In recent years, Medicare fraud and abuse cases have been on the rise in the United States. Nowhere is the problem more visible than in Chicago, where an increase in the number of cases has prompted officials to put a moratorium on new home health agencies.

With so many cases of Medicare fraud being prosecuted, innocent people sometimes are accused. If you believe you are under investigation for a criminal offense related to Medicare fraud or abuse, it’s critical that you work with an experienced attorney to help protect your rights. Michael J. Petro has more than 30 years of experience providing criminal defense for individuals charged with white-collar crimes like Medicare fraud and abuse.

What are some examples of highly visible Medicare fraud cases in Chicago?

Biggest Medicare Fraud Case

Recently as part of the DOJ’s  targeting of Medicare fraud, the U.S. Department of Justice charged more than 240 people — including a dozen in and around Chicago — with perpetrating fraud against the Medicare system through false billing of more than $700 million.

The case was announced in Washington, D.C., and was described as the biggest roundup of defendants in history. Defendants included a variety of medical professionals, such as patient recruiters, doctors, owners of pharmacies, and providers of home health care services. They were accused of billing for unneeded services, equipment and care.

Also, defendants were accused of conspiracy to commit health care fraud, money laundering, and violations of anti-kickback statutes. In Chicago, three cases were related to home health services, an industry that officials described as especially vulnerable to abuse and fraud.

False Certification of Patients

A doctor at Mobile Doctors of Chicago was convicted in 2016 of charges related to false certification of patients as being confined to their homes. The certifications were part of a plan to defraud Medicare, investigators said.

Dr. Banio Koroma was convicted of two counts of health care fraud, along with two counts of making false statements about health care matters, following a four-day trial in Chicago federal court. The doctor at the time worked for Mobile Doctors, which arranged in-home doctor visits with homebound patients. The company closed in 2013.

Evidence presented in the trial indicated that Dr. Koroma falsely certified that patients were confined to their homes and needed nursing services that they actually did not require. Each health care-related count against the doctor carried a maximum sentence of 10 years imprisonment.

The Medicare Fraud Strike Force — which included agents from several federal agencies, including the FBI — carried out the investigation and had previously secured the conviction of Mobile Doctors’ chief executive officer.

Billing of Non-Existent or Fraudulent Services

Henry Smilie, chief executive officer of Chicago-based Home Physician Services, was arrested in 2015 for allegedly billing Medicare more than $1 million for nonexistent or fraudulent services.

Smilie was arrested after a sting operation that used an undercover, 71-year-old man who posed as a patient and told doctors and nurses who visited his home that he was not homebound. However, the company classified the visits as treating a homebound individual, and Medicare was billed for thousands of dollars for his treatment.

Federal agents with search warrants also searched the company’s Chicago offices, and a former employee told agents that Smilie would instruct workers to make up services to meet requirements for Medicare payments.

Conversations with the man posing as a patient were covertly recorded, with the man telling employees that he often left his home. The company continued to submit bills to Medicare and continued the house calls to the man’s home, and an employee was recorded telling the man to be careful what he disclosed about his activities.

Illegal Dispensing of Prescription Medications

A Chicago-area doctor was arrested in 2014 and charged with illegal dispensing of prescription medicines and fraudulent billing of Medicare.

Following a search by federal agents, Sathish Narayanappa Babu was arrested, and agents seized more than $100,000 from his business bank account. Later that year, he pleaded guilty, and federal prosecutors planned to seek a sentence between 57 and 71 months in prison.

Prosecutors said Babu had intentionally prescribed oxycodone and other controlled substances to an undercover agent posing as a patient.  In truth, Babu had never examined or seen the undercover agent  the complaint alleged.

Babu also allegedly allowed unlicensed employees affiliated with his company, Anik Life Sciences, to write prescriptions to the undercover agent in the name of the doctor.

Conspiring to illegally dispense oxycodone has a maximum penalty of 20 years imprisonment and a fine of up to $1 million, investigators noted.

Criminal Defense for Health Care Fraud and Abuse

Are you being investigated for Healthcare Fraud?   Have you been charged with Medicare abuse or another form of health care fraud? If so, understand that the criminal penalties for conviction can be severe, and your professional reputation and licensure can suffer long-lasting damage. By working with an experienced Medicare fraud attorney, you take an important step toward safeguarding your rights. For a consultation, contact Attorney Michael J. Petro.

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