Physician Pleads Guilty to Role in Detroit-Area Medicare Fraud Scheme
A licensed physician and former owner of a Detroit-area medical practice pleaded guilty today for his role in a $4.2 million health care fraud scheme.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul Abbate of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office made the announcement.
Hicham Elhorr, M.D., 47, of Dearborn, Michigan, pleaded guilty before U.S. District Judge Nancy G. Edmunds of the Eastern District of Michigan to one count of conspiracy to commit health care fraud. A sentencing hearing is scheduled for Oct. 20, 2015.
Elhorr owned House Calls Physicians P.L.L.C., which was located in Allen Park, Michigan. According to admissions in his plea agreement, from approximately August 2008 to September 2012, Elhorr conspired with others to commit health care fraud by billing Medicare for purported in-home physician services that were not provided by licensed physicians. Elhorr admitted that he employed unlicensed individuals who held themselves out as licensed physicians and purported to provide physician home visits and other services to Medicare beneficiaries in Michigan. The unlicensed individuals prepared medical documentation that Elhorr and other licensed physicians signed as if they had performed the visits when, in fact, Elhorr and the other licensed physicians had not treated the beneficiaries. The visits were then billed as if performed by the licensed physicians.
According to court documents, between approximately March 2008 and September 2012, House Calls Physicians billed Medicare more than $11.5 million for the cost of physician home services. Of that amount, Elhorr admitted that he caused the submission of approximately $4.2 million in false and fraudulent claims.
This case was investigated by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Eastern District of Michigan. This case is being prosecuted by Assistant Chief Catherine K. Dick and Trial Attorneys Matthew C. Thuesen and F. Turner Buford of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5 billion. In addition, the HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.