The Justice Department has charged 23 Michigan residents for their alleged involvement in two schemes to defraud Medicare of more than $61.5 million by paying kickbacks and bribes and billing CMS for unnecessary medical services that were not provided.
According to court documents, Walid and Jalal Jamil — operators of several home health agencies in the Detroit metropolitan area — allegedly concealed their ownership interest in these agencies using straw owners and submitted about $50 million in fraudulent home health care claims to CMS.
Prosecutors alleged they paid bribes to co-conspirators to recruit patients in violation of the Anti-Kickback Statute. The patients did not need home healthcare or qualify for it under Medicare rules, and many times were not provided the care for which CMS was billed, according to the Justice Department.
Walid and Jalal Jamil allegedly made quid pro quo relationships with physician clinics to receive the information to fraudulently bill CMS. Prosecutors said the fraudulent claims totaled more than $43 million.
Employees of Walid and Jalal Jamil's home health agencies and recruiters they allegedly paid to refer Medicare beneficiaries were also charged in connection with the scheme.
Since at least 2015, prosecutors also allege that Radwan Malas operated Southfield, Mich.-based Infinity Visiting Physician Services as a home visiting physician company and ordered physicians to certify patients referred by Walid and Jalal Jamil for medically unnecessary services that were billed and never performed. Mr. Malas allegedly told physicians to order the highest-reimbursing urine drug test for patients so he could receive a referral fee from the lab that processed the samples.
Defendants billed CMS more than $11.5 million in fraudulent claims for which they were paid nearly $4 million, which they misappropriated for their personal benefit, according to court documents. Mr. Malas is also accused of laundering the misappropriated funds through illegal financial transactions.
Physicians, a nurse and a medical assistant employed by Infinity were also charged in connection with the scheme, as well as Michael Molloy, co-owner of Integra Lab Management in Southfield.
Click here for more information on the charges and the defendants.