(WXYZ) — The Department of Justice has charged 23 Michigan residents for their alleged involvement in two schemes to defraud Medicare of more than $61.5 million, according to court documents unsealed this week.
According to the feds, the two schemes involved paying kickbacks and bribes, and billing Medicare for unnecessary medical services that were never provided.
In the first case, United States v. Jamil, the feds allege Walid Jamil, 62, and Jalal Jamil, 69, owned and operated several home health agencies in metro Detroit and concealed their ownership using straw owners. The feds say they submitted about $50 million in fraudulent home healthcare claims to Medicare.
According to the feds, Walid and Jalal allegedly paid bribes to other co-conspirators to recruit patients, violating the Federal Anti-Kickback Statute, and those patients didn't need home health care or quality for it.
The feds say Walid and Jalal received more than $43 million from Medicare which were misappropriated for their personal benefit.
“The alleged actions of these defendants is an astonishing abuse of our health care system,” said U.S. Attorney Dawn N. Ison for the Eastern District of Michigan. “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.”
Others charged in that case include Carol Ibrahim, 45, and Delaine Jackson, 48, who were allegedly employed by one or more of the home health agencies and operated them. The feds say they each allegedly made illegal payments to patient recruiters and submitted false claims to Medicare.
Ibrahim Sammour, 62, was a registered nurse employed by the agencies and fraudulently billed Medicare for services he never provided, according to the feds.
Mary Smelter-Bolton, 69,, and Cass Hawkins, 52, were allegedly recruiters paid to refer Medicare beneficiaries for home health services.
The second case, United States v. Malas, et al., started around February 2015, the feds said. Radwan Malas, 43, operated Infinity Visiting Physician Services PLC and allegedly ordered physicians he employed to certify patients referred by Walid and Jalal for home health services, the feds say.
According to the feds, he allegedly then billed Medicare for services that were never provided, including 60-minute complex patient visits and other services that weren't medically necessary including B-12 and Toradol injections.
The feds say Malas demanded physicians in his office order the highest-reimbursing drug test for patients.
According to the feds, the defendants billed Medicare for more than $11.5 million in fraudulent claims and were paid nearly $4 million which they allegedly misappropriated for their personal benefit.
“At the FBI, we swear an oath to protect the American people,” said Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division. “Fraudsters look to orchestrate their schemes at the cost of our health care systems, patients, and taxpayers. The FBI and our law enforcement partners remains dedicated to investigating and bringing to justice those who seek to exploit our U.S. healthcare system at the expense of its patients.”
Others charged in the case include Alejandro Mataverde, 79, and, Cornelius Oprisiu, 82, who are both physicians, and Shafiq Rehman, 59, a licensed nurse practitioner, who were reportedly employed by Infinity. The feds allege they provided medically unnecessary services to the beneficiaries or submitted false claims.
Michael Molloy, 50, was the co-owner of Integra Lab Management LLC which allegedly processed the high-reimbursing and allegedly medically unnecessary tests submitted by Infinity.
Montaha Hogeige, 39, was allegedly a mecial assistant for Infinity who the feds say areed to receive a her salary from Integra as a kickback to Infinity.
