MICHIGAN HOME HEALTH AGENCY OWNER PLEADS GUILTY IN MEDICARE FRAUD SCHEME

FROM:  U.S. JUSTICE DEPARTMENT 
Thursday, August 15, 2013
Michigan Physical Therapist and Home Health Agency Owner Pleads Guilty for Role in Medicare Fraud Scheme

A greater Detroit-area physical therapist who was also an owner of a home health agency pleaded guilty yesterday for his role in a $22 million home health care fraud scheme.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade, Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office, Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office, and Special Agent in Charge Erick Martinez of Internal Revenue Service Criminal Investigation made the announcement.

Hemal Bhagat, 32, of Troy, Mich., pleaded guilty on Aug. 14, 2013, before U.S. District Judge Bernard A. Friedman in the Eastern District of Michigan to one count of conspiracy to commit health care fraud.  At sentencing, scheduled for Nov. 12, 2013, Bhagat faces a maximum penalty of 10 years in prison and a $250,000 fine.

According to information contained in plea documents, Bhagat admitted that from approximately May 2009 through October 2011, he conspired with others to commit health care fraud through billing Medicare for home health care services that were not actually rendered and/or not medically necessary.  A licensed physical therapist, Bhagat began working in June 2009 for Troy-based Prestige Home Health Services Inc., a home health agency owned by alleged co-conspirators.   In approximately August 2009, he and other co-conspirators became owners of Royal Home Health Care Inc., a home health agency also located in Troy.

Bhagat admitted that his co-conspirators at Prestige and Royal paid kickbacks to patient recruiters to obtain the information of Medicare beneficiaries, which the co-conspirators then used to bill Medicare for services that were not provided to these beneficiaries and/or were not medically necessary.   He and his co-conspirators then created fictitious therapy files appearing to document physical therapy services provided to Medicare beneficiaries, when in fact no such services had been provided and/or were not medically necessary.   Bhagat’s role in creating the fictitious therapy files was to sign documents – including physical therapy evaluations, supervisory patient visits, and patient discharge forms – indicating that he and others had provided physical therapy services to particular Medicare beneficiaries, when in fact they had not.   Bhagat admitted to knowing that the documents he falsified would be used to support false claims to Medicare by his co-conspirators at Prestige and Royal.   He submitted or caused the submission of claims to Medicare for services that were not medically necessary and/or not provided, which in turn caused Medicare to pay approximately $4,767,359.03.

This case was investigated by the FBI, HHS-OIG and IRS Criminal Investigation and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.  This case is being prosecuted by Trial Attorney Niall M. O’Donnell, Deputy Chief Charles E. Duross, and Trial Attorney James McDonald of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

TWO CONVICTED IN DETROIT AREA $14.5 MILLION MEDICARE FRAUD SCHEME

Photo Credit: U.S. Marshals Service

FROM: U.S. DEPARTMENT OF JUSTICE

Friday, October 26, 2012

Detroit Area Physician, Home Health Agency Owner and Patient Recruiter Convicted in $14.5 Million Medicare Fraud Scheme
WASHINGTON – A federal jury in Detroit today convicted a physician, a home health agency owner and a patient recruiter for their participation in a $14.5 million Medicare fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan; Robert Foley III, Special Agent in Charge of the FBI Detroit Field Office; and Special Agent in Charge Lamont Pugh, III of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Detroit Office.

Dr. Pramod Raval, 59, was found guilty in U.S. District Court for the Eastern District of Michigan of one count of conspiracy to commit health care fraud and one count of conspiracy to solicit or receive health care kickbacks in exchange for referring patients to two Detroit area home health care companies, Patient Choice Home Healthcare Inc. and All American Home Care Inc.

Chiradeep Gupta, 38, a physical therapist and part-owner of All American, was found guilty of one count of conspiracy to commit health care fraud, one count of conspiracy to commit money laundering and three substantive counts of money laundering.

Richard Shannon, 39, a patient recruiter, was found guilty of one count of conspiracy to commit health care fraud.

The defendants were charged in a superseding indictment returned March 27, 2012. Sixteen other individuals who worked at or were associated with Patient Choice and All American have previously pleaded guilty.

According to evidence presented at trial, the defendants and their co-conspirators caused the submission of false and fraudulent claims to Medicare through Patient Choice and All American, two home health care companies located in Oak Park, Mich., that purported to provide skilled nursing and physical therapy services to Medicare beneficiaries in the greater Detroit area.

The evidence showed that the defendants and their co-conspirators used patient recruiters, who paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary. The owners of Patient Choice and All American paid physicians to sign referrals and other therapy documents necessary to bill Medicare. Physical therapists and physical therapist assistants provided through contractors would then create fake medical records using the blank, pre-signed forms obtained by the patient recruiters to make it appear as if physical therapy services were actually rendered, when, in fact, the services had not been rendered.

According to evidence presented at trial, Raval referred both patients from his own practice and patients brought into the scheme by recruiters to Patient Choice and All American in exchange for kickbacks. Gupta provided to Patient Choice and All American physical therapists and physical therapist assistants who created fake patient files using blank, pre-signed forms obtained by patient recruiters, to make it appear as if the physical therapy services billed to Medicare had actually been given. Gupta also doctored and directed the doctoring of fake patient files. The evidence at trial showed that Gupta laundered the proceeds of the fraud through multiple shell companies. Shannon paid patients in cash in order to obtain their signatures on blank physical therapy forms used to create fake therapy documents.

Vishnu Meda, a physical therapist assistant at Patient Choice and All American, was acquitted today of one count of conspiracy to commit health care fraud.

The case was prosecuted by Assistant Chief Gejaa T. Gobena and Trial Attorneys Catherine K. Dick and Niall M. O’Donnell of the Criminal Division’s Fraud Section. The investigation was led by the FBI and HHS-OIG, and was brought by the Medicare Fraud Strike Force, a joint effort of the U.S. Attorney’s Office for the Eastern District of Michigan and the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.