- From approximately February 2004 until February 2010, Poul Thorsen executed a scheme to steal grant money awarded by the Centers for Disease Control and Prevention (CDC). CDC had awarded grant money to Denmark for research involving infant disabilities, autism, genetic disorders, and fetal alcohol syndrome. CDC awarded the grant to fund studies of the relationship between autism and the exposure to vaccines, the relationship between cerebral palsy and infection during pregnancy, and the relationship between developmental outcomes and fetal alcohol exposure.
- Thorsen worked as a visiting scientist at CDC, Division of Birth Defects and Developmental Disabilities, before the grant was awarded.
- The initial grant was awarded to the Danish Medical Research Council. In approximately 2007, a second grant was awarded to the Danish Agency for Science, Technology, and Innovation. Both agencies are governmental agencies in Denmark. The research was done by the Aarhaus University and Odense University Hospital in Denmark.
- Thorsen allegedly diverted over $1 million of the CDC grant money to his own personal bank account. Thorsen submitted fraudulent invoices on CDC letterhead to medical facilities assisting in the research for reimbursement of work allegedly covered by the grants. The invoices were addressed to Aarhaus University and Sahlgrenska University Hospital. The fact that the invoices were on CDC letterhead made it appear that CDC was requesting the money from Aarhaus University and Sahlgrenska University Hospital although the bank account listed on the invoices belonged to Thorsen.
- In April 2011, Thorsen was indicted on 22 counts of Wire Fraud and Money Laundering.
- According to bank account records, Thorsen purchased a home in Atlanta, a Harley Davidson motorcycle, an Audi automobile, and a Honda SUV with funds that he received from the CDC grants.
- Thorsen is currently in Denmark and is awaiting extradition to the United States.
- On November 7, 2012, Patricia Mubanga Chisanga was indicted on charges of health care fraud and conspiracy to commit health care fraud. Previously, Chisanga's co-conspirator Uche Ben Odunzeh plead guilty one count of conspiracy to commit health care fraud and was sentenced to 19 months in prison.
- Emerald Medical Services (Emerald) is a durable medical equipment company operating in the District of Columbia and purportedly providing wheelchairs and other medical equipment to Medicaid patients.
- Chisanga is listed as the Vice President of Operations on the business records for Emerald.
- Investigators believe that authorization forms necessary for the submission of claims to Medicaid were altered after they were signed by the prescribing physician. These forms were allegedly used by Emerald to bill Medicaid for more expensive equipment than was actually provided to the patients.
- Emerald would provide patients with a lower level power wheelchair when, in fact, a higher level wheelchair was authorized.
- From approximately January 2008 through March 2011, Emerald collected $480,000 from Medicaid for durable medical equipment that was never provided.
- OIG Special Agents confronted Chisanga about her participation in the scheme. After this confrontation, she fled the United States to Ethiopia, then took a flight to her native Zambia.
- Chisanga remains at large.
- In September 2009, Fentahun Belay Ferede was indicted on charges of health care fraud.
- Ferede was the owner and operator of Tana Medical Supplies Inc., a Los Angeles-based durable medical equipment (DME) company.
- From approximately September 2007 until May 2008, Ferede allegedly defrauded Medicare by billing more than $900,000 of DME consisting mainly of motorized wheelchairs and accessories that were either never provided, not legally prescribed, or not medically necessary.
- Investigators believe that Ferede is the owner of an electronics products export company in Hong Kong.
- Ferede remains at large and is believed to be in Hong Kong in the People's Republic of China.
Lilit Galstyan (aka Nina Galstyan), Julieta Ghazaryan, and Marine Movsisyan
- In September 2010, Lilit Galstyan, Julieta Ghazaryan, and Marine Movsisyan were indicted on charges of health care fraud, conspiracy to commit mail fraud, wire fraud, and conspiracy to commit money laundering. Galstyan, Ghazaryan, and Movsisyan, along with their co-conspirators, allegedly billed Medicare, using stolen provider identities, for more than $40 million in false claims for services that were never rendered.
- According to the indictment, Galstyan, Ghazaryan, Movsisyan and their co-conspirators allegedly stole personal identifying information of physicians and Medicare beneficiaries to submit claims to Medicare for equipment for beneficiaries whom the physicians never saw. They also allegedly employed visa holders from eastern European countries and used the visa holders' identities to submit false claims to Medicare for services never rendered.
- Although the crime ring was based in the Los Angeles area, investigators believe that the trio and their co-conspirators traveled throughout the country to open fake businesses. These "false fronts" were opened in over 40 States and were located far from the physicians' actual practices in order to conceal the false billings from the physicians. The locations served as "mail drops" so that the conspirators could receive documents used to further the scheme, including Medicare correspondence and bank checks, according to the indictment.
- Investigators believe that the trio and their co-conspirators received more than $19 million in reimbursements from Medicare for services that were never provided. A large portion of the profits from the alleged schemes were laundered through shell businesses owned by the visa holders, according to the indictment.
- Co-conspirators Eduard Oganesyan and Karen Chilyan previously pled guilty and were sentenced to 11 years' and 8 years' incarceration, respectively. In addition, Oganesyan and Chilyan were ordered to pay joint and several restitution in the amounts of $10.6 million and $7.7 million, respectively. A third co-conspirator, Arus Gyulbudakyan, also previously pled guilty and was sentenced to 13 months' imprisonment and ordered to pay $500,000 in restitution, joint and several. Gyulbudakyan will be deported to Armenia after she has served her time in jail.
- Galstyan, Ghazaryan, and Movsisyan remain at large.
- In September 2007, Jose Argos was indicted on charges of conspiracy to defraud the United States, health care fraud, submission of false claims, money laundering conspiracy, and money laundering. According to court documents, Argos allegedly caused the submission of approximately $2.7 million in claims to Medicare for durable medical equipment (DME) that his company never provided to Medicare patients.
- Argos was president and registered agent of MedStar Services, a DME company in Miami, Florida. Investigators believe that Argos conspired with OIG Most Wanted Fugitive Gustavo Smith and others to defraud Medicare by submitting false claims for reimbursement.
- Argos, Smith, and their co-conspirators acquired MedStar and obtained a Medicare provider number to submit claims to Medicare for DME that the company purportedly provided. The defendants received approximately $1.5 million in reimbursements from Medicare for DME that was never prescribed or provided to Medicare patients. Smith and Argos then attempted to transfer the proceeds to a foreign country.
- Both Argos and Smith remain fugitives from justice.
- In March 2011, Vivian Yusuf was indicted on charges of conspiracy to commit health care fraud, health care fraud, and aggravated identity theft. Investigators believe that Yusuf and her co-conspirators billed Medicare for more than $3.4 million for durable medical equipment (DME) that was neither medically necessary nor prescribed by a physician.
- Yusuf owned and operated Ivy Health Care Supply, a DME company based in Stafford, Texas. According to court records, Yusuf and her co-conspirators allegedly improperly acquired Medicare patient information to submit false claims to Medicare. The defendants then forged physicians' signatures on prescriptions and certificates of medical necessity (CMN). They also altered prescriptions and CMNs after they had been signed by physicians. The defendants then billed Medicare for power wheelchairs, orthotic equipment, and other medical supplies that were not prescribed or otherwise authorized by a physician, were not medically necessary, and were not requested by the beneficiaries.
- Investigators believe that Yusuf and her co-conspirators falsely billed Medicare for claims for nearly 800 Medicare patients, primarily located in Texas and Louisiana. Based on these claims, Ivy Health Care Supply was reimbursed approximately $1.6 million from Medicare. Yusuf and her co-conspirators allegedly diverted these funds from her business for their own personal use and benefit, as well as that of others.
- Federal authorities believe that Yusuf fled the United States in January 2011 and is currently residing in Nigeria.
- On April 17, 2013, Jorge Jesus Cubilla Fernandez was indicted on charges of health care fraud and wire fraud. Investigators believe that through his company, Fernandez falsely billed Medicare for $1.8 million for durable medical equipment (DME) that was never provided to beneficiaries.
- Fernandez was the owner and operator of Jet Medical Supply, a DME company based in Louisville, Kentucky. According to the indictment, Jet Medical billed Medicare for wound care supplies and was reimbursed approximately $900,000 from May 2010 until February 2011.
- The investigation revealed that a number of billings submitted by Jet Medical were for beneficiaries whose Medicare numbers had been compromised and/or had been associated with fraud by another provider. In addition, Jet Medical allegedly billed for items, benefits, products, supplies, or services purportedly provided to beneficiaries located outside of Kentucky, mainly from Florida.
- Interviews with the Medicare beneficiaries who purportedly received DME and services from Jet Medical revealed that they never received DME or any services from Jet Medical.
- Fernandez remains at large and is believed to be residing in south Florida.
- On July 7, 2009, Jahaziel Garcia Gonzalez was indicted on charges of health care fraud and forfeiture. Investigators believe that through his company, Gonzalez submitted nearly $2.4 million in false claims to Medicare for durable medical equipment (DME) items and services that were not prescribed by doctors or provided as claimed.
- Gonzalez controlled and operated A & L Professional, Inc., a DME company based in Miami, Florida. According to the indictment, from around October 2008 to around March 2009, Gonzalez allegedly submitted or caused the submission of numerous false claims to Medicare on behalf of A & L Professional for powered air mattresses, non-disposable pump canisters, and other DME that was not prescribed by doctors or provided as claimed.
- Medicare reimbursed A & L Professional nearly $1 million for these false claims. Gonzalez allegedly transferred these funds from A & L Professional's corporate bank account to himself and others.
- An arrest warrant for Gonzalez was issued in July 2009, but he could not be located. Gonzalez remains at large.
- In July 2012, Won Suk Lee was indicted on charges of health care fraud, aiding and abetting, and causing an act to be done. According to the indictment, Lee and his co-conspirators are responsible for approximately $2.1 million in false claims submitted to Medicare.
- Lee owned and operated Won Suk Lee Acupuncture and Herb, Inc. (aka Huntington Park Acupuncture Clinic and Variety Choice, Inc.), two clinics located in Huntington Park, a suburb of Los Angeles. Lee, an acupuncturist, and his staff allegedly provided acupuncture and massage services to Medicare patients from August 2009 through February 2011. However, these services were not covered by Medicare.
- Investigators believe that Lee provided Medicare beneficiaries' health identification cards and other personal and medical information to California Neuro-Rehabilitation Institute, Inc. (CNR), a clinic enrolled as a Medicare provider for physical therapy services.
- CNR then allegedly submitted false claims to Medicare for Medicare-covered services, such as physical therapy, even though the beneficiaries did not receive any services from CNR. Lee's co-conspirators created patient files for the beneficiaries that included false documentation for covered services allegedly provided at CNR to support the fraudulent Medicare claims. CNR received approximately $1.2 million from Medicare for these fraudulent claims.
- Lee remains a fugitive and is believed to be residing in South Korea.
Osman E. Yousif, Amir Bala Elamin, Mudar A.M. Ismail, and
Elsiddig H. Elfaki
- In March 2008, Osman E. Yousif, Amir Bala Elamin, Mudar A.M. Ismail, and Elsiddig H. Elfaki were indicted on charges of conspiracy to defraud the United States, health care fraud, wire fraud, mail fraud, and aiding and abetting. According to the indictment, the co-conspirators were paid approximately $970,000 by Medicaid.
- These co-conspirators created six ambulette companies in Youngstown, Ohio, that appeared to be distinct, separate companies. However, they acted as a single ambulette transportation company, sharing provider billing information, business and/or residential addresses, transportation services, patient lists, and money.
- Yousif was the owner of ON Time Transportation, Elamin was the owner of Niles Transportation, Ismail was the owner of Nobility Express Transportation, and Elfaki was the owner of Townjet Transportation.
- These co-conspirators allegedly shared or rotated Medicaid patients to create the impression that the patients were receiving ambulette transportation from different providers.
- Ismail was convicted after a jury trial and sentenced. He fled before reporting to prison. Yousif, Elamin, and Elfaki fled prior to trial. All the co-conspirators remain at large.
- Investigators believe that they are residing in Sudan.
- In August 2012, Karo Gotti Blkhoyan and Anush Sahakyan were indicted for conspiracy to commit health care fraud, health care fraud, conspiracy to commit money laundering, and money laundering. According to the indictment, Blkhoyan, Sahakyan and their co-conspirators billed Medicare for approximately $1.1 million in false and fraudulent claims for services never rendered and were paid more than $300,000.
- According to the indictment, Blkhoyan, Sahakyan, and their co-conspirators conspired to defraud Medicare. Together, they owned and operated Pinnacle Group Services (PGS), a medical clinic located in Columbia, South Carolina, from October 2009 until August 2010. PGS was a sham entity; no patients ever went there and the identities of physicians were stolen to bill Medicare for services.
- The co-conspirators have been arrested and are awaiting the judicial process.
- Blkhoyan and Sahakyan remain at large and are believed to be in Los Angeles, California.
OIG Fugitive: Jorge Caro
- In May 2007, a State criminal complaint was filed against Jorge Caro, charging him with grand theft, scheming to defraud, filing false and fraudulent insurance claims, criminal use of personal identification information of a deceased individual, and money laundering. According to the criminal complaint, Caro falsely billed Medicare for more than $5 million for medical services that either were never provided or were unnecessary.
- In May 2006, Jorge Caro became the registered agent and president of Karem Medical Center, Inc., a medical clinic based in Miami, Florida. Investigators believe that the physicians who were purportedly providing services at Karem Medical Center had never heard of Karem and had never seen any of the patients. Interviews of patients revealed that they had never been to Karem and that the treatment or services billed to Medicare had never been provided.
- According to the criminal complaint, Karem Medical Center billed Medicare for approximately $5.2 million in false claims and was paid approximately $1.63 million.
- Caro is a fugitive at large. Authorities believe that Caro may be residing in Cuba.
- In May 2009, Iftikhar Ghouri was indicted on charges of Health Care Fraud, Payment of Kickbacks, and Criminal Forfeiture. Investigators believe that Ghouri and his co-conspirators submitted approximately $9 million in fraudulent claims to Medicare for physical and occupational therapy services and treatments that were not provided or were medically unnecessary.
- According to court documents, Ghouri operated All American Rehab Care, Inc. (AARC), a purported physical and occupational therapy provider. Ghouri allegedly paid kickbacks to health care professionals to persuade them to refer patients to AARC for therapy.
- Additionally, Ghouri and his co-conspirators allegedly created false physical and occupational therapy files using information that they either purchased or stole from Medicare beneficiaries. The files were then given to approved Medicare providers, who billed Medicare for physical and occupational therapy services that were not provided.
- Investigators believe that Ghouri went to Canada in September 2007 and has since traveled to Pakistan, where he was born and may be currently residing.
- In May 2004, a criminal indictment was filed against Asher Vanounu, charging him with health care fraud. Investigators believe that Vanounu billed Medicare for approximately $817,700 and received approximately $258,500 in reimbursements for durable medical equipment (DME) that either was not provided to patients or was not medically necessary.
- Vanounu owned and operated Valley View Medical Supply, a DME supplier in Las Vegas. According to the indictment, Vanounu allegedly caused fraudulent bills to be submitted to Medicare that falsely claimed that DME was provided to Medicare beneficiaries, when in fact it was not. The DME billed to Medicare included back braces, leg braces, powered air mattresses, commode chairs, and semi electric hospital beds.
- Investigators believe that Vanounu fraudulently listed the same referring physician on all the DME claims that Valley View submitted to Medicare. However, the physician never examined the patients, nor did the physician certify the medical necessity for the items ordered.
- Investigators believe Vanounu fled the United States and remains a fugitive at-large.
- In June 2012, Pedro Luis Perez was indicted on charges of health care fraud and aggravated identity theft.
- RP Best Choice Corp., a durable medical equipment (DME) company, owned by Pedro Luis Perez, fraudulently billed for Medicare patients who lived out of State and had never been to Texas. The majority of the patients were from Florida. Perez's company billed Medicare by falsely claiming that doctors in McAllen, Texas, whose billing information he had stolen, had referred their patients to RP Best Choice for DME.
- From January 2010 through August 2011, RP Best Choice Corp. was paid over $520,000 in fraudulent Medicare reimbursements for equipment never provided to patients.
- Investigators believe that Perez never resided in McAllen, Texas, and operated his business from Miami, Florida.
- Perez remains at large and is believed to be in Cuba.
- In June 2009, an arrest warrant was issued for Gevork Aidinian on charges of Grand Theft, Identity Theft, Insurance Fraud-False Wiring, and Health Benefits Fraud. Investigators believe that Aidinian fraudulently billed and received money from Medicare for clinical laboratory work that was either not prescribed by a doctor or was not provided to patients.
- Aidinian was the president and owner of American Premier Laboratory (American Premier), located in Reseda, CA, in the Los Angeles area. Aidinian was also listed as the Chief Executive Officer of Labx, which was at the same location as American Premier. According to court records, Aidinian allegedly used the identities of physicians to bill Medicare for laboratory work that was never provided or never prescribed.
- From June 2008 through June 2009, American Premier and Labx were paid more than $2 million in fraudulent Medicare reimbursements for clinical laboratory services.
- Investigative interviews with doctors whose identities were used by American Premier and Labx revealed that the doctors did not refer patients to either establishment.
- Investigators also interviewed Medicare patients whose identities were used to bill for laboratory services. Patients said they never went to either American Premier or Labx, and had not heard of either establishment.
- Investigators believe that Aidinian fled the country in 2009, and he remains at large.
- In July 2008, an arrest warrant was filed on Tigran Asaryan on charges of fraudulent schemes and artifices, theft, and aggravated taking identity of another.
- From October 2007 until approximately July 2008, Asaryan was the owner and operator of Core Medical Group located in Phoenix, Arizona.
- Core billed Medicare for over $600,000 and was paid over $460,000 for durable medical equipment that was never ordered or delivered or medically necessary.
- None of the Medicare patients who reportedly received equipment resided in Phoenix.
- All the referring physicians that Core used were based in California and none were from Phoenix.
- Asaryan is currently a fugitive and his whereabouts are unknown.
- In October 2009, a felony complaint was filed in California against Ekaterina Shlykova for a total of 67 charges, including Identity Theft, Money Laundering, Forgery, and Theft.
- Shlykova was the office manager of Lazarus Jewelry, an alleged "shell" company based in Los Angeles. During a search conducted at Lazarus Jewelry, agents found hundreds of bank accounts and monetary instruments as well as dozens of pieces of stolen personally identifiable information.
- Shlykova is known to use multiple identities, including the name Marina Ruslanovna Sekinaeva. According to the felony complaint, this name was obtained at the same time that fraudulent information was obtained by Evgeny Lyadov, who is charged separately with Grand Theft and Making Fraudulent Claims Against Medicare.
- Investigators believe that Shlykova and her co-conspirators were involved in a scheme in which various Durable Medical Equipment companies submitted false Medicare claims for dead beneficiaries and beneficiaries who lived out of the local area. These companies then allegedly used Lazarus Jewelry to launder approximately $53 million that they fraudulently obtained from Medicare.
- Shlykova remains at large.
OIG Fugitives: The Benitez Brothers:
Carlos Benitez, Luis Benitez, Jose Benitez
- Carlos, Luis, and Jose Benitez, commonly referred to as the Benitez brothers, allegedly schemed to submit false and fraudulent claims to Medicare, pocketing approximately $110 million from Medicare, according to a Federal indictment.
- The Benitez brothers owned and directed a string of medical clinics in the Miami area, purportedly providing infusion treatments to HIV-infected Medicare beneficiaries. But the medication the brothers provided to patients either was allegedly medically unnecessary or was never actually administered.
- The brothers allegedly paid kickbacks to patients in exchange for the patients’ Medicare information, which they then used to submit false claims to the Federal Government for reimbursement.
- More than 20 co-conspirators of the Benitez brothers have been charged in the Southern District of Florida with involvement in the HIV-infusion conspiracy. Most of them have pleaded guilty or have been convicted by a jury. A physician involved in the conspiracy was sentenced to a record-setting 30 years in prison.
- Enrique Gonzalez, an OIG Most Wanted fugitive extradited on July 25, 2012, was connected to the Benitez Brothers.
- In May 2009, Ehsan Rana and his co-conspirators were indicted on charges of Health Care Fraud and Criminal Forfeiture. Investigators believe that Rana and his co-conspirators received more than $5.5 million in fraudulent claims from Medicare for physical and occupational therapy services and treatment that were never provided or were medically unnecessary.
- Rana was the owner and operator of Alternative Physical Therapy, a Michigan-based company that purportedly provided physical and occupational therapy services and treatment to Medicare providers.
- Rana and his accomplices also allegedly established several fictitious companies in an effort to conceal the money and assets gained from the scheme.
- According to court documents, from July 2003 through March 2007, Rana's accomplices allegedly created physical and occupational therapy files using information that they purchased or stole from Medicare beneficiaries, and then sold the files to Rana. Investigators believe that Rana and his accomplices paid doctors and therapists to sign fictitious files indicating that services were needed or were provided. Rana and others used their businesses, including Alternative Physical Therapy, to submit approximately $9 million in false physical and occupational therapy claims to Medicare, seeking payment for medical services and treatment that were not provided.
- After the Pakistan-born Rana was confronted about his participation in the scheme, he fled the United States and remains at large.
- In October 2007, Raed Almasri was indicted on conspiracy charges related to health care fraud. Investigators believe that Almasri and his co-conspirators falsely billed Medicare more than $20 million for providing Medicare patients with regularly scheduled nonemergency ambulance transports to dialysis treatments, when in fact the beneficiaries did not qualify for the transports.
- Almasri jointly owned and operated Americare Medical Service (AMS), a Houston, Texas, company that transported Medicare and Medicaid dialysis patients to and from their dialysis treatments. According to court documents, Almasri and his co-conspirators allegedly bribed nurses and emergency medical technicians to refer dialysis patients to AMS. Almasri and his co-conspirators also provided kickbacks in the form of cash, gift cards, and "loans" to dialysis patients in exchange for ambulance transportation by AMS. In addition, the defendants presented fake prescriptions to staff in nursing homes to secure staff physicians' signatures for ambulance transports of dialysis patients who had never been under the care of the nursing home or who had not been a patient at the nursing home for several months or years.
- Co-conspirators Mazen Abdallah and Wesam Abdallah have each been sentenced to 17 months of incarceration and ordered to pay $637,425 in restitution, joint and several, while two other co-conspirators, Murad Almasri and Ayad Fallah, were each sentenced to 20 months and ordered to pay $1.6 million in restitution, joint and several.
- Raed Awad Almasri remains a fugitive.
- In May 2009, an arrest warrant was issued for Anupal Gayen on charges of health care fraud and health care fraud conspiracy.
- According to court documents, Gayen and his codefendants controlled several medical therapy and medical services companies in Michigan and allegedly paid Medicare beneficiaries to sign Medicare reimbursement forms for treatment and services that were not provided. Gayen and his co-conspirators then allegedly filed the reimbursement forms with Medicare, fraudulently seeking payment.
- Through their scheme, Gayen and his co-conspirators are believed to have submitted more than $18 million in fraudulent claims to Medicare.
- When Gayen was confronted about his participation in the scheme, he fled the United States and remains at large.
- In February 2007, Andrei (aka Andre) Vulpe and Valentin Munteanu were charged in the State of Arizona with fraudulent schemes, theft, and aggravated identity theft. According to charging documents, between January and November 2007, Vulpe and Valentin Munteanu attempted to defraud Medicare of over $3.5 million by billing for durable medical equipment that was either not medically necessary or not provided to Medicare beneficiaries in Arizona.
- Munteanu owned Pride Medical Supplies in Scottsdale and Vulpe owned AV Medical Supplies in Mesa. It is believed that through their companies, Munteanu and Vulpe conspired with others to submit false and fraudulent claims to Medicare and launder the unlawfully obtained proceeds.
- Munteanu and Vulpe allegedly obtained Medicare beneficiaries' information and used physicians' information without their knowledge to bill Medicare. In addition, Munteanu allegedly stole the identity of another individual in this fraudulent scheme.
- Munteanu and Vulpe have fled the country, and their whereabouts are unknown.
OIG Fugitive: Susan Bendigo
- In February 2009, Susan Bendigo (aka Susan Lim) and co-conspirators were accused in a Federal indictment of billing Medi-Cal, California's Medicaid program, for $17.1 million in fraudulent claims. Approximately $10 million was paid to Bendigo and others; about half of which came from the claims she submitted for services that were allegedly provided by unlicensed staff.
- Bendigo was a registered nurse and also the Director of Nursing for MedCare Plus Home Health Provider, Inc. (MedCare), operating in Santa Fe Springs, California. MedCare purportedly provided nurses for home health agencies. Investigators believe that, from May 2004 through May 2007, Bendigo sent unlicensed nurses to treat patients under Medi-Cal, even though she knew that Medi-Cal required licensed nurses to perform the work.
- Bendigo remains at large. Authorities believe she may be residing in the Philippines.
- In December 2007, a 38-count indictment was filed charging Eugenio R. Hernandez, Maricel B. Hernandez, and Jorge Ramirez with conspiracy to commit health care fraud, health care fraud, money laundering conspiracy, and money laundering.
- According to court documents, Eugenio Hernandez was the reported owner of S.L. Medical Center, Inc.; Maricel Hernandez was the reported owner of Care Medical Office, Inc.; and Jorge Ramirez was the reported owner of the Rehabilitation Institute and Science Clinic, Inc. All three companies operated in the greater Miami area and purportedly provided infusion therapy to Medicare patients suffering from blood disorders and other conditions.
- Investigators believe that these companies billed Medicare more than $110 million between April and December 2005 for infusion therapy services that were never provided to patients. After receiving payments from Medicare, the defendants allegedly laundered the fraudulently obtained funds through various shell companies to conceal the scheme to defraud and use the funds for their personal benefit.
- Eugenio and Maricel Hernandez fled the country and are believed to be residing in Cuba.
- Ramirez was captured in December 2008 at Miami International Airport. He pleaded guilty to one count of health care fraud and is serving his nearly 6-year jail sentence. Ramirez was also ordered to pay over $4 million in restitution.
OIG Fugitive: Manuel Lopez
- In March 2008, Manuel Aneiros Lopez was indicted on charges of health care fraud and forfeiture allegation. Investigators believe that through his company, Lopez falsely billed Medicare for medical equipment and services that were never provided to Medicare patients.
- In January 2008, Lopez became the sole officer and registered agent of H&O Medical Supply Corporation based in Miami Lakes, Florida. According to court documents, Lopez submitted approximately $600,000 in Medicare claims for health care benefits, items, and services that were not medically necessary, not prescribed by a doctor, and were not provided to patients.
- Lopez received approximately $250,000 in reimbursements for his false claims and he transferred the funds from H&O's bank account to himself and others.
- Investigators believe that Lopez fled the United States in March 2008 and may be residing in Cuba.
OIG Fugitive: Rajindera Sachdeva
- From approximately January 2005 until December 2006, Rajindera Sachdeva was an occupational therapist who worked with various Medicare providers.
- According to investigators, Sachdeva created occupational and physical therapy files for services that were never provided to patients. The files were then sold to co-conspirator Ehsan Rana, the owner of Alternative Physical Therapy, Incorporated. Alternative Physical Therapy billed Medicare for occupational and physical therapy services that were not provided. Files were also sold to Tri-County Rehabilitation.
- Sachdeva was paid approximately $3.3 million from Medicare.
- Sachdeva and co-conspirator Venkata Rama-Reddy Medapti created occupational and physical therapy files for services that were not provided to patients. SAT Rehabilitation Services billed Medicare for the physical and occupational therapy services that were not provided.
- Sachdeva was indicted on charges of Health Care Fraud.
OIG Fugitive: Gautam Gupta
- On June 13, 2011, an arrest warrant was issued against Gautam Gupta, charging him with health care fraud, mail fraud, and conspiracy to commit fraud. Dr. Gupta and his associates allegedly received approximately $25 million in reimbursements from Medicaid and private health insurers for medical services that were either unnecessary or not performed.
- Dr. Gupta owned and operated the Nutrition Clinic, a weight loss clinic with several locations in Northern Illinois and the Chicago metropolitan area. According to the arrest warrant, the clinic required new patients to undergo medical tests, such as thyroid ultrasounds and echocardiograms, without regard to medical necessity for the tests. The Nutrition Clinic would then submit claims to Medicaid and private insurance companies, indicating that these tests were related to a specific medical diagnosis.
- The clinic also allegedly submitted claims for "evaluation and management" services performed by Dr. Gupta, when in actuality neither Dr. Gupta nor any other medical doctor saw these patients. In addition, investigators found that Dr. Gupta directed office staff to enlist insured patients for additional procedures, such as "nuclear stress tests" that were not medically necessary. The clinic would then bill the patients, Medicaid, and private insurers for those services.
- Authorities believe that Gupta is currently residing in India.
- On July 14, 2011, the U.S. Attorney for the Central District of Illinois issued another news release related to Dr. Gupta: Indictment Charges Two Doctors with Defrauding Medicaid, Insurance Companies of $24 Million in Operation of Weight-Loss Clinics
- In April 2010, Iyaye Ishmael, Tom Henderson Alabraba, and their co-conspirators were indicted on charges of conspiracy, health care fraud, and identify theft.
- From approximately July 2004 to November 2009, Ishmael, Alabraba, and others allegedly defrauded the Medicare program by billing Medicare more than $8.5 million for reimbursement for durable medical equipment that was either never provided, not legally prescribed, or not medically necessary.
- Ishmael was reported to be president of United Medical Services and co-owner of Central Medical, Inc. Alabraba was reportedly president of Tal-MED. All three were durable medical equipment supply companies in the Kansas City, Kansas area. According to the indictment, Ishmael, Alabraba, and others would fraudulently use the stolen identity of physicians in order to submit claims for equipment for beneficiaries whom the physicians had never seen. The companies would either not provide the equipment or would provide a relatively inexpensive piece of equipment compared to the cost of the equipment billed to Medicare.
- Ishmael, Alabraba, and their co-conspirators would allegedly share beneficiary information in order to submit additional Medicare billings.
- One of Ishmael and Alabraba's co-conspirators has pleaded guilty to Conspiracy to Commit Health Care Fraud and Health Care Fraud. Another is awaiting trial.
- Authorities believe that Ishmael may be residing in Nigeria. Alabraba's whereabouts are unknown; he was last reported to be in Katy, Texas.
- In October 2008, an arrest warrant was issued for Rodolfo Bouza on health care fraud charges for allegedly billing Medicare for more than $750,000 in false claims.
- Bouza owned and operated Newburg Services, Inc., based in Louisville, Kentucky, that purportedly provided bandages and durable medical equipment (DME) to Medicare beneficiaries.
- Investigators believe that Bouza, through his company, billed Medicare for DME that was never provided to beneficiaries or prescribed by a physician. Bouza allegedly stole the provider numbers of physicians, as well as the names and personally identifiable information of Medicare beneficiaries.
- Investigators interviewed staff of two physicians whose names were on the DME billing records as prescribing physicians. Both practices said they never heard of Newburg Services, and none of the beneficiaries on the lists were patients of the physicians. Investigators also contacted beneficiaries purported to have received DME supplies from Newburg Services, and the beneficiaries said they never heard of the company and never received DME supplies from the company.
- Bouza remains at large.
- In July 1995, Robert Allen Lopez was arrested in Miami and charged with conspiracy to commit health care fraud. Lopez is suspected of causing over $4 million in false Medicare claims to be filed.
- According to the indictment, from July 1991 until June 1994, Lopez and others conspired to defraud the United States Government by filing false Medicare claims and structuring cash transactions to evade currency reporting requirements.
- Investigators found that Lopez established numerous companies in Miami using fake owners to conceal the fact that he was the true owner of these companies. These companies allegedly filed false Medicare claims on behalf of beneficiary recipients for services that were either medically unnecessary or were not provided.
- According to the indictment, Lopez also allegedly recruited friends and relatives to assist him as fake owners. He directed them to open bank accounts where the fraudulently obtained Medicare checks were deposited and easily converted to cash. To avoid currency reporting requirements for cash transactions exceeding $10,000, it is believed that Lopez directed the fake owners to make structured cash withdrawals from the accounts.
- On July 31, 1995, Lopez was arrested, charged with conspiracy, and released on bail on the condition that he not change his residence or leave the area without first obtaining permission from the United States Probation Office. Lopez violated the terms of his release when he could not be found at his residence and later failed to appear for sentencing. Authorities believe Lopez may be in Mexico or Colombia.
- In July 2008, Aliyevich Abukov was indicted on charges of Wire Fraud, Aggravated Identity Theft, Health Care Fraud, and Criminal Forfeiture.
- Abukov purchased an Oregon corporation known as Quickmed Supply, LLC, and arranged for the location to falsely appear to be engaged in the sale of medical equipment mainly orthotics. As a part of the scheme, Abukov fraudulently obtained and used medical doctors' Unique Physician Identification Numbers as well as patient information to bill Medicare for , medical equipment that were never provided to Medicare beneficiaries.
- Investigators believe that from 2007 to 2008, Abukov and others submitted approximately $1.1 million in fraudulent claims to Medicare. As a result, Abukov received $759,340 in fraudulent payments by interstate wire transfer. He opened a bank account designated to receive Medicare reimbursement by wire transfer from a Medicare program contractor in Baton Rouge, Louisiana.
- In July 2007, Sideig Ahmed was indicted on charges of Health Care Fraud. He was the principal owner of A-Elite Transportation, which provided transportation services in the Indianapolis, Indiana, area.
- Investigators believe that between approximately May 2003 and April 2007, Ahmed submitted claims to Medicaid for providing transportation in wheelchair-accessible vehicles to patients that he knew could walk and did not use wheelchairs.
- Ahmed defrauded Medicaid of over $200,000 by charging for transportation that was more expensive than patients needed.
- Ahmed is believed to be living in Khartoum, Sudan.
- In May 2009, Shafiulla Abdul Hanif was indicted on charges of Health Care Fraud Conspiracy, Health Care Fraud, Money Laundering Conspiracy, and Criminal Forfeiture. Investigators believe that Hanif and his co-conspirators submitted over $18 million in fraudulent claims to Medicare for medical treatments and services that were not provided or were medically unnecessary.
- According to court documents, Hanif was a co-owner and controller of TriStar Rehab Services, Inc. (TriStar); S.U.B. Rehabilitation & Physical Therapy Center, Inc. (S.U.B); Hands-On Rehab Services, Inc. (HOR); and M&M Management, Inc. (M&M). All companies were located in the Detroit Area. TriStar and S.U.B. allegedly provided outpatient physical therapy, occupational therapy, and speech pathology services to patients. M&M and HOR allegedly hired and maintained licensed and unlicensed therapists to provide physical and occupational therapy to patients.
- Investigators believe that from January 2003 through March 2007, Hanif and his co-conspirators paid Medicare beneficiaries to sign Medicare reimbursement forms for medical treatments and services at their businesses that were actually not provided or were medically unnecessary. Through their companies, Hanif and his co-conspirators then fraudulently filed reimbursement forms with Medicare, seeking over $18 million in payment for these false medical services and treatments.
- Hanif fled the United States once he was confronted about his participation in the scheme, and he remains at large. Co-conspirators Muhammad Azeem and Anupal Gayen also fled the United States and remain fugitives. Co-conspirators Suresh Chand, Jaquita Lovelace, Syed Aziz, Solomon Nathaniel, Jay Jha, Baskaran Thangarasan, and Sandeep Aggarwal each pleaded guilty and were sentenced to a combined 22 years in prison and ordered to pay more than $9.7 million in restitution, joint and several.
- In February 2011, Francisco Chavez was indicted on charges of Health Care Fraud, Aggravated Identity Theft, and Criminal Forfeiture. Chavez is believed to have submitted more than $11 million in claims to Medicare for durable medical equipment that was never provided to Medicare beneficiaries.
- Chavez was the president and registered agent of World Class Medical Services, Corporation, a durable medical equipment company based in Miami, Florida, that sold supplies such as pressure support ventilators, standard motorized wheelchairs, and enteral formula. According to court documents, Chavez fraudulently obtained and used medical doctors' Unique Physician Identification Numbers to bill Medicare for durable medical equipment that was never provided.
- Investigators believe that from March through August 2006, World Class submitted more than $11 million in claims to Medicare for durable medical equipment supplies. As a result, World Class was paid approximately $1.7 million by Medicare. However, beneficiaries complained that they never received any of the items billed to Medicare by World Class.
- Chavez is being detained in Spain on charges related to a narcotics arrest at the Barajas Airport (Spain). U.S. authorities are working with the Spanish Government to have him extradited to the United States.
- In February 2010, Luciano Velazquez was indicted on charges of Health Care Fraud, False Statements Related to Health Care Fraud Matters, and Aggravated Identity Theft. Investigators believe that through his fraudulent companies, Velazquez billed Medicare more than $8 million in false claims, collecting approximately $2.9 million.
- Velazquez owned and operated Luciano Medical Center and S & A Rehabilitation Center (SARC), both located in Hialeah, Florida, just outside of Miami. Both centers purported to provide medical services, including rare outpatient HIV infusion and cancer drug therapies.
- According to the indictment, Velazquez submitted false Medicare Enrollment Applications in order to fraudulently receive claim payments for services allegedly provided by Florida physicians. Additionally, Velazquez allegedly used the identifying information of Medicare beneficiaries to submit claims for services that were never provided.
- Velazquez also owned and controlled Velazquez Development of Florida, an alleged shell company by which proceeds from the fraudulent scheme were moved.
- Approximately $175,000 was seized from SARC's bank account through a warrant in November 2007.
- Velazquez is currently at large.
- In October 2008, Jose Garcia-Suarez was indicted on charges of conspiracy, health care fraud, and aggravated identity theft.
- From May 2007 to March 2008, Garcia-Suarez and others allegedly billed Medicare for $333,000 for intravenous infusion cancer treatments that were never performed.
- Garcia-Suarez was president of Continuum Care Solutions, a company that purportedly provided infusion therapy services. According to the indictment, Garcia-Suarez applied to be a Medicare provider using the illegally obtained identification of four physicians who had Medicare provider numbers. He then used the doctors' names as the company's physicians in order to submit at least nine fraudulent bills for reimbursement from Medicare for intravenous infusion cancer treatments that were never performed.
- Authorities believe that Garcia-Suarez may be residing in the Dominican Republic.
- In October 2008, Pablo Sanu-Yasell was indicted on charges of conspiracy to commit health care fraud, health care fraud, and aggravated identity theft.
- From September 2007 to March 2008, Sanu-Yasell and others allegedly defrauded the Medicare program by submitting $120,000 in fraudulent claims for intravenous infusion cancer treatments that were never performed.
- Sanu-Yasell was president of Longer Life Services, a company that purportedly provided infusion therapy services. According to court papers, Sanu-Yasell applied to be a Medicare provider using the illegally obtained identification of four physicians who were Medicare providers. Sanu-Yasell then used the doctors' names as the company's physicians in order to submit fraudulent bills for reimbursement from Medicare for intravenous infusion cancer treatments that were never performed.
- Authorities believe that Sanu-Yasell may be residing in the Dominican Republic.
- In May 2009, an arrest warrant was issued for Muhammad Azeem on charges of health care fraud conspiracy, health care fraud, and money laundering conspiracy. It is believed that through their alleged scheme, Azeem and his accomplices submitted over $18 million in fraudulent claims to Medicare.
- According to court documents, from January 2003 through March 2007, Azeem and his co-defendants controlled several medical therapy and medical services companies in Michigan and paid Medicare beneficiaries to sign Medicare reimbursement forms for medical treatment and services that were not provided.
- After receiving the signed Medicare forms, it is alleged that Azeem and his accomplices filed the forms with Medicare, seeking payment for services and treatment that were not actually provided to the beneficiaries.
- Azeem and his co-conspirators also established several fictitious companies in an effort to conceal the money and assets gained from the scheme.
- Azeem fled the United States after being confronted by authorities about his participation in the scheme, and he remains at large.
Ezechukwu "Dr. Joshua" Ohaka
- Ezechukwu Ohaka, along with co-conspirators, allegedly submitted more than $3.1 million in fraudulent claims to Medicare for durable medical equipment (DME), according to a Federal indictment. The "gross proceeds of the fraud" allegedly totaled approximately $1.08 million, the indictment stated.
- Through his Houston-based company, Luant & Odera, Inc., Ohaka and others allegedly billed for medically unnecessary power wheelchairs, motorized scooters, and wheelchair accessories that were either not medically necessary or were not provided. In some instances, Ohaka and others purportedly would bill Medicare for more expensive wheelchairs than they provided to beneficiaries.
- The beneficiaries who received the scooters and wheelchairs had either not been to a doctor, did not have a prescription, as required by Medicare, and/or did not meet medical necessity requirements as defined by Medicare.
- Falsely referring to himself as a doctor ("Dr. Joshua Ohaka"), Ohaka and co-conspirators targeted Medicare beneficiaries who were living in the paths of Hurricanes Katrina and Rita.
- Ohaka, originally from Nigeria, allegedly paid kickbacks to individuals to recruit Medicare beneficiaries so that Luant could file bogus claims with Medicare for DME.
- In April 2008, Gustavo Adolfo Smith was convicted on charges of conspiracy to defraud the United States, health care fraud, submission of false claims, and money laundering.
- According to court records, from February 2005 to May 2007, Smith owned and operated MedStar Services, a durable medical equipment (DME) company in the Miami area. Smith was responsible for submitting more than $2.9 million in bills to Medicare for medical equipment that was never provided to Medicare beneficiaries. From these claims submissions, Smith received approximately $1.5 million from Medicare.
- Smith persuaded his associates to register as the president and registered agents of MedStar so he could remain hidden to operate the fraudulent scheme. Smith maintained the majority of control over MedStar and he attempted to launder proceeds from his fraudulent claims by withdrawing and wire-transferring approximately $200,000 to a bank in Canada.
- After being convicted, Smith was ordered to wear an electronic monitoring device while awaiting sentencing. On June 14, 2008, Smith's monitoring device set off an alert; authorities responding to the alert were unable to locate Smith. Later on the same day, authorities learned that Smith had boarded a flight from Miami to Santo Domingo, Dominican Republic.
- Carlos Warter was a medical doctor licensed to practice medicine in the State of Hawaii. From December 2004 through December 2008, he fraudulently billed the Hawaii Medicaid program, Hawaii QUEST (the State's Medicaid managed care program), Hawaii Blue Cross Blue Shield, and TRICARE for services not provided and for inflated services.
- Through the false and inflated claims, Warter billed these programs approximately $1 million and received approximately $530,000 in purported reimbursements.
- Warter operated a psychiatry practice in Hawaii, but he frequently traveled out of state and out of country for business and personal purposes. Warter submitted claims for psychotherapy services supposedly provided by him on days when he was not in Hawaii.
- According to a Federal indictment, claims submitted by Warter overstated the amount of time spent with his patients. Many of the claims submitted represented that he had provided psychotherapy sessions of 45-50 minutes or 75-80 minutes, but these sessions usually lasted only 15-20 minutes.
- Warter was arrested by Argentina officials on May 23, 2011 based on a U.S. request for provisional arrest pending Federal charges.
OIG Fugitive: Oleg Kheyson
- Between September 2006 and July 2010, in the Eastern District of New York and elsewhere, Oleg Kheyson and others participated in a scheme to defraud Medicare, a U.S. Government-sponsored health care program. It is alleged that during the time of the conspiracy and scheme to defraud Medicare, Best Equipment submitted fraudulent claims in the amount of approximately $1.28 million.
- Kheyson was a co-owner of Best Equipment, a medical provider certified (or otherwise authorized) to provide medical supplies to Medicare patients at a location on West 1st Street in Brooklyn. In 2008, Kheyson and others requested to add a second Best Equipment site on Brighton 13th Street; Medicare rejected this application, and thus Kheyson was never authorized to treat patients from the Brighton 13th Street site. However, despite this rejection, our evidence shows that from 2006 through July 2010, Kheyson and others billed Medicare for thousands of services from the unauthorized Brighton 13th Street site by submitting the claims through his certified location on West 1st Street.
- Kheyson and others also defrauded Medicare by submitting fraudulent claims for orthopedic insoles. In order for Best Equipment to receive reimbursement for orthopedic insoles, the Medicare patient had to have a shoe that was an integral part of a leg brace that was covered by Medicare.
- However, upon review of billing data for whom Best Equipment claimed it provided orthopedic insoles, none of the patients received orthopedic shoes or leg braces from Best Equipment or any other Medicare provider; therefore, all of the claims for orthopedic insoles were considered fraudulent.
OIG Fugitive: Etienne Allonce
- In December 2007, Etienne Allonce and his wife, Helene Michel, were indicted on charges of health care fraud. Allonce and Michel were owners of Medical Solutions Management, Inc. (MSM), a durable medical equipment (DME) company operating out of Hicksville, NY. Tri-State Surgical Supply (Tri-State) is a DME company that has a contract with numerous nursing homes in Long Island, Queens, and Brooklyn, to provide Medicare and Medicaid covered DME supplies to residents.
- According to the indictment, MSM employees allegedly posed as sub-contractors for Tri-State in order to gain access to several nursing homes. Once they entered the nursing homes under false pretenses, MSM employees allegedly accessed medical charts (containing private information protected by The Health Insurance Portability and Accountability Act of 1996 or HIPAA) for residents who required specialized wound care. MSM then allegedly billed Medicare Part B and/or and Medicaid for wound care supplies that were never ordered or provided.
- It is also believed that MSM employees stole original documents containing HIPAA information from medical charts in facilities, in order to "manufacture" fraudulent MSM charts in an effort to legitimize their medical billings.
- In July 2007, Michel was arrested and charged with illegal reentry into the United States after being deported to Haiti several years earlier. After Michel and Allonce were indicted on health care fraud charges for their participation in the aforementioned scheme, Allonce fled the United States to avoid prosecution and is believed to be residing in Haiti.
- Allonce abandoned the young daughter he had with Michel, leaving the girl without any parents while her mother remains incarcerated pending trial.
OIG Fugitive: Tarek Wehbe
- Between January 2002 and January 2007, Wehbe, a physician, allegedly submitted fraudulent claims to Medicare, Medicaid, and private health insurance carriers in order to obtain reimbursement for services that were either not provided, medically unnecessary, and/or over-charged.
- Wehbe allegedly perpetrated this fraud through the Renaissance Medical Group (RMG), based in Providence, Rhode Island, of which Wehbe was the president and owner. Health insurance carriers reimbursed RMG over $1.8 million by either depositing payments into RMG's bank account or sending reimbursement checks to RMG through the mail .
- These funds were deposited into and transferred between Wehbe's personal bank accounts and those of RMG, which he controlled. Wehbe allegedly laundered money through an account in a foreign country.
- Also, on more than 100 occasions, Wehbe allegedly issued prescriptions for controlled substances, such as Oxycodone and Hydrocodone, without medical justification.
- According to an April 2007 Federal indictment, Eduardo Moreno allegedly stole hundreds of thousands of dollars from the Medicare program, submitting false and fraudulent claims for durable medical equipment (DME) “and related health care benefits, items and services” that were medically unnecessary.
- Moreno used a “straw owner” and other methods to hide the money and property he obtained through these fraudulent schemes, the indictment alleged. (A straw owner is an individual who maintains the appearance of owning property in order to disguise the identity of the real owner.)
- He was arrested by the Miami Police Department on an open warrant. He failed to appear in court and his current whereabouts are unknown.
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Unimplemented OIG recommendations summarized.
FY 2013 Work Plan
OIG projects planned for 2013.
Significant OIG activities in 6-month increments.