16 in Metro Arrested in Largest-Ever Medicare Fraud Sweep

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More than a dozen metro Detroit health-care workers have been arrested in a $712 million fraud and kickback scheme that federal officials are calling the “largest national Medicare fraud takedown in history.”

“This action represents the largest criminal health-care fraud takedown in the history of the Department of Justice,” U.S. Attorney General Loretta Lynch said in a statement announcing the sweep by the Medicare Fraud Strike Force.

A total of 243 individuals in six states, including 46 doctors, nurses and other licensed medical professionals, bilked the government out of $712 million in false billings, the government said.

The cases, which span 17 federal jurisdictions, include allegations of anti-kickback statutes, money laundering and identify theft. Arrests were made in Michigan, Florida, Texas, California, New York and Louisiana.

“The defendants include doctors, patient recruiters, home health-care providers, pharmacy owners and others,” Lynch said. “They billed for equipment that wasn’t provided, for care that wasn’t needed and services that weren’t rendered.”

FBI Director James Comey said the people charged in the scheme “targeted the system each of us depends on in our most vulnerable moments.”

“Health-care fraud is a crime that hurts all of us and each dollar taken from programs that help the sick and the suffering is one dollar too many,” he said.

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In the Detroit metro area, sixteen individuals – including six doctors, a social worker, a pharmacist and two physical therapists – were charged with a variety of health care fraud and kickback schemes totaling over $122 million.

The schemes involved services that were medically unnecessary or never rendered, including physician visits, hospice care, home health care, and the billing but not dispensing of pharmaceuticals.

In addition, law enforcement agents executed search warrants at eight locations and seizure warrants of 24 bank accounts related to the alleged schemes. The Centers for Medicare and Medicaid Services has moved to suspend 14 providers associated with the schemes.

In a statement, Barbara McQuade, U.S. attorney general for Michigan’s Eastern District, said health-care fraud has been pervasive throughout the Detroit metro area in recent years.

“We hope that cases like these will alert doctors, pharmacists and other providers that criminal investigators are now scrutinizing billing records so that we can detect fraud and hold wrongdoers accountable,” McQuade said

The Michigan cases are:

United States v. Tahir, et al.: Five individuals, two physicians and three owners of hospice and home health care companies, were charged in an indictment with conspiring to commit health-care fraud for their alleged roles in a $58.3 million scheme to defraud Medicare by submitting fraudulent claims for home health care and hospice services that were medically unnecessary or not provided.

The owners of the home health care and hospice companies, two of whom are also physical therapists, allgedly paid physicians and recruiters kickbacks for referring patients, then billed Medicare for medically unnecessary services, which were often never provided. The companies, located in Livonia are A Plus Hospice and Palliative Care, At Home Hospice and At Home Network Inc., a home health care agency.

The physicians who allegedly solicited and received kickbacks also submitted claims to Medicare for medically unnecessary physician services through their companies, Waseem Alam, M.D., P.C., Woodward Urgent Care, and Hatem Ataya, M.D., P.C., the government said.

Those physicians prescribed beneficiaries medically unnecessary prescriptions, including controlled substances, for which Medicare also paid, according to the allegations

The defendants charged in the indictment are Shahid Tahir, 45, of Bloomfield Township; Dr. Waseem Alam, 59, of Troy; Dr Hatem Ataya, 47, of Flushing; and Muhammad Tariq, 60,and Manawar Javed, 40, both of West Bloomfield.

United States v. Goldfein, M.D., et al.: Four individuals, a physician and three owners of home health care companies, were charged in a superseding indictment with conspiracy to commit health care and wire fraud, health care fraud, wire fraud and conspiracy to pay or receive health care kickbacks.

The indictment alleges that the fraudulent claims were submitted by physicians who took kickbacks to refer home health care, then billed medically unnecessary services and prescribed unnecessary medications billed to Medicare.

The defendants charged in the indictment are Dr. William Binder, 58, and Muhammad Zafar, 43, both of Brownstown;, Tariq Khan, 47, of Woodhaven; and Ghulam Shakir, 43 (address unavailable).

United States v. Daneshvar, M.D.: Dr. Gerald Daneshvar, 39, of West Bloomfield was charged by indictment with his alleged role in a more than $5 million conspiracy to commit health-care fraud by referring non-homebound patients for home health care services as well as billing for upcoded physician visits through Lake MI Mobile Doctors, PC (“Mobile Doctors”).

The owner of Mobile Doctors and another physician employee were indicted in the Northern District of Illinois in 2013 for their roles in the same scheme.

United States v. Lerner, M.D., et al.: Dr. Laran Lerner, 59, of Northville, and pharmacist and pharmacy owner Mohamad Bazzi, 42, of Dearborn, were charged by complaint with a more than $24 million health-care fraud scheme.

The government alleges Lerner provided medically unnecessary prescriptions for expensive pharmaceuticals for which Bazzi’s pharmacy, Advanced Pharmacy Services (APS) would bill Medicare, but not dispense.

In addition, Lerner allgedly billed for unnecessary physician visits and referred beneficiaries for medically unnecessary home health-care services through his clinic, Greater Detroit Physical Therapy & Rehabilitation, located in Westland,

United States v. Qadir, M.D.: Dr. Rizwan Qadir, 52, of Bloomfield Hills, was charged by complaint with conspiracy to commit health-care fraud in a $19 million Medicare fraud scheme.

The government alleges Qadir paid patient recruiter Johnny Younan to bring him patients, for whom he would bill medically unnecessary tests and visits. Qadir also allegedly referred the beneficiaries for medically unnecessary home health care services.

United States v. Younan: Johnny Younan, 52, of Centerline, was charged by complaint with conspiracy to pay or receive health care kickbacks to a physician, who would also prescribe Medicare beneficiaries controlled substances as an inducement to provide their Medicare information for billing.

United States v. Celestine Brown: Celestine Brown, 50, of Ypsilanti, a licensed social worker, was charged by information with one count of health-care fraud and one count of structuring in connection with her alleged role in a $3.8 million scheme to defraud Medicare through the submission of false claims for psychotherapy services that were never rendered.

Brown allgedly submitted the false claims through her company CBC Services, LLC, located in Ypsilanti. Brown is also alleged to have then structured cash withdrawals from her bank accounts in amounts of less than $10,000 to avoid reporting requirements.

United States v. Tamara Brown: Tamara Brown, 42, of Southfield, was charged by complaint with her part in a $1.3 million kickback conspiracy. The complaint alleges that Brown solicited and received kickbacks from two Detroit area home health care agencies, Cherish Home Health Services, LLC, and Empirical Home Health Care, Inc., in return for providing patient referrals from a physician.

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Departments of Justice and Health and Human Services 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 2,300 defendants who collectively have falsely billed the Medicare program for over $7 billion.

Including today’s enforcement actions, nearly 900 individuals have been charged in national takedown operations, which have involved more than $2.5 billion in fraudulent billings.

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