensive physical therapy and home health care services that were not medically necessary or never provided. As part of the scheme, Collado allegedly also paid kickbacks and bribes to patient recruiters, in return for those recruiters providing patients to Nestor for these unnecessary or phantom home health care and therapy services. DOJ

June 13, 2014

Gwendolyn Climmons-Johnson, the owner and operator of Urgent Response EMS, a Houston area ambulance company, was sentenced to 97 months in prison and to pay roughly $1M for her role in a $2.4M Medicare fraud scheme. In October she had been convicted by a federal jury in Houston of four counts of health care fraud. According to evidence presented at trial, from January 2010 through December 2011, Climmons-Johnson and others conspired to enrich themselves by submitting false and fraudulent claims to Medicare for ambulance services that were medically unnecessary and/or not provided. DOJ

May 22, 2014

An owner and operator of community mental health centers in Baton Rouge as well as a patient recruiter for a related facility in Houston were convicted for their roles in a $258M Medicare fraud scheme involving three facilities that filed fraudulent claims for psychiatric services that were unnecessary or never actually provided. The ongoing investigation into these three community mental health centers — Shifa Community Mental Health Center, Serenity Center and Shifa Community Mental Health Center — has so far resulted in the convictions of 17 employees of these facilities, including therapists, marketers, administrators, owners and the medical director. DOJ

May 22, 2014

Zahir Yousafzai, the co-owner or operator of four Detroit-area home health agencies involved in a $13.8M Medicare fraud scheme was sentenced to serve 72 months in prison and pay $4.1M in restitution. According to court records, Yousafzai and his co-conspirators paid and directed the payment of various medical professionals, including doctors, nurses, physical therapists and physical therapist assistants, to create fictitious patient files to document purported home health services that were never provided. The healthcare companies involved included First Care Home Health Care, Moonlite Home Care, Physicians Choice Home Health Care and Quantum Home Care. DOJ

May 14, 2014

Richard Shannon, a patient recruiter for All American and Patient Choice, two home health care companies that provide skilled nursing and physical therapy services to Medicare beneficiaries in the greater Detroit area, was sentenced to 86 months in prison for his role in a $14.5M Medicare fraud scheme. The evidence showed that Shannon paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary. Shannon recruited destitute beneficiaries from housing projects and soup kitchens in the Detroit area, obtaining their patient information in exchange for cash and promises of prescription narcotics prescribed by co-conspirator physicians. DOJ

February 25, 2014

Diagnostic Imaging Group agreed to pay $15.5M to resolve allegations that its diagnostic testing facility falsely billed federal and state health care programs for tests that were not performed or not medically necessary and by paying kickbacks to physicians. The allegations were first raised in three qui tam lawsuits filed under the whistleblower provisions of the False Claims Act. DOJ
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