Medicare Fraud Strike Force Charges 21 Individuals in Detroit as Part of Nationwide Takedown

Twenty-one individuals have been charged in the Eastern District of Michigan for their participation in a series of separate schemes to defraud Medicare, announced the Departments of Justice and Health and Human Services (HHS). These charges are part of a nationwide takedown by Medicare Fraud Strike Force operations that led to charges against 111 defendants in nine cities for their alleged participation in Medicare fraud schemes involving more than $225 million in false billing.

The Detroit arrests were announced by Barbara L. McQuade, United States Attorney for the Eastern District of Michigan; Greg Andres, Deputy Assistant Attorney General of the Criminal Division; Andrew G. Arena, Special Agent in Charge, Federal Bureau of Investigation (FBI); and Lamont Pugh III, Special Agent in Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Office of Investigation.

“With this takedown, we have identified and shut down large-scale fraud schemes operating throughout the country. We have safeguarded precious taxpayer dollars. And we have helped to protect our nation’s most essential health care programs, Medicare and Medicaid,” said Attorney General Holder. “As today’s arrests prove, we are waging an aggressive fight against health care fraud.”

“Today, Strike Force operations have charged doctors, nurses, health care executives, and others—from Los Angeles to New York and cities in between—with engaging in Medicare fraud schemes that cheat taxpayers and patients alike,” said Assistant Attorney General Lanny A. Breuer. “With this nationwide takedown and the expansion of the Strike Force to two additional cities, our message is clear: we are determined to put Medicare fraudsters out of business.”

Charged were Joann McGhee, 45, of Southfield, Michigan; Tariq Mahmud, 53, of Canton, Michigan; Fatima Hassan, 43, of Dearborn, Michigan; Victor Jayasundera, 57, of Southfield, Michigan; Carol Gant, 65, of Berkley, Michigan; Vanessa Dowell, 49, of Oak Park, Michigan; Karina Hernandez, 26, of Doral, Florida; Marieva Briceno, 45, of Doral, Florida; Dora Binimelis, 57, of Miami, Florida; Jonathan Agbebiyi, 61, of Rochester Hills, Michigan; Santiago Villa-Restrepo, 33 of Doral, Florida; Juan Villa, 28, of Doral, Florida; Isaac Carr, 28, of Belleville, Michigan; Diana Brown, 50, of Farmington Hills, Michigan; Jasmine Oliver, 32, of Oak Park, Michigan; Henry Briceno, 57, of Miami, Florida; Mehran Javidan, 48, of West Bloomfield, Michigan; Vishnu Pradeep Meda, 30, of Troy, Michigan; Ram Naresh Rajulapati, 31, of Canton, Michgan; Errol Sherman, 63, of West Bloomfield, Michigan; and Surya Nallani, 43, of Troy, Michigan.

The Detroit-area schemes involved a total of more than $23 million in fraudulent claims submitted to Medicare. The defendants include owners and operators of companies, doctors, physical and occupational therapists, office employees, and patient recruiters. The investigations were conducted jointly by the FBI and HHS-OIG, under the auspices of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Eastern District of Michigan and the Criminal Division’s Fraud Section.

The joint DOJ-HHS Medicare Fraud Strike Force is a multi-agency team of federal, state, and local investigators designed to combat Medicare fraud through the use of Medicare data analysis techniques and an increased focus on community policing. The strike force operations in Miami, Los Angeles, Baton Rouge, Brooklyn, Detroit, Houston, Tampa, Chicago, and Dallas are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009, between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. In May 2009, Attorney General Holder and HHS Secretary Sebelius announced the expansion of the strike force into Detroit and Houston to build upon existing partnerships between the agencies in a heightened effort to reduce fraud and recover taxpayer dollars. In December 2009, strike force operations were expanded to Brooklyn, Baton Rouge, and Tampa. With the arrests announced today, the strike force has now expanded into Dallas and Chicago.

Since their inception in March 2007, the strike force operations in nine districts have charged more than 990 individuals who collectively have falsely billed the Medicare program for more than $2.3 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

United States Attorney Barbara L. McQuade stated, “As our nation works to provide affordable health care to our citizens, we must prevent providers from stealing from the taxpayers. We want health care providers to know that we are paying attention to billing records, and that abuses will be aggressively prosecuted. We hope that our recent successes and continued efforts will deter others from cheating the health care system.”

“Today’s health care fraud sweep in Detroit shows—yet again—that those who victimize Medicare patients and taxpayers will be forced to face justice,” said Lamont Pugh III, Special Agent in Charge of the Department of Health & Human Services Office of Inspector General for the Region including Detroit. “These indictments and arrests demonstrate how OIG working with its law enforcement partners will untangle the threads of even the most complicated criminal plots.”

FBI Special Agent in Charge Andrew G. Arena stated, “Today’s criminal charges are another chapter in the continuing fight against health care fraud in southeast Michigan. As taxpayers, Medicare fraud affects all of us. The FBI, with our law enforcement partners, is committed to aggressively investigating and bringing to justice, those who abuse the health care system.”

Today in Detroit the HEAT Strike Force arrested individuals involved in the following cases:

U.S. v. Hernandez et al.

Ten individuals, 6 from Miami, Florida, including a physician, six clinic owners or managers, two clinic employees, and one patient recruiter were charged with conspiracy to commit health care fraud in connection with a $5.4 million scheme to defraud Medicare by submitting fraudulent diagnostic testing claims. The clinics involved are Bless, LLC, Manuel MC, LLC, and Alpha & Omega MC, LLC all located in Livonia, Michigan. The tests, primarily nerve conduction studies, were being performed unnecessarily or were not being performed at all. Medicare was billed approximately $515 per test.

U.S. v. Mahmud et al.

Five individuals were charged with conspiracy to commit health care fraud and health care fraud in connection with an approximately $900,000 scheme to defraud the Medicare program by submitting fraudulent claims for physical and occupational therapy services. Comprehensive Rehab Services, Inc., located in Dearborn, Michigan, purchased fictitious physical and occupational therapy files from a contractor and billed Medicare for services reflected in those files, which were never in fact provided.

U.S. v. Javidan et al.

Three individuals, including the owner and controller of Acure located in Troy, Michigan, and two physical therapists, were charged with conspiracy to commit health care fraud, health care fraud and conspiracy to offer or pay health care kickbacks in connection with an approximately $2 million scheme to defraud the Medicare program by submitting fraudulent claims for home health care services. The defendants are alleged to have billed Medicare for the cost of physical therapy and other services that were not medically necessary or were never in fact performed.

U.S. v. Sherman

Erroll Sherman, a podiatrist doing business in Oak Park, Michigan, was charged with health care fraud in connection with an approximately $700,000 scheme to defraud the Medicare program by submitting fraudulent claims for podiatry services. Sherman was billing Medicare for services never provided.

U.S. v. Nallani

Suriya Nallani, a physician doing business in Troy, Michigan, was charged with health care fraud in connection with an approximately $8.5 million physicians visiting group operation. Dr. Nallani billed Medicare for excessive home visits which required that she physically be present during these home visits, when in fact she was out of the country. In addition, Dr. Nallani billed for home visits on particular days which would be virtually impossible to complete given the number of hours in a day and the geographical distance between each home.

U.S. v. McGhee

Joann McGhee, doing business as Meridian Human Services, Inc., located in Southfield, Michigan, was charged with health care fraud in connection with an approximately $6.1 million scheme to defraud the Medicare program by submitting fraudulent claims for psychotherapy services. McGhee is also charged in an indictment in the Western District of Tennessee with billing Medicare approximately $1.1 million for psychotherapy services that were never performed.

An indictment is merely a charge and defendants are presumed innocent until proven guilty.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.