23 Michigan residents charged in $61.5 million Medicare fraud scheme

Nearly two dozen Michiganders involved in home health care are accused of bilking Medicare out of $61.5 million through kickbacks, bribes, and medical services never rendered, according to federal authorities.

The U. S. Department of Justice is charging 23 Michigan residents in the alleged scheme, according to a news release.

Walid Jamil, 62, and Jalal Jamil, 69, both of Oakland County, operated and owned numerous home health agencies in metro Detroit. The pair operated these businesses using straw owners — they used their friends and family to hide their identities, according to the Justice Department.

Walid and Jalal Jamil submitted approximately $50 million in fraudulent home health care claims to Medicare, the government contends. The pair also allegedly paid bribes to co-conspirators to find patients in violation of the Federal Anti-Kickback Statute. These patients did not actually need home health care, nor did they qualify for home health care under Medicare and actually did not receive the care but Medicare was still billed, the government said.

“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 Polite Jr., of the Justice Department’s Criminal Division, in a written statement. “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.”

The pair also allegedly entered into favor-based relationships with physician clinics to receive the necessary information to submit the fraudulent Medicare bills. They received approximately $43 million from Medicare and used it for their personal benefit.

"The alleged actions of these defendants is an astonishing abuse of our health care system,” U.S. Attorney for the Eastern District of Michigan Dawn Ison said in a written statement. “By allegedly submitting fraudulent claims and paying illegal kickbacks, these defendants looted Medicare in order to line their own pockets at great cost to taxpayers. My office is grateful for the continued work of the Health Care Fraud Strike Force to root out corrupt medical professionals.”

Attorneys of record have not yet been listed in federal court documents for the defendants charged in this case, except for Jalal Jamil. He is being represented by Bloomfield Hills attorney Robert Harrison, who was not readily available for comment.

Carol Ibrahim, 45, of Oakland County, and Delaine Jackson, 48, of Wayne County, were employees at one or more of the health care agencies and operated these businesses under Walid Jamil. Ibrahim and Jackson allegedly made illegal payments to patient recruiters and submitted false claims to Medicare. Ibrahim was also claimed to be one of the straw owners of one of the home health agencies.

Ibrahim Sammour, 69, of Oakland County, served as a registered nurse that was employed by Jamil home health agencies. Sammour also committed fraud allegedly by billing Medicare for home health services that he never provided, he also falsely certified patients as "homebound," the government said.

Mary Smelter-Bolton, 69, of Oakland County, and Cass Hawkins, 52 , of Wayne County, were allegedly recruiters paid by Jamil home health agencies to refer Medicare beneficiaries for home health services. The claims were billed to Medicare but they were not eligible for reimbursement.

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Radwan Malas, 43, of Oakland County, operated Infinity Visiting Physician Services PLC (Infinity) as a home visiting physician company and allegedly used the physicians he employed to certify patients referred by Walid and Jalal Jamil for home health services.

Malas also billed Medicare for services he never provided the patients, such as 60-minute complex patient visits and services that were not medically necessary, including B12 and Toradol injections.

He also allegedly demanded that physicians in the office order the highest reimbursing urine drug test for patients, which was also medically unnecessary, but for which Malas allegedly was given a referral fee from the laboratory that processed the samples.

Defendants billed Medicare over $11.5 million in fraudulent claims for which they were paid $4 million, which they misappropriated for their personal benefits, prosecutors contend.

Malas also allegedly laundered the misappropriated funds by conducting illegal financial transactions.

“At the FBI, we swear an oath to protect the American people,” said Assistant Director Luis Quesada, of the FBI’s Criminal Investigative Division, in a written statement. “Fraudsters look to orchestrate their schemes at the cost of our health care systems, patients, and taxpayers. The FBI and our law enforcement partners remain dedicated to investigating and bringing to justice those who seek to exploit our U.S. health care system at the expense of its patients.”

Alejandro Mataverde, 79, of Oakland County, Cornelius Oprisiu, 82, of Livingston County, both physicians and Shafiq Rehman , 59, of Wayne County, a licensed nurse practitioner, were all employees of Infinity. They allegedly provided medically unnecessary services to Medicare beneficiaries or submitted claims to Medicare for medical services that were never provided to patients.

“Those who attempt to defraud Medicare often do so at the risk of compromising the integrity of federal health care programs and disregarding the health and well-being of patients,” said Special Agent in Charge Mario Pinto, of the Department of Health and Human Services Office of Inspector General (HHS-OIG), in a written statement. “HHS-OIG is proud to work alongside our law enforcement partners to protect federal health care programs and hold bad actors accountable for their actions.”

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Michael Molloy, 50, of Wayne County, was a co-owner of Integra Lab Management LLC (Integra), allegedly processed urine tests submitted by Infinity. Molloy and his co-owners allegedly paid the salaries of the Infinity employees and made monthly payments to Malas in exchange for the physician orders for the medically unnecessary urine drug tests. 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. Hogeige did this in an 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, in a written statement. “IRS-CI will work tirelessly with our law enforcement partners to investigate those who illegally target our Medicare program for personal financial gain."

All of the individuals in the scheme are facing 10 years or more.

Ten other individuals are also being charged by criminal information for their alleged involvement in the fraud schemes.

The names of 10 other defendants charged in this case were not released by the Department of Justice. According to the DOJ, those individuals have been charged in a formal charging document known as Information — which does not involve a grand jury voting on the charges, and typically means the defendant is cooperating and expected to reach a plea deal.

The FBI Detroit Field Office, HHS-OIG, and IRS-CI are investigating the cases. Trial Attorney Shankar Ramamurthy, of the Criminal Division’s Fraud Section, is prosecuting the cases.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program.

Free Press staff writer Tresa Baldas contributed to this report.

This article originally appeared on Detroit Free Press: FBI busts Michigan scammers targeting Medicare