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Posted 18 February 2011 - 04:16 AM
A doctor, a chiropractor and eight others in Houston were among 111 individuals suspected of bilking Medicare and Medicaid out of $225 million through a variety of referral and kickback schemes.
"Every action taken by someone who's defrauding the system affects legitimate users of the system," said U.S. Attorney Jose Angel Moreno. "All of those people who are denied access because they (health care funds) were ill-spent someplace else affects them personally and raises the cost for everyone."
The 10 in Houston, according to indictments, are connected to $13.3 million in illegal billings to Medicare, the nation's largest health insurer, or to Medicaid, the joint federal-state health coverage program.
Arrests were also carried out in Los Angeles; New York; Baton Rouge, La.; Chicago; Dallas; Detroit; Tampa, Fla.; and Miami.
The crackdown, a joint effort between the Health and Human Services Department's Office of Inspector General and the FBI, also was assisted by the Texas Attorney General's Office and local law enforcement.
The arrests were made public Washington with an announcement from U.S. Attorney Eric Holder and HHS Secretary Kathleen Sebelius. Nearly two years ago, Holder and Sebelius created the Health Care Fraud Prevent and Enforcement Action Team, or HEAT, an interagency task force to aggressively pursue health care fraud cases.
"Today's news is the combination of a lot of hard work and unprecedented level of collaboration across the country," Sebelius said.
Claims, referrals suspect
The government has recovered $4 billion as a result.
In Houston, Dr. Ben Echols, 61, chiropractor Justina Okehie, 55, and eight others were charged with filing $13.3 million in fraudulent claims to Medicare. Echols was charged with trying to defraud Medicare for home health care charges totaling $5.2 million between Oct. 2008 and Feb. 2009.
Okehie, owner and operator of Adom Rehabilitation Services and Healthcare and Wellness Medical Clinic, is accused along with her co-defendants, Cassandra Tasby Barnes, 47, and Melloneen Elizabeth Davis, 52, with paying cash to "marketers" and others for referring and transporting Medicare and Medicaid beneficiaries to the two companies. The three were charged with conspiracy to commit health care fraud after submitting $4.7 million in illegal claims to Medicare for chiropractic and physical therapy services.
Ekpedeme Obot, 34, of Houston, the owner of Praise DME, was charged with fraud in connection with a $1.3 million Medicare scheme seeking reimbursement of medical equipment.
Sharon Beal, 47 and Kemmie Houston, 42, owners of STK Consultants, were charged in a $851,000 Medicare billing scheme. They are accused of seeking illegal reimbursement for medical equipment including braces, heating pads, power chairs and wheelchair accessories that were not medically necessary.
Akinsunbo Ainbile, 43, of Richmond, owns Hallco, a medical equipment company. He's accused of charging $694,000 to Medicare for unnecessary items.
Simone Ball, 24, of Stafford, and Philip Ware, 30, of Missouri City, owners of Preferred Plus Medical Supply, were charged in a $654,00 scheme to bill Medicare for improper medical equipment.
The Obama administration has budgeted an additional $300 Simone Ball, 24, of Stafford, and Philip Ware, 30, of Missouri City, owners of Preferred Plus Medical Supply, were charged with conspiracy to commit health care fraud in connection with an approximately $654,000 scheme to defraud the Medicare program through the submission of fraudulent claims for durable medical equipment. Preferred Plus Medical Supply, previously located at 900 Westpark Drive in Houston, is closed.
These cases will be prosecuted by Department of Justice trial lawyers attached to the Houston HEAT Strike Force.
The Houston takedown is a result of investigations conducted by FBI’s Houston Field Division, the Houston office of Health and Human Services Office of the Inspector General (HHS-OIG), Office of Investigations; and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) with the assistance provided by the U.S. Railroad Retirement Board Office of Inspector General during today’s arrest efforts.
U.S. v. Ernest Amadi, et al.
This indictment charges Ernest Amadi, 53, the CEO and Administrator of Alliance Healthcare Services, L.P., located on Estate Lane in Dallas, and four co-defendants, George Opurum, 60, Agatha Opurum, 53, Edith Amadi, 49, and Ollie Futrell, 55, each with one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the U.S. and to receive and pay health care kickbacks. Defendant Futrell, who was a patient recruiter for Alliance, is also charged with three counts of payment and receipt of health care kickbacks.
According to the indictment, Ernest Amadi and his wife, Edith Amadi, both of Wylie, Texas, as well as George Opurum and his wife, Agatha Opurum, both of Richardson, Texas, paid kickbacks to Ollie Futrell, of Garland, Texas, for referring Medicare patients to Alliance. Edith Amadi and Agatha Opurum were nurses at Alliance. George Opurum was the CFO and Alternate Administrator of Alliance. From November 2008 through November 2010, Alliance billed Medicare approximately $1,031,758 on behalf of Medicare beneficiaries to whom it purportedly provided home health care services.
Each of the conspiracy to defraud the U.S. and to receive and pay health care kickbacks counts and each of the substantive counts of payment and receipt of health care kickbacks carries a maximum statutory sentence of five years in prison and a $250,000 fine, upon conviction.
An indictment is an accusation by a federal grand jury, and a defendant is entitled to the presumption of innocence unless proven guilty.
These cases are being prosecuted by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Northern District of Texas.
To learn more about the HEAT Strike Force, please visit:
Nationally, more than 700 law enforcement agents fanned out to arrest 111 people accused of illegally billing Medicare more than $225 million. The arrests are the latest in a string of major busts in the past two years as authorities have struggled to pare the fraud that’s believed to cost the government between $60 billion and $90 billion each year. Stopping Medicare’s budget from hemorrhaging that money will be key to paying for President Barack Obama’s health care overhaul.
Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder partnered in 2009 to allocate more money and manpower in fraud hot spots. Thursday’s indictments were for suspects in Miami, Los Angeles, Dallas, Houston, Detroit, Chicago, Brooklyn, Tampa, Fla., and Baton Rouge, La.
They show that "health care fraud is not easy money," Holder said at a press conference in Washington.
A podiatrist performing partial toenail removals was among 21 indicted in Detroit. Dr. Errol Sherman is accused of billing Medicare about $700,000 for the costly and unnecessary procedures, which authorities said amounted to little more than toenail clippings. The podiatrist billed Medicare for 20 nail removals on three toes of one patient, according to the indictment. He charged Medicare about $110 for each procedure.
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