{"id":52137,"date":"2023-02-08T15:08:07","date_gmt":"2023-02-08T23:08:07","guid":{"rendered":"https:\/\/cjnotebook.com\/?p=52137"},"modified":"2023-02-08T15:16:43","modified_gmt":"2023-02-08T23:16:43","slug":"23-michigan-residents-charged-in-alleged-61-5-million-medicare-fraud-scheme","status":"publish","type":"post","link":"https:\/\/cjnotebook.com\/?p=52137","title":{"rendered":"23 Michigan Residents Charged in Alleged $61.5 Million Medicare Fraud Scheme"},"content":{"rendered":"

\"\"Court documents were unsealed this week charging 23 Michigan residents for their alleged involvement in two illegal schemes to defraud Medicare of more than $61.5 million, officials stated.<\/span><\/p>\n

The defendants paid kickbacks and bribes and billed Medicare for unnecessary medical services that were never provided, according to authorities.<\/span><\/p>\n

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\u201cAs alleged, the defendants and their co-conspirators repeatedly paid illegal bribes and kickbacks so they could submit claims for medically unnecessary home health services throughout the Detroit metropolitan area, exposing patients to needless physician services and drug testing and costing Medicare tens of millions of dollars,\u201d said Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department\u2019s Criminal Division.\u00a0<\/span><\/p>\n

United States v. Jamil, et al.<\/u><\/em><\/span><\/strong><\/p>\n

\"\"According to court documents, Walid Jamil, 62, and Jalal Jamil, 69, both of Oakland County, owned and operated several home health agencies in the Detroit metropolitan area. <\/span><\/p>\n

They allegedly concealed their ownership interest in these agencies using straw owners \u2013 including family members and associates \u2013 and submitted approximately $50 million in fraudulent home healthcare claims to Medicare. <\/span><\/p>\n

Specifically, Walid and Jalal Jamil allegedly paid bribes to other co-conspirators to recruit patients violating the Federal Anti-Kickback Statute.<\/span><\/p>\n

\"\"These patients did not need home health care, did not qualify for home health care under Medicare rules, and in many instances, were not provided the care for which Medicare was billed. <\/span><\/p>\n

Walid and Jalal Jamil allegedly entered into\u00a0quid pro quo<\/em>\u00a0relationships with physician clinics to receive the necessary information to fraudulently bill Medicare. <\/span><\/p>\n

Based on their fraudulent claims, Walid and Jalal Jamil received more than $43 million from Medicare, which they misappropriated for their benefit.<\/span><\/p>\n

\"\"\u201cThe alleged actions of these defendants is an astonishing abuse of our health care system,\u201d said U.S. Attorney Dawn N. Ison for the Eastern District of Michigan. \u201cBy allegedly submitting fraudulent claims and paying illegal kickbacks, these defendants looted Medicare 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.\u201d<\/span><\/p>\n

Carol Ibrahim, 45, of Oakland County, and Delaine Jackson, 48, of Wayne County, were employed by one or more of the Jamil home health agencies and operated these agencies at the direction of Walid Jamil. <\/span><\/p>\n

They each allegedly made illegal payments to patient recruiters and submitted false claims to Medicare.<\/span><\/p>\n

Ibrahim was allegedly a straw owner of one of the Jamil home health agencies.<\/span><\/p>\n

\"\"Ibrahim Sammour, 62, of Wayne County, was a registered nurse employed by the Jamil home health agencies. <\/span><\/p>\n

Sammour is alleged to have fraudulently billed Medicare for home health services he never provided and falsely certified patients as \u201chomebound.\u201d<\/span><\/p>\n

Mary Smelter-Bolton, 69, of Oakland County, and Cass Hawkins, 52, of Wayne County, were allegedly recruiters paid by various Jamil home health agencies to refer them Medicare beneficiaries for home health services that were then billed to Medicare, even though the claims were not eligible for reimbursement.<\/span><\/p>\n

United States v. Malas, et al.<\/u><\/em><\/span><\/strong><\/p>\n

\"brownAccording to court documents, beginning in at least February 2015, Radwan Malas, 43, of Oakland County, operated Infinity Visiting Physician Services PLC (Infinity) as a home visiting physician company and allegedly ordered the physicians he employed to certify patients referred by Walid Jamil and Jalal Jamil for medically unnecessary home health services. <\/span><\/p>\n

He then allegedly billed Medicare for services that were never actually provided to these patients \u2013 including 60-minute complex patient visits \u2013 and for services that were not medically necessary \u2013 including B-12 and Toradol injections. <\/span><\/p>\n

Malas also allegedly demanded that physicians in his office order the highest-reimbursing urine drug test for patients, which was medically unnecessary, but for which Malas allegedly received a referral fee from the laboratory that processed the samples.<\/span><\/p>\n

As part of this scheme, the defendants billed Medicare over $11.5 million in fraudulent claims for which they were paid nearly $4 million, which they misappropriated for their benefit. <\/span><\/p>\n

Malas is also alleged to have laundered the misappropriated funds by conducting illegal financial transactions.<\/span><\/p>\n

Alejandro Mataverde, 79, of Oakland County, Cornelius Oprisiu, 82, of Livingston County, both physicians; and Shafiq Rehman, 59, of Wayne County, a licensed nurse practitioner, were employed by Infinity. <\/span><\/p>\n

They allegedly provided medically unnecessary services to Medicare beneficiaries or submitted claims to Medicare for medical services not provided to the patients.<\/span><\/p>\n

Michael Molloy, 50, of Wayne County, was co-owner of Integra Lab Management LLC (Integra), which processed the high-reimbursing and allegedly medically unnecessary urine tests submitted by Infinity. <\/span><\/p>\n

Molloy and his co-owners allegedly paid the salary of Infinity employees and made monthly payments to Malas in exchange for the physician orders for the medically unnecessary urine drug testing. <\/span><\/p>\n

As a result of the illegal kickbacks, Integra submitted approximately $2.8 million in fraudulent claims to Medicare and was paid more than $730,000.<\/span><\/p>\n

Montaha Hogeige, 39, of Wayne County, was a medical assistant employed by Infinity who allegedly agreed to receive her salary from Integra as an illegal kickback to Infinity in exchange for physician orders for high-reimbursing urine drug testing.<\/span><\/p>\n

The charges alleged in the indictments against these defendants for their alleged participation in these schemes are described in the following table:<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
Defendant<\/strong><\/span><\/td>\nCharges (and maximum term of imprisonment)<\/strong><\/span><\/td>\n<\/tr>\n
Walid Jamil<\/span><\/td>\nConspiracy to commit health care fraud (10 years)<\/span><\/p>\n

Specific instances of health care fraud (10 years each)<\/span><\/p>\n

Conspiracy to defraud the United States through the payment and receipt of illegal health care kickbacks (5 years)<\/span><\/p>\n

Payment of illegal healthcare kickbacks (10 years)<\/span><\/td>\n<\/tr>\n

Jalal Jamil<\/span><\/td>\nConspiracy to commit health care fraud (10 years)<\/span><\/p>\n

Specific instances of health care fraud (10 years each)<\/span><\/td>\n<\/tr>\n

Carol Ibrahim<\/span><\/td>\nConspiracy to commit health care fraud (10 years)<\/span><\/p>\n

Health care fraud (10 years)<\/span><\/p>\n

Conspiracy to defraud the United States through the payment of illegal health care kickbacks (5 years)<\/span><\/p>\n

Payment of illegal health care kickbacks (10 years)<\/span><\/td>\n<\/tr>\n

Delaine Jackson<\/span><\/td>\nConspiracy to commit health care fraud (10 years)<\/span><\/p>\n

Health care fraud (10 years)<\/span><\/p>\n

Conspiracy to defraud the United States through the payment of illegal health care kickbacks (5 years)<\/span><\/p>\n

Payment of illegal health care kickbacks (10 years)<\/span><\/td>\n<\/tr>\n

Ibrahim Sammour<\/span><\/td>\nConspiracy to commit health care fraud (10 years)<\/span><\/td>\n<\/tr>\n
Mary Smelter-Bolton<\/span><\/td>\nConspiracy to defraud the United States through the receipt of illegal health care kickbacks (5 years)<\/span><\/p>\n

Receipt of illegal health care kickbacks (10 years)<\/span><\/td>\n<\/tr>\n

Cass Hawkins<\/span><\/td>\nConspiracy to defraud the United States through the receipt of illegal health care kickbacks (5 years)<\/span><\/p>\n

Receipt of illegal health care kickbacks (10 years)<\/span><\/td>\n<\/tr>\n

Radwan Malas<\/span><\/td>\nConspiracy to commit health care fraud (10 years)<\/span><\/p>\n

Health care fraud (10 years)<\/span><\/p>\n

Conspiracy to defraud the United States through the payment and receipt of illegal health care kickbacks (5 years)<\/span><\/p>\n

Receipt of illegal health care kickbacks (10 years)<\/span><\/p>\n

Money laundering (10 years)<\/span><\/td>\n<\/tr>\n

Alejandro Mataverde<\/span><\/td>\nConspiracy to commit health care fraud (10 years)<\/span><\/p>\n

Health care fraud (10 years)<\/span><\/td>\n<\/tr>\n

Cornelius Oprisiu<\/span><\/td>\nConspiracy to commit health care fraud (10 years)<\/span><\/p>\n

Health care fraud (10 years)<\/span><\/td>\n<\/tr>\n

Shafiq Rehman<\/span><\/td>\nConspiracy to commit health care fraud (10 years)<\/span><\/p>\n

Health care fraud (10 years)<\/span><\/td>\n<\/tr>\n

Michael Molloy<\/span><\/td>\nConspiracy to commit health care fraud (10 years)<\/span><\/p>\n

Conspiracy to defraud the United States through payment of illegal health care kickbacks (5 years)<\/span><\/p>\n

Payment of illegal health care kickbacks (10 years)<\/span><\/td>\n<\/tr>\n

Montaha Hogeige<\/span><\/td>\nConspiracy to defraud the United States through the payment and receipt of illegal health care kickbacks (5 years)<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Ten other individuals were also charged with criminal information for their alleged participation in the fraud schemes.<\/span><\/p>\n

The FBI Detroit Field Office, HHS-OIG, and IRS-CI are investigating the cases.<\/span><\/p>\n

Trial Attorney Shankar Ramamurthy of the Criminal Division\u2019s Fraud Section is prosecuting the cases.<\/span><\/p>\n

The Fraud Section leads the Criminal Division\u2019s efforts to combat health care fraud through the Health Care Fraud Strike Force Program.<\/span><\/p>\n

\"black Since March 2007, this program, comprised of 15 strike forces operating in 25 federal districts, has charged more than 5,000 defendants who collectively have billed federal health care programs and private insurers more than $24 billion.<\/span><\/p>\n

More information can be found at https:\/\/www.justice.gov\/criminal-fraud\/health-care-fraud-unit<\/a>.<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

Court documents were unsealed this week charging 23 Michigan residents for their alleged involvement in two illegal schemes to defraud Medicare of more than $61.5 million, officials stated. The defendants paid kickbacks…<\/p>\n","protected":false},"author":1,"featured_media":51842,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3255],"tags":[],"class_list":["post-52137","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-federal-court"],"yoast_head":"\n23 Michigan Residents Charged in Alleged $61.5 Million Medicare Fraud Scheme<\/title>\n<meta name=\"description\" content=\"Court documents were unsealed this week charging 23 Michigan residents for their alleged involvement in two illegal schemes to defraud Medicare of more\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/cjnotebook.com\/?p=52137\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" 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