Brooklyn Medicare Fraud Strike Force: Recent Cases from the May 2014 Nationwide “Takedown”

In our last post, we discussed the history and tactics of the Department of Justice’s Medicare Fraud Strike Force.  We also talked briefly about the recent Healthcare Fraud nation-wide “takedown.”  But as we also mentioned, this was not one giant case involving 90 defendants, but rather dozens of cases, scattered throughout six different cities.  Each one of those cases has a different history; a different story.  From a practical perspective, it can be instructive to take a look at all the cases charged in a particular Strike Force city to get a feel or a sense of what types of cases are being brought there and how the government investigates healthcare fraud differently in different places.  In this installment, we’ll start off by looking at the four cases brought in the Eastern District of New York in Brooklyn.

U.S. v. Chikwere Onyekwere and Uchechi Onyekwere, 14 CR 274 EDNY

The government alleges in its indictment that the defendants, owners and operators of two DME companies (durable medical equipment, such as wheelchairs and surgical supplies)  (“Excellent Care Medical Supply” and “Academy Medical Supply”), submitted false and fraudulent claims to Medicare Managed Care, also known as “Medicare Part C.”  The U.S. Attorney for the Eastern District of New York charges that the defendants created sham (or “dummy”) companies, contacted Healthfirst, Medicare’s approved Managed Care Organization, and claimed that DME had been ordered for their members.  They obtained authorization codes from Healthfirst that they used when the defendants allegedly submitted claims for the sale of DME to these members.  The government claims that defendants Onyekwere (who were brother and sister) submitted over $13 million in fraudulent claims for reimbursement of DME to Healthfirst and Medicare and that Healthfirst paid out over $4 million in reimbursement for those claims.

The Onyekwere siblings were charged with several counts of Healthcare Fraud under 18 U.S.C. § 1347, Healthcare Fraud Conspiracy under 18 U.S.C. § 1349 and HIPAA violations (illegal use of protected healthcare information) under 42 U.S.C. § 1320d-6.  They face the possibility of more than 10 years in prison.

U.S. v. Gene Thornhill, Tina Thornhill and Roman Johnson, 14 CR 278 EDNY

In this case, the government alleges that the defendants were owners and operators of various clinics that provided vitamin infusions, physical therapy, ultrasounds, echocardiograms and other medical services.  The government believes that the defendants submitted claims for these services that were either not medically necessary, not provided at all, or otherwise did not qualify for reimbursement from Medicare.  The indictment (which is proof of nothing) alleges that the defendants submitted claims for physical and occupational therapy on behalf of the same patient for months and even years at a time and that such treatment was not medically necessary and was not actually provided.  The government also believes that the defendants had non-licensed individuals providing the physical therapy as well as vitamin infusion.

The government also believes that in response to governmental requests, the defendants created fake medical files containing false information about the services provided as well as the medical necessity of those services in order to conceal the purported fraud.

The government believes that the defendants submitted false claims valued at approximately $14 million.  The defendants are charged with Healthcare Fraud Conspiracy, Falsification of Records in a Federal Investigation, under 18 U.S.C. § 1519, False Statements Relating to Health Care Matters, under 18 U.S.C. § 1035(a)(1) and Money Laundering, under 18 U.S.C. § 1957(a) and (b).

U.S. v. Haroutyoun Margossian

In this case, the government claims that Dr. Margossian was an OB/GYN doctor who claimed to be performing thousands of Anorectal Manometry (“ARM”) Testing.  The government noticed that Dr. Margossian was the fifth most “prodigous” biller of this test in the nation. (As an aside: This is proof of nothing — if it were, ask yourself:  Why didn’t they also charged the first, second, third and fourth most “prodigous” billers?  This is a common tactic of the Strike Force.  What they are really doing is trying to present an image to the public and the jury using salacious and provocative data and statements.)   They also claim that they randomly sampled his patients, 17 of whom claimed that they never had this procedure.  The government also claimed to analyze Dr. Margossian’s travel records which indicated that he purportedly filed claims for the ARM test while he was out of the country.  The government also analyzed the amount of time it “should” take to perform the ARM test and determined that based on the number of procedures, Dr. Margossian could not have physically performed the number of procedures claimed on a variety of particular days.

Based on this, Dr. Margossian was charged with Healthcare Fraud, for allegedly defrauding Medicare out of millions of dollars.

U.S. v. Syed Imran Ahmed, 14 CR 277 EDNY

Dr. Ahmed is a physician with offices in Brooklyn and Long Island.  A significant portion of his practice involved performing “incision and drainage” and “wound debridement” surgical procedures.  The government claims that in a three year period, Dr. Ahmed billed Medicare approximately $85 million for these surgical procedures that either never took place, or if they did, they were not performed in an operating room (thus, requiring a larger reimbursement).  Medicare paid Dr. Ahmed approximately $7.5 million for these procedures that they now seek to recover.

The government also believes that Dr. Ahmed illegally funneled those allegedly fraudulently obtained moneys into various bank accounts in an effort to cover up the supposed illegal nature of his conduct.  It also claims that Dr. Ahmed fabricated medical records in an effort to conceal the alleged false billings.

These four cases are prime examples of the types of cases brought by the prosecutors in the Brooklyn Medicare Fraud Strike Force.  Because of the high stakes and technical data analysis employed in the prosecution, it is critical for anyone charged with Healthcare Fraud or related crimes to seek out a Federal Criminal Lawyer experienced in Healthcare Fraud matters.

To learn more about Federal criminal laws, such as those involving Healthcare Fraud and related crimes, review the Federal criminal law section of Crotty Saland PC’s website linked above and below.

Founded by former prosecutors, the Federal criminal defense lawyers at Crotty Saland PC represent clients accused of violating Federal criminal laws and statutes in the New York City, New York State and District Courts throughout the United States.

 

Updated: