A Dallas physician assistant who willingly processed fake prescriptions, a Detroit rehabilitation center owner who submitted false occupational therapy claims and a Maryland executive who bilked taxpayers of more than $7 million are among the latest in the federal government’s lengthening list of successful Medicare and Medicaid fraud prosecutions.
Cal Graves, 31, a physician assistant working at the South Dallas Community Health Center, was convicted in federal court of one count of conspiracy to commit healthcare fraud. He was sentenced to five years in prison, fined $250,000 and required to make restitution to the government.
Physician Daniel Leong, who wrote the fake prescriptions processed by Graves, goes to trial later this year. Leong “signed a blank prescription and instructed Graves and other staff at SDMC to copy and use this pre-signed prescription as needed,” U.S. Attorney Sarah Saldana said.
“Patients had their prescriptions filled at pharmacies, which then submitted claims to Medicare and Medicaid for reimbursement. However, Medicare and Medicaid would not have paid those claims if they had known that Leong never saw the patient or supervised Graves’ examination and treatment of the patients or that Leong did not prescribe the medications,” Saldana said.
For more on the case, go here.
In the Detroit case, Tariq Mahmud, 54, was convicted in federal court on one count of conspiracy to commit healthcare fraud and six counts of health care fraud, according to the Department of Justice (DOJ). He was the fifth defendant to be found guilty in a $3 million Medicare fraud case filed in last year.
“According to evidence presented during the trial, Mahmud was the owner of Comprehensive Rehabilitation Services Inc. (CRS), a fraudulent rehabilitation agency located in Dearborn, Mich. Between January 2003 and February 2007, CRS purchased falsified physical and occupational therapy files from more than 30 therapy and rehabilitation companies and used them to fraudulently bill Medicare for more than $3 million,” DOJ said in a statement.
For more from DOJ on the case, go here.
In the Maryland case, Jacqueline Wheeler, 54, of Chevy Chase, was convicted in a federal court in the District of Columbia on one count of conspiracy to commit health care fraud and 34 counts of making false statements while submitting more than $7 million in false claims to Medicaid.
Wheeler could get as much as 10 years in prison and a $250,000 fine for the conspiracy count and five years in prison and a $250,000 fine on each of the 34 false statements. She is now being held in jail pending an October sentencing date.
“This CEO stole millions trying to get rich off a program designed to provide health care for our most vulnerable citizens,” said U.S. Attorney Ronald Machen.
For more on the case, go here.
These three convictions are the latest in the work of the Health Care Fraud Prevention & Enforcement Action Team (HEAT) and Health Care Fraud Task Force that combine prosecutors and investigators from DOJ, the Department of Health and Human Services Inspector-General (HHS-IG) and state law enforcement personnel.
Lst year, the effort resulted in a “record number of 323 defendants, who allegedly collectively billed the Medicare program more than $1 billion. Strike force teams secured 172 guilty pleas, convicted 26 defendants at trial and sentenced 175 defendants to prison. The average prison sentence in strike force cases in FY 2011 was more than 47 months,” according to the HHS-IG.
In addition, the effort “recovered nearly $4.1 billion in taxpayer dollars in Fiscal Year (FY) 2011. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled,” the HHS-IG said.
