Eight Indicted in Health Care Fraud and Drug Distribution Scheme
|U.S. Attorney’s Office October 06, 2011|
DETROIT—An indictment returned by a federal grand jury in Detroit was unsealed today charging eight individuals for their roles in a health care fraud and drug distribution scheme, United States Attorney Barbara L. McQuade announced today. McQuade was joined in her announcement by Special Agent in Charge Andrew G. Arena of the Federal Bureau of Investigation (FBI) and Lamont Pugh, Special Agent in Charge of the Inspector General of the Department of Health and Human Services (HHS).
Charged in the indictment were Orlando Mena, of Miami, FL; .Xiomara Rodriguez, of Miami, FL; Dr. Russell Crispell, of Troy, MI; Reinald Orellana, of Westland, MI; Lisette Orellana, of Miami, FL; Akim Mena of Miami, FL; Dr. Virinder Grewal, of Williamston, MI; and Carla Degraffenreid of Detroit.
The indictment alleges that the defendants conspired to defraud Medicare with a fraudulent diagnostic testing scheme operating at World Health Care, LLC and Wyoming Medical Centers, PLC. As part of the scheme, Medicare was billed in excess of $2 million for medically unnecessary tests and services. The indictment also charges Orlando Mena, Xiomara Rodriguez, Dr. Russell Crispell, Reinald Orellana, Lisette Orellana, and Akim Mena with conspiracy to distribute Oxycontin (oxycodone) and 13 counts of distribution of a controlled substance.
The indictment alleges Xiomara Rodriguez incorporated World Health Care in Redford, Michigan, on July 11, 2008. Orlando Mena, and others recruited Medicare beneficiaries in Southeast Michigan to see Dr. Russell Crispell, who was employed by World Health Care. Most of the patients were scheduled for doctor visits by employee Lisette Orellana. The Medicare beneficiaries would be transported to World Health Care by employee “drivers,” who were under the direction and control of Akim Mena. The Medicare beneficiaries would be required to undergo medically unnecessary tests in order to receive a prescription for Oxycontin. In addition, Medicare beneficiaries were paid in cash for their time and the use of their Medicare card for billing purposes.
The indictment also alleges that Akim Mena would arrange to have drivers transport the Medicare beneficiaries to various pharmacies to fill their prescriptions. Once the prescription was filled, the driver would pay the Medicare beneficiaries from $150 to $800, in cash, for their Oxycontin prescription, for further distribution.
The indictment alleges that Reinaldo Orellana and Akim Mena incorporated Wyoming Medical Centers in East Lansing, Michigan, on March 25, 2009, and acquired a valid Medicare provider number to submit Medicare claims for office visits and tests. Medicare beneficiaries were required to visit Wyoming Medical Centers, and see Dr. Virinder Grewal, who did not perform a medical examination, but caused a claim to be submitted to Medicare for various diagnostic tests, then the Medicare beneficiaries would return to World Health Care to receive a prescription for Oxycontin.
“Today’s indictments and arrests illustrate the Office of Inspector General’s continued and sustained commitment to the fight against fraud in Federal health care programs,” said Lamont Pugh III, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General for the Chicago Region. “The OIG in concert with our law enforcement partners, will continue to protect Medicare beneficiaries and the taxpayers through these types of enforcement actions.”
FBI Special Agent in Charge Arena stated, “Health care fraud and the abuse/diversion of prescription medications are increasing criminal threats to the United States. Dishonest health care providers involved in fraudulent activities frequently exploit Medicare and Medicaid through fraudulent billing schemes which abuse tax payer’s dollars. The FBI remains committed to investigating this fraud and bringing these individuals to justice.”
“Medicare fraud steals funds from all of us as taxpayers,” McQuade said. “Our hope is that robust enforcement of these cases will deter other providers from committing Medicare fraud in the future.”
An indictment is a charging document and not evidence of guilt. Each and every defendant is presumed to be innocent.