Detroit-Area Clinic Owner Sentenced to 40 Months in Prison for Role in $19 Million Health Care Fraud Scheme

WASHINGTON—A Detroit-area adult day care center owner was sentenced today to serve 40 months in prison for billing for unnecessary psychotherapy services, or services that were not provided, as part of a health care fraud conspiracy that led to more than $19 million in fraudulent Medicare billings.
The sentence was announced by 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; and Special Agent in Charge Lamont Pugh, III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office.
Checarol Robinson, 41, was sentenced by U.S. District Judge Nancy G. Edmunds in the Eastern District of Michigan. In addition to her prison term, Robinson was sentenced to serve two years of supervised release and was ordered to pay $599,438 in restitution, jointly and severally with her co-defendant, Louisa Thompson, who awaits sentencing following a guilty plea for her role in the scheme.
Robinson pleaded guilty on August 2, 2012, to an indictment charging her with one count of conspiracy to commit health care fraud and three counts of health care fraud.
According to Robinson’s admissions during her guilty plea proceeding, Robinson owned group homes where Medicare beneficiaries resided. In return for payments, Robinson provided these Medicare beneficiaries’ information to a fraudulent psychotherapy company—Caldwell Thompson Manor Inc.—owned by co-conspirator Thompson. That information was then used to bill Medicare for psychotherapy services that were not provided or were not medically necessary.
Robinson later owned and operated P&C Adult Day Center, which was incorporated in May 2010 and purported to provide psychotherapy services. Robinson admitted she falsely billed Medicare for individual and group therapy services that were not provided by P&C or were not medically necessary, using the Medicare beneficiaries from her group homes. Thompson, a licensed social worker and Robinson’s co-conspirator from the scheme at Caldwell Thompson, signed patient charts for psychotherapy services purportedly performed at P&C that were medically unnecessary or never performed.
According to court documents, a total of more than $19 million in false claims were submitted by the co-conspirators throughout the course of the conspiracy. Evidence presented at today’s sentencing demonstrated that Robinson was responsible for causing the submission of more than $2 million in fraudulent billings.
This case was prosecuted by Assistant Chiefs Gejaa T. Gobena and Catherine K. Dick of the Criminal Division’s Fraud Section and Assistant U.S. Attorney for the Eastern District of Michigan Philip A. Ross. It was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.
Since their inception in March 2007, strike force operations in nine locations have charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

Clinic Owners Sentenced for Roles in $13.3 Million Medicare Fraud Scheme

WASHINGTON—Miami residents Raymond Arias, 42, and his wife, Emelitza Arias, 25, have been sentenced in Detroit to 100 months and 12 months in prison, respectively, for their participation in a $13.3 million Medicare 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; and Special Agent in Charge Lamont Pugh, III of the U.S. Department of Health and Human Service’s Office of Inspector General’s (OIG) Chicago Regional Office, made the announcement after sentencing by U.S. District Paul D. Borman of the Eastern District of Michigan.
The Ariases were also sentenced to two years of supervised release following their respective prison terms. At sentencing on May 7, 2013, the court ordered Raymond Arias to pay $5.4 million in restitution. Today at sentencing, the court ordered Emelitza Arias to pay $531,883 in restitution, jointly and severally. The defendants agreed to forfeit approximately $40,000 seized by federal agents during the investigation.
The Ariases pleaded guilty on October 17, 2012, to one count of conspiring to commit health care fraud. According to the plea documents, beginning in approximately 2009, Raymond Arias opened Elite Wellness where he submitted claims to Medicare for infusion therapy treatments that were never rendered. In three months, Elite Wellness submitted in excess of $10 million in claims to Medicare. Emelitza Arias joined the scheme by opening a second clinic, Carefirst Physical Therapy & Rehabilitation Center, which submitted approximately $940,000 in claims to Medicare for infusion therapy treatments that were never rendered.
The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan. This case was prosecuted by Trial Attorney Catherine Dick of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Philip A. Ross of the Eastern District of Michigan.
Since their inception in March 2007, the Medicare Fraud Strike Force operations in nine districts have charged more than 1,480 individuals who collectively have falsely billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

Michigan Physician Pleads Guilty to Role in Medicare Fraud Scheme

WASHINGTON—A Detroit-area physician pleaded guilty today to making fraudulent referrals for home health care as part of a $1.6 million home health care fraud scheme, announced 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, and 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.
Dr. Sonjai Poonpanij, 82, of Rochester, Michigan, pleaded guilty before Senior U.S. District Judge Arthur J. Tarnow in the Eastern District of Michigan to one count of conspiracy to commit health care fraud.
According to court documents, Dr. Poonpanij admitted that beginning in approximately July 2010, he conspired with others to commit health care fraud by referring Medicare beneficiaries for home health care that was not medically necessary and causing false and fraudulent claims to be submitted to Medicare.
Dr. Poonpanij admitted that he saw patients at a psychotherapy center in Flint, Michigan, known as New Century Adult Day Program Services LLC, and referred Medicare beneficiaries at New Century to home health care companies—including a home health care company known as Angle’s Touch Home Health Care LLC—even though he knew that those beneficiaries did not qualify for home health care. According to court documents, Dr. Poonpanij wrote prescriptions for narcotics requested by the beneficiaries in exchange for their enrollment with Angle’s Touch for home health care that they did not need or receive. In addition to referring patients that he saw at New Century, Dr. Poonpanij also referred beneficiaries whom he had never seen or treated to Angle’s Touch and other home health agencies. Dr. Poonpanij signed plans of care for these beneficiaries that were used to bill Medicare for services that were either never actually performed or were not performed in the beneficiaries’ homes as required.
Court documents allege that between September 2008 and September 2012, Dr. Poonpanij caused Angle’s Touch and two other home health agencies to submit claims to Medicare for services that were not medically necessary and/or not provided, which caused Medicare to pay these companies approximately $1,318,954.
At sentencing, scheduled for August 14, 2013, Dr. Poonpanij faces a maximum penalty of 10 years in prison and a $250,000 fine.
This case is being prosecuted by Trial Attorney Niall M. O’Donnell of the Criminal Division’s Fraud Section. It was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.
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.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

Detroit-Area Home Health Agency Owner Sentenced to 60 Months for Role in $13 Million Health Care Fraud Scheme

WASHINGTON—A Detroit-area home health care agency owner was sentenced today to 60 months in prison for causing the submission of over $1 million in false and fraudulent billing to Medicare as part of a $13.8 million health care fraud conspiracy.
The sentence was announced by 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; and Special Agent in Charge Lamont Pugh, III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office.
According to plea documents, Rehan Khan was an owner of Moonlite Home Care Inc. As the co-owner of Moonlite, Khan paid and directed the payment of sums to doctors to refer patients for home health care services to Moonlite that were not medically necessary and/or never rendered. Khan also worked as a physical therapy assistant for several home health agencies in the Detroit area, known as Physicians Choice Home Health Care LLC and First Care Home Health Care LLC. Khan paid and directed the payment of kickbacks to beneficiaries for Physicians Choice, First Care, and Moonlite. The Medicare beneficiaries sometimes pre-signed forms and visit sheets that were later falsified to indicate that they had received home health services that they had never received. Other times, the Medicare beneficiaries’ signatures were forged on forms and visit sheets to indicate that they received home health services that they had never received.
Khan paid and directed the payment of various medical professionals, including nurses, physical therapists, and physical therapy assistants, to create fictitious patient files to document home health services purportedly provided by Moonlite that were never rendered. Khan also signed fictitious patient files purporting to have given physical therapy services at all three home health care agencies that were in fact never rendered.
From about January 2011 through about September 2011, Khan submitted or caused the submission of fraudulent claims by Moonlite, for which Medicare paid approximately $891,473. From about January 2009 through about September 2011, Medicare paid approximately $866,512 to Physicians Choice and First Care for fraudulent physical therapy claims based on falsified files and notes signed by Khan. In total, Khan was responsible for approximately $1,757,985 in false and fraudulent claims to Medicare.
This case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan. The case was prosecuted by Assistant Chief Catherine K. Dick of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Philip A. Ross of the Eastern District of Michigan.
Since their inception in March 2007, strike force operations in nine locations have charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to www.stopmedicarefraud.gov.

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BOSTON—A Brockton woman and three of her employees were charged with defrauding insurance companies in connection with physical therapy services.
Walkyria Massie, a/k/a Vicky Lopes, 37, of Brockton; Edward Rossi, 53, of Rochester; Deidre Chouinard, 36, of North Attleboro; and Manuela Andrade, 24, of Brockton, were charged in an indictment unsealed yesterday with conspiracy to commit mail fraud and three separate instances of mail fraud.
The indictment alleges that Massie was the owner and operator of Westgate Physical Therapy in Brockton. Patients would seek treatment at Westgate for minor injuries, generally sustained in car accidents. Massie employed Chouinard, a physical therapist; Rossi, a physical therapy assistant; and Andrade, an office manager. The indictment alleges that Massie, Rossi, Chouinard, and Andrade conspired together to falsify patient treatment charts to reflect therapy that was either never given, or was performed by unlicensed personnel, including Massie herself. Massie caused these fraudulent physical therapy claims to be submitted by mail to private insurance companies for payment. Various insurance companies paid more than $400,000 in bodily injury claims to Westgate and its patients during a two-year period, based on these fraudulent submissions.
On the charges of conspiracy to commit mail fraud and mail fraud, the defendants face a statutory maximum penalty of 20 years in prison, followed by three years of supervised release and a $250,000 fine.
United States Attorney Carmen M. Ortiz; Richard DesLauriers, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division; and Anthony DiPaolo, Vice President/Chief of Investigations of the Insurance Fraud Bureau of Massachusetts, made the announcement today. The case is being prosecuted by Assistant U.S. Attorney Shelbey Wright of Ortiz’s Health Care Fraud Unit.
The details contained in the indictment are allegations. The defendants are presumed to be innocent unless and until proven guilty beyond a reasonable doubt in a court of law.

Adrian Resident Pleads Guilty to Health Care Fraud and Filing a False Tax Return

The operator of a human resources company pleaded guilty to health care fraud and filing a false tax return, announced U.S. Attorney Barbara McQuade.
Ms. McQuade was joined in the announcement with Special Agent in Charge Erick Martinez of the Internal Revenue Service Criminal Investigation (IRS-CI) Detroit Field Office and Special Agent in Charge Robert D. Foley III of the FBI’s Detroit Field Office.
Jason Syrek, age 39, of Adrian, pleaded guilty before United States District Judge Paul D. Borman on May 15, 2013.
According to court records, between May 2008 and December 2010, Syrek engaged in health care fraud and tax fraud while operating CAS Resources of Adrian, Michigan. CAS Resources provided outsourcing of human resource services, such as payroll, taxes and employee benefits administration, including health care coverage.
CAS collected $1.75 million in premiums from client companies in November and December 2010, an amount due to Blue Cross Blue Shield of Michigan (BCBSM), but never paid by Syrek. He admitted diverting these funds for personal use.
According to the plea agreement, in January, 2011, Syrek as the director of CAS Resources, filed a Form 941 for 2010: Employer’s Quarterly Federal Tax return for the third quarter. The Form 941 was filed with the IRS and stated that CAS Resources paid $1,862,902 in payroll taxes. Syrek knew he had diverted these funds for his own personal use and only paid $633,332 in payroll taxes. In addition to the third quarter Form 941 for 2010, Syrek filed approximately seven other Form 941s with the IRS which he did not pay. In total, from 2010 through 2011, Syrek’s tax due is $13.4 million.
Syrek used the money to buy beachfront properties, several cars, a boat, and investment properties. In order to pay his debt, Syrek will forfeit his homes, beach properties in Florida, 2009 32.5’ Sea Ray Boat, and cars, to include a 2008 Ferrari F430 and 2008 Porsche Boxster.
“Fraud schemes like this one may involve sophisticated methods, but they are nothing more than stealing. This defendant robbed health care programs and taxpayers for his personal benefit,” McQuade said.
“Syrek’s conduct was egregious in that he effectively stole funds that were withheld on behalf of employees,” said Erick Martinez. “His actions cost the government $13.4 million dollars in tax loss alone.”
“Those who commit health care fraud and other related crimes will face severe penalties for their illegal acts,” stated FBI Special Agent in Charge Foley. “The FBI is committed to working with the IRS and other agencies to bring these individuals to justice.”
Sentencing is scheduled for August 13, 2013. Syrek faces a maximum sentence of 87 months’ imprisonment under the terms of the plea agreement, which was taken under advisement by the court, and a fine of up to $250,000. In addition, Syrek has agreed to pay restitution in the amount of $1,754,922.98 to BCBSM and $13,405,212 to the IRS.
This case is being prosecuted by Assistant United States Attorneys Sarah Resnick Cohen and Linda Aouate and investigated by special agents of the IRS Criminal Investigation and the FBI.

Grand Jury Returns Indictment Charging Manhattan Physician with Unlawfully Distributing Prescription Drugs

TOPEKA, KS—A grand jury has returned an indictment charging a physician in Manhattan, Kansas with unlawfully distributing prescription drugs, U.S. Attorney Barry Grissom said today.
Physician Michael Schuster, 53, who operates Manhattan Pain and Spine in Manhattan, Kansas, is charged with four counts: one count of conspiracy to illegally distribute controlled substances, one count of unlawful distribution of controlled substances, one count of unlawfully distributing controlled substances to a person under 21 years ol,d and one count of maintaining a premises in furtherance of unlawful drug distribution.
The indictment alleges that Schuster employed unlicensed staff members who distributed controlled substances to patients using Schuster’s signature on prescriptions while he was traveling out of the state or out of the country. Schuster was out of the office when a total of 540 patients received prescriptions for medications including oxycodone, morphine, hydromorphone, methadone, oxymorphone, tapentadol, fentanyl, amphetamine, methylphenidate, hydrocodone, alprazolam, clonazepam, diazepam, and zolpidem.
Schuster initially was charged in a criminal complaint filed April 23, 2013, in U.S. District Court in Topeka. According to an investigator’s affidavit, the investigation began early in 2012 when the Riley County Police Department received reports that Schuster was issuing prescriptions for high dosages of scheduled drugs based on minimal or cursory physical examinations.
The indictment returned today states that controlled substances may be dispensed and distributed lawfully by means of a prescription that is issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice. The practitioner must be registered with the Drug Enforcement Administration. Signing a blank prescription and having unauthorized, unlicensed individuals who are not registered with the DEA distribute controlled substances is not a lawful prescription.
The indictment alleges Schuster routinely pre-signed blank prescription forms with the intent that his unlicensed staff members would use them to issue controlled substances to patients while he was not at the clinic.
Count two of the indictment alleges Schuster caused unlicensed staff using blank prescriptions to distribute controlled substances while he was out of the clinic at various locations including Russia, South Africa, Uruguay, Canada, New York, Chile, Argentina, Brazil, and Israel.
Count three alleges that on June 16, 2010, Schuster caused oxycodone to be distributed to a person under the age of 21, who is identified in the indictment as Rex V.
Count four alleges that from April 2007 to August 2012 Schuster knowingly maintained a premises, his office at 1135 Westport Drive in Manhattan, Kansas, for the purpose of unlawfully distributing controlled substances.
The indictment also seeks the forfeiture of all the proceeds from the crimes.
Upon conviction, the crimes carry the following penalties:
Conspiracy: A maximum penalty of 20 years in federal prison and a fine up to $1 million. If death or bodily injury results from the crime, the penalty is not less than 20 years.
Unlawful distribution of controlled substances: A maximum penalty of 20 years in federal prison and a fine up to $1 million. If death or bodily injury results from the crime, the penalty is not less than 20 years.
Unlawful distribution of controlled substances to a person under 21 years old: A maximum penalty of 20 years in federal prison and a fine up to $1 million. If death or bodily injury results from the crime, the penalty is not less than 20 years.
Maintaining drug involved premises: A maximum penalty of 20 years and a fine up to $500,000.
Investigating agencies include the Riley County Police Department; the Federal Bureau of Investigation; the Department of Defense, Criminal Investigative Service (DCIS); the Department of Health and Human Services, Office of Inspector General (HHS-OIG); the Drug Enforcement Administration (DEA); the Department of Homeland Security-Homeland Security Investigations (DHS-HSI); and the Diplomatic Security Service (DSS).
In all cases, defendants are presumed innocent until and unless proven guilty. The indictments merely contain allegations of criminal conduct.