By Seth Stern and Laurel Brubaker Calkins - May 2, 2012 2:25 PM ET
Federal authorities charged 107 people with Medicare fraud in a multistate operation, alleging schemes involving about $452 million in false billing, officials in Washington announced.
“This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in strike force history,” the government said in a statement, referring to the Medicare Fraud Strike Force.
A registered nurse discusses medication with a patient during a house call on March 26, 2012 in Denver. Photographer: John Moore/Getty Images
In Louisiana, a federal grand jury indicted seven people in a case that the U.S. said resulted in $225.6 million in fraudulent claims’ being billed to the government health-care program over six years, about half the total.
Those indicted in federal court in Baton Rouge, Louisiana, included the owners and employees of two community mental-health clinics that allegedly billed for therapies patients didn’t receive, according to an indictment unsealed today.
Medicare, a health program for the elderly and the disabled, paid $37.9 million as part of the fraud, according to a memo in support of detention in a Louisiana case.
Alleging “a pattern of brazenly disregarding legal and administrative processes,” prosecutors asked that Hoor Naz Jafri and Roslyn F. Dogan, both of Baton Rouge, be jailed without bail until trial. They are accused of fraud at two community mental-health clinics they owned in that city.
Victims ‘Most Vulnerable’
“Jafri and Dogan directed and facilitated a large-scale scheme to bilk Medicare of hundreds of millions of dollars by taking advantage of the most vulnerable,” U.S. Attorney Donald J. Cazayoux Jr. in Baton Rouge said in court papers.
The women recruited patients from nursing homes, homeless shelters, an apartment complex Jafri owned and hospitals in towns hundreds of miles away, Cazayoux said in court papers. The women admitted the patients without regard to eligibility and continued treating them even after therapists complained it was inappropriate to do so.
“After the entities through which they operated their fraudulent scheme were placed on suspension by Medicare in September 2011, they reconstituted their fraudulent enterprise by purchasing another company,” Cazayoux alleged.
Theft From Government
“Finally, Dogan participated in and encouraged the destruction of possibly incriminating files, and she personally even stole evidence from the U.S. Attorney’s Office in order to obstruct the investigation and conceal fraudulent activity,’’ Cazayoux said in court papers.
Jafri, a naturalized U.S. citizen from India, faces eight counts of conspiracy and health-care fraud; Dogan, four. If convicted of all charges, Jafri faces as much as 80 years in prison and Dogan as much as 40 years.
The indictment against the seven defendants was filed under seal one day before four other employees, who worked as therapists at the two treatment centers, pleaded guilty to one count each of conspiracy to commit health-care fraud.
The four workers confessed to falsifying treatment documentation for services they didn’t provide and for patients who didn’t attend the facilities, according to the court filing.
Prosecutors contend Shifa Community Mental Health Center and Serenity Center, which were owned by Jafri, would bill Medicare for three or four daily group-therapy sessions when none had occurred.
Those charged are also accused of providing clinically inappropriate services to some patients and for billing for services given patients who were hospitalized elsewhere at the time. Dogan was a part owner and director of Serenity, according to the indictment.
The Obama administration has said it is cracking down on Medicare fraud. Attorney General Eric Holder and Kathleen Sebelius, the secretary of health and human services, made today’s announcement on the national sweep.
To contact the reporters on this story: Seth Stern in Washington at firstname.lastname@example.org; Laurel Brubaker Calkins in Houston at of email@example.com.