Four Detroit-Area Residents Arrested in Connection with $14.5 Million Home Health Care Fraud Scheme

WASHINGTON—Four Detroit-area residents were arrested today by federal agents from the Department of Health and Human Services, Office of the Inspector General (HHS-OIG) and the FBI as part of an ongoing investigation into a $14.5 million home health care fraud scheme, announced the Departments of Justice and HHS.

In a two-count second superseding indictment returned on Dec. 2, 2010, and unsealed today, four additional individuals are alleged to have participated in a Medicare fraud scheme operated out of Patient Choice Home Healthcare (Patient Choice) and All American Home Care (All American), two Oakland County, Mich., home health agencies that purported to provide in-home health services. Maira Suleman, 30; John Thomas, 32; Sherry Prescott, 50; and Myra Jones, 50, were each charged with conspiracy to commit health care fraud. Pramod Raval, M.D., 57, who was previously charged with conspiracy to violate the Anti-Kickback Statute, was also charged with conspiracy to commit health care fraud in the indictment unsealed today.

Twenty-one individuals, including the four arrested today, have now been charged for their alleged roles in this health care fraud scheme. The original indictment was returned on Jan. 12, 2010, with the first superseding indictment returned on July 13, 2010. To date, 10 defendants have pleaded guilty for their roles.

According to the superseding indictment unsealed today, the defendants’ co-conspirators owned and operated Patient Choice and All American. These agencies purported to provide home health therapy services to Medicare beneficiaries that were unnecessary and/or were never performed. Suleman, Thomas, and Prescott are alleged to have falsified medical records used to justify and/or bill services to Medicare. In addition, the indictment alleges that Jones and several other individuals recruited Medicare beneficiaries for the owners of Patient Choice and All American, paying the beneficiaries kickbacks for their Medicare information and their signatures on documents that detailed physical therapy services that were either never rendered or not medically necessary.

In addition, the indictment alleges that Dr. Raval and the owner and operator of Patient Choice, Muhammad Shahab, engaged in a conspiracy where Shahab would pay kickbacks to Raval in exchange for patient referrals and access to Medicare beneficiaries under Dr. Raval’s care. Shahab was charged in the original indictment and he pleaded guilty on Feb. 25, 2010, to conspiracy to commit healthcare fraud. Sentencing in his case has been scheduled for Feb. 11, 2011.

The indictment also alleges that Medicare paid Patient Choice and All American more than $14.5 million for services that were medically unnecessary and/or not provided between August 2007 and September 2009. The charge of health care fraud conspiracy carries a maximum penalty of 10 years in prison and a $250,000 fine. The charge of conspiracy to violate the Anti-Kickback Statute carries a maximum prison sentence of five years and a fine of up to $25,000.

An indictment is merely a charge and defendants are presumed innocent until proven guilty.

Today’s arrests were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan; Special Agent in Charge Andrew G. Arena of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS-OIG Chicago Regional Office.

This case is being prosecuted by Assistant Chief John K. Neal and Trial Attorney Gejaa T. Gobena of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG. The case 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 seven districts have obtained indictments of more than 825 individuals who collectively have falsely billed the Medicare program for more than $2 billion. In addition, HHS’s 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.