Michigan Agency Owner Pleads Guilty in $8 Million Fraud Scheme
Zahir Shah, 48, of West Bloomfield, Michigan, pleaded guilty to fraud charges for his role in a scheme involving approximately $8 million in fraudulent Medicare claims for home health services procured through illegal kickbacks, according to the Department of Justice (DOJ).
Shah pleaded guilty to one count of conspiracy to commit health care fraud and wire fraud and one count of conspiracy to pay and receive kickbacks in connection with Medicare beneficiaries. As part of the guilty plea, Shah admitted that he submitted false certifications to enroll and stay enrolled as a Medicare provider.
He further admitted to paying illegal kickbacks to recruiters in exchange for Medicare beneficiary referrals and billed Medicare for claims procured through these illegal kickbacks. Shah caused a loss of about $8 million to Medicare through false and fraudulent claims from 2007 to 2017.
In a separate case, another home health care agency owner based in Michigan pleaded guilty to charges for his role in a scheme involving Medicare claims for services that were procured through the payment of illegal kickbacks.
Atheir Amarrah, 43, of West Bloomfield, the owner of Prompt Care Home Health Services Inc. pleaded guilty to one count of conspiracy to pay and receive health care kickbacks in connection with Medicare beneficiaries and to four substantive counts of paying health care kickbacks. Sentencing is scheduled for Sept. 25. The scheme is alleged to have resulted in a loss up to $1.8 million to the Medicare program, spanning from 2013 through 2017.
Texas Nurse Convicted in $3.5 Million Fraud Scheme
A 51-year-old nurse of Sugar Land, Texas, has been convicted of conspiracy to commit health care fraud and six counts of health care fraud and conspiracy to violate the anti-kickback statute, announced U.S. Attorney Ryan K. Patrick.
John Dubor, who owned and operated Care Committers Health Services home health care agency in Richmond, was convicted after the jury deliberated for less than six hours following a three-day trial. The jury heard evidence that Dubor paid marketers and group home owners for Medicare beneficiary information and subsequently billed Medicare and Medicaid for home health services for which the beneficiaries did not quality and/or did not receive.
He also personally falsified home health patient assessment forms documents to make beneficiaries appear sicker on paper to receive higher reimbursement rates from Medicare, according to the DOJ. Dubor instructed his employees to falsify home health certifications and forge physician signatures. Medicare paid him approximately $3.5 million.
The beneficiaries had no recollection of ever being treated by the Houston physicians listed on their home health orders, according to the DOJ. Lorraine Whitaker, 59, Dubor’s co-conspirator, had previously pleaded conspiracy to violate the anti-kickback statute and is awaiting sentencing. Dubber faces up to 10 years in federal prison for each count of health care fraud and up to five years for conspiracy to violate the anti-kickback statute. A hearing is set for Sept. 7, 2018.
Doctor Convicted in $8.9 Million Health Care Fraud Scheme
A jury found a physician guilty today for her role in a scheme involving approximately $8.9 million in fraudulent Medicare claims for home health care and other physician services that were procured through illegal kickbacks, were not medically necessary, not actually provided, or were provided by the defendant, who was not a licensed physician during the conspiracy.
Millicent Traylor, 47, of West Bloomfield, Michigan, was convicted of one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive kickbacks in connection with Medicare beneficiaries, and five counts of health care fraud following a four-day trial, the DOJ reported. Sentencing is scheduled for Sept. 27.
Taylor, who was unlicensed at the time of the scheme—which ran from 2011 to 2016—acted as a physician for companies, providing services that were not medically necessary and were billed to Medicare as if they were provided by a licensed physician, according to the DOJ. She also conspired to bill Medicare for services that were never rendered and falsified records.
Evidence showed Taylor and co-conspirators paid and received kickbacks in exchange for referring Medicare beneficiaries to serve as patients at clinics, and she fraudulently signed the names of licensed physicians on prescriptions for opioid medications, such as oxycodone, as a means of inducing patient participation in the scheme.
Written by Amy Baxter