DALLAS – Attorney General Loretta E. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Mathews Burwell announced today an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings. Twenty-three state Medicaid Fraud Control Units also participated in today’s arrests. In addition, the HHS Centers for Medicare & Medicaid Services (CMS) also suspended a number of providers using its suspension authority provided in the Affordable Care Act. This coordinated takedown is the largest in the history of the Medicare Fraud Strike Force, both in terms of the number of defendants charged and loss amount.
“As this takedown should make clear, health care fraud is not an abstract violation or benign offense – It is a serious crime,” said Attorney General Loretta Lynch. “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people – many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends. The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.”
“The charges announced today in Dallas are an example of the outstanding investigative work by this district’s Medicare Fraud Strike Force that has been in operation since 2011,” said U.S. Attorney John Parker of the Northern District of Texas. “Medicare and Medicaid fraud not only increases health care costs, but it victimizes the elderly and those who may be vulnerable. This office and its Strike Force will continue to aggressively target, investigate and prosecute anyone trying to defraud these crucial programs.”
Nine of the 12 defendants charged in north Texas were charged in connection with three separate home health care schemes. The other three defendants were charged in another indictment related to hearing-related health care services.
One indictment charges three employees of Elder Home Health Services (ElderCare) with conspiracy to commit health care fraud. Celestine Okwilagwe, aka “Tony Okwilagwe, 48, the owner, and Paul Emordi, 50, a supervisor, allegedly operated ElderCare, a Medicare and Medicaid provider in Garland, Texas, when both were previously excluded from participating in any federal health care benefit program. Adetutu Etti, 58, an administrator for ElderCare, allegedly concealed Okwilagwe and Emordi’s exclusions from Medicare and Medicaid. According to the indictment, from approximately January 2013 through May 2016, Okwilagwe billed Medicare and Medicaid more than $3.4 million for claim reimbursements to which it was not entitled.
In a superseding indictment, the physician owner of Molina Medical Housecall Services, PA, dba U.S. Medical Housecall Services, PA, Hector Molina, 51, of Irving, Texas, and four others are each charged with one count of conspiracy to commit health care fraud. In addition to Dr. Molina, others charged in the conspiracy include Blanca Mata, 47, of Forney, Texas; Lidia Antonio, 56, also of Irving; Ivan Castilleja, 38, of Dallas; and George Richard Rivaux, 43, of San Antonio, Texas. Molina is also charged with 11 counts of health care fraud and one count of aggravated identity theft. Housecall Services employees Mata, Antonio and Rivaux are also each charged with two counts of health care fraud. According to the indictment, from approximately January 2010 through April 2015, Molina and others caused Medicare to be falsely billed $28.6 million for care plan oversight.
In the last home health scheme, physician assistant Shawn Chamberlain of Collin County, Texas, is charged in an information with one count of conspiracy to commit health care fraud. Chamberlain, who was also part-owner of Boomer House Calls (Boomer), hired a physician to apply for a Medicare number to allow him to bill Medicare for physician home visits and to sign false physician certifications for home health care. Chamberlain provided these false physician certifications for home health to Timely Home Health Services, Inc. in Dallas from approximately August 2013 through September 2015. Chamberlain and his co-conspirators caused Medicare to be billed approximately $1.6 million for false certifications, unnecessary home health services and unnecessary physician home visits.
In the remaining indictment, three family members from Garland, Harlan R. Hill, 52; his wife Latecia P. Hill, 50; and her mother, Pearle L. Madere, 71; were each charged with one count of conspiracy to commit health care fraud and 14 counts of health care fraud. Harlan Hill owned and operated Total Senior Ear Care (TSEC); Latecia Hill served as its administrator; and Pearle Madere ran day-to-day operations. TSEC, whose offices were located in Dallas, provided hearing-related services to Medicare beneficiaries living in nursing homes. These hearing services, however, were not provided and were fraudulently billed to Medicare for reimbursement. In fact, this fraudulent business, created by Harlan and Latecia Hill and Pearle Madere caused Medicare to pay TSEC more than $5.1 million for services never rendered or necessary. The indictment also includes a forfeiture allegation that would require Harlan and Latecia Hill, upon conviction, to forfeit their home in Garland, as well as a Mercedes-Benz and a Maserati Quattraporte.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations and since its inception in March 2007 has charged over 2,900 defendants who collectively have falsely billed the Medicare program for over $8.9 billion.
Including today’s enforcement actions, nearly 1,200 individuals have been charged in national takedown operations, which have involved more than $3.4 billion in fraudulent billings. Today’s announcement marks the second time that districts outside of Strike Force locations participated in a national takedown, and they accounted for 40 defendants charged in this takedown.
An indictment/information is merely an allegation and defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law. If convicted, however, each count of conspiracy to commit health care fraud and substantive health care fraud count carries a maximum statutory penalty of 10 years in federal prison and a $250,000 fine.
The cases announced today are being prosecuted and investigated by U.S. Attorney’s Offices nationwide, along with Medicare Fraud Strike Force teams from the Criminal Division’s Fraud Section and from the U.S. Attorney’s Offices of the Southern District of Florida, Eastern District of Michigan, Eastern District of New York, Southern District of Texas, Central District of California, Eastern District of Louisiana, Northern District of Texas, Northern District of Illinois and the Middle District of Florida; and agents from the FBI, HHS-OIG, Drug Enforcement Administration, DCIS and state Medicaid Fraud Control Units.
Assistant U.S. Attorneys Kate Pfeifle and Adrienne Frazior of the Northern District of Texas and Trial Attorney Jason Knutson of the Criminal Division’s Fraud Section are prosecuting the cases filed in the Northern District of Texas.
The court documents for each case will posted online, as they become available, here: https://www.justice.gov/opa/documents-and-resources-june-22-2016-medicare-fraud-strike-force-press-conference.