August 21: Week That Was in Healthcare Fraud and Malpractice
By - Here is a general roundup of the past week’s developments in healthcare fraud and malpractice, as reported by the Department of Justice and the Office of Inspector General. The crimes reported below result in multiple millions of dollars in healthcare fraud and the possibility of extensive prison time.
California ambulance company guilty of Medicare fraud
Yaroslav “Steven” Proshak, Emilia Zverev, and Sharetta Michelle Wallace were each convicted this week of one count of conspiracy to commit healthcare fraud and five counts of healthcare fraud in a case brought as part of the Medicare Fraud Strike Force. Proshak was the owner and operator of Los Angeles-based ProMed Medical Transportation, an ambulance transportation company providing Medicare beneficiaries with non-emergency ambulance transportation. Zverev was a billing manager and Wallace supervided emergency medical technicians (EMTs).
According to trial evidence, between 2008 and 2010, the defendants plotted to bill Medicare for ambulance transportation services, knowing such services were unnecessary. Additionally, the defendants told ProMed EMTs to obscure patients’ medical conditions by making changes to paperwork and creating fraudulent documents to validate transportation services as being erroneously needed.
Trial evidence states ProMed submitted $2.4 million in false and fraudulent Medicare claims for the unneeded ambulance transportation services with Medicare paying for $1.2 million of these claims.
$4.5M California Medicare fraud scheme
Hovik Simitian, an owner and operator of three Los Angeles medical clinics – Columbia Medical Group Inc, Life Care Medical Clinic, and Safe Health Medical Clinic – pleaded guilty this week to submitting $4.5 million in fraudulent claims to Medicare.
In addition to pleading guilty, Simitian stated from 2010 to 2014 he and co-conspirators paid cash kickbacks to those patient recruiters who brought Medicare beneficiaries through clinic doors. Simitian added they also billed Medicare for medically unnecessary lab tests and fabricated documentation in an attempt to prove nonexistent services had been provided. Over $4.5 million in false and fraudulent claims were submitted to Medicare via Simitian and his co-conspirators. Over $1.6 million of these claims were paid for through Medicare.
NJ ambulance provider charged in 17-count fraud case
Imadeldin Awad Khair (also known as Nadr Khair) of Clifton, New Jersey is in hot healthcare water this week for his involvement operating a “lucrative” ambulance company that received Medicare and Medicaid funds although a previous healthcare fraud conviction had banned him from conducting business. Khair was charged with one count of healthcare fraud, one count of obstruction of a federal audit, 11 counts of tax evasion, and 4 counts of money laundering.
Regarding his 2003 convictions, Khair was barred from participating with federal health programs, such as Medicare and Medicaid, for over a decade. Says the Department of Justice, “Despite this, Khair has since 2005 been an operator and a de facto owner of K & S Invalid Coach, a licensed ambulance and wheelchair transportation service operating out of Clifton. Nearly all of K & S’s patients were Medicare or Medicaid beneficiaries requiring regular transportation to dialysis treatment. ”
Medicare paid over $6.5 million in claims submitted by K & S, with Medicaid paying over $1 million in claims since January of 2010 alone.
“Khair and others at K & S concealed his involvement in the company from Medicare and N.J. Medicaid, including his substantial control over K & S’s bank accounts and operations, including the authority to hire and terminate employees, determine employee salaries, and enforce company policies,” confirms the Department of Justice. “In order to carry out the tax evasion, Khair paid the ‘off the books’ wages via cash or handwritten check and directed K&S employees to underreport to the company’s payroll company the actual number of hours worked.”
