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Livingston County doctor indicted for health care fraud

Court documents were unsealed this week charging 23 Michigan residents, including a Livingston County doctor, for their alleged involvement in two illegal schemes to defraud Medicare of more than $61.5 million by paying kickbacks and bribes and billing Medicare for unnecessary medical services that were never provided.

Among those charged in a federal indictment was Dr. Cornelius Oprisiu, 82, of Livingston County, as well as fellow physician Alejandro Mataverde, 79, of Oakland County, and Shafiq Rehman, 59, of Wayne County, a licensed nurse practitioner. According to a press release from the U.S. Department of Justice, all three were employed by Infinity Visiting Physician Services PLC (Infinity)  a home visiting physician company.

They allegedly provided medically unnecessary services to Medicare beneficiaries or submitted claims to Medicare for medical services that were not provided to the patients.

“As alleged, the defendants and their co-conspirators repeatedly paid illegal bribes and kickbacks so they could submit claims for medically unnecessary home health services throughout the Detroit metropolitan area, exposing patients to needless physician services and drug testing and costing Medicare tens of millions of dollars,” said Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division. “As these actions demonstrate, we will work tirelessly to tackle complex, illegal schemes that take advantage of vulnerable populations and defraud federal programs of taxpayer dollars meant to provide health care to millions of Americans.”

According to court documents, Walid Jamil, 62, and Jalal Jamil, 69, both of Oakland County, owned and operated several home health agencies in the Detroit metropolitan area. They allegedly concealed their ownership interest in these agencies using straw owners – including family members and other associates – and submitted approximately $50 million in fraudulent home health care claims to Medicare.

Specifically, Walid and Jalal Jamil allegedly paid bribes to other co-conspirators, including Dr. Oprisiu, to recruit patients in violation of the Federal Anti-Kickback Statute.

“These patients did not need home health care, did not qualify for home health care under Medicare rules, and in many instances were not actually provided the care for which Medicare was billed,” stated the press release. “Walid and Jalal Jamil allegedly entered into quid pro quo relationships with physician clinics to receive the necessary information to fraudulently bill Medicare. Based on their fraudulent claims, Walid and Jalal Jamil received more than $43 million from Medicare, which they misappropriated for their personal benefit.”

Carol Ibrahim, 45, of Oakland County, and Delaine Jackson, 48, of Wayne County, were employed by one or more of the Jamil home health agencies and operated these agencies at the direction of Walid Jamil. They each allegedly made illegal payments to patient recruiters and submitted false claims to Medicare. Ibrahim was also allegedly a straw owner of one of the Jamil home health agencies.

Ibrahim Sammour, 62, of Wayne County, was a registered nurse employed by the Jamil home health agencies. Sammour is alleged to have fraudulently billed Medicare for home health services he never provided and falsely certified patients as “homebound.”

Mary Smelter-Bolton, 69, of Oakland County, and Cass Hawkins, 52, of Wayne County, were allegedly recruiters paid by various Jamil home health agencies to refer them Medicare beneficiaries for home health services that were then billed to Medicare, even though the claims were not eligible for reimbursement.

According to court documents, beginning in at least February 2015, Radwan Malas, 43, of Oakland County, operated Infinity as a home visiting physician company and allegedly ordered the physicians he employed to certify patients referred by Walid Jamil and Jalal Jamil for medically unnecessary home health services. He then allegedly billed Medicare for services that were never actually provided to these patients – including 60-minute complex patient visits – and for services that were not medically necessary – including B-12 and Toradol injections. Malas also allegedly demanded that physicians in his office order the highest-reimbursing urine drug test for patients, which was medically unnecessary, but for which Malas allegedly received a referral fee from the laboratory that processed the samples.

As part of this scheme, the defendants billed Medicare over $11.5 million in fraudulent claims for which they were paid nearly $4 million, which they misappropriated for their personal benefit. Malas is also alleged to have laundered the misappropriated funds by conducting illegal financial transactions.

Michael Molloy, 50, of Wayne County, was co-owner of Integra Lab Management LLC (Integra), which processed the high-reimbursing and allegedly medically unnecessary urine tests submitted by Infinity. Molloy and his co-owners allegedly paid the salary of Infinity employees and made monthly payments to Malas in exchange for the physician orders for the medically unnecessary urine drug testing.

As a result of the illegal kickbacks, Integra submitted approximately $2.8 million in fraudulent claims to Medicare and was paid more than $730,000.

Montaha Hogeige, 39, of Wayne County, was a medical assistant employed by Infinity who allegedly agreed to receive her salary from Integra as an illegal kickback to Infinity in exchange for physician orders for high-reimbursing urine drug testing.

“Medicare is designed to provide vital government funded services to our people. It is not a slush fund for thieves and fraudsters,” said Acting Special Agent in Charge Charles Miller of the IRS Criminal Investigation (IRS-CI) Detroit Field Office. “IRS-CI will work tirelessly with our law enforcement partners to investigate those who illegally target our Medicare program for personal financial gain.”

Dr. Oprisiu was charged with Conspiracy to Commit Health Care Fraud and Health Care Fraud, both ten year felonies.

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