Since May 2012, the OIG has leveled penalties of almost $13 million in restitution/fines, along with jail terms equal to 70 years behind bars, to providers who have been found guilty of fraudulently billing nerve conduction tests.
In Michigan, Chyawan Bansil, PT, was found guilty of billing for EMG and nerve conduction tests that were never performed. The government also alleged that Bansil laundered the proceeds of his fraud scheme by withdrawing funds from corporate bank accounts and re-depositing those funds into accounts he controlled. Bansil must pay $2.25 million to resolve the government’s claims and an additional $350,000 to Blue Cross Blue Shield of Michigan. He must also file amended tax returns for 2008 through 2010 and forfeit $156,000 in seized funds. As a result of his guilty plea, Bansil will be excluded from participation in any Federal health care program for a period of at least 5 years.
In Chicago, Bahir Haj Khalil, co-owner of House Call Physicians, Mohammed Khamis Rashed, co-owner of House Call Physicians and Paschal U. Oparah, a suspended podiatrist, were all found guilty of fraud. According to the evidence presented at trial, the fraud involved billing for services that were not medically necessary, including nerve conduction tests. Khalil, who does not have a US license to practice medicine, even said during a secret recording by an undercover agent that he, not a doctor, should decide when patients needed procedures like nerve conduction tests. Khalil received 10 years in prison and was ordered to pay $2.9 million in restitution and forfeiture. He faces deportation at the end of his sentence. Rashed received 6 months in prison and a $20,000 fine. Oparah received 18 months in prison and was ordered to pay $791,095 in restitution.
In Brooklyn, Dr. Gustave Drivas, owner of Bay Medical Center, whose sentence is pending and is currently at large, faces up to 72 years in prison and $2 million restitution when captured. He is convicted of bilking Medicare for $77 million, including $47 million for services that include nerve conduction testing.
In Michigan, Dr. Emilio Haber/RiteCare LLC was found guilty of performing unnecessary nerve conduction tests on patients willing to feign certain symptoms. Haber has been sentenced to five years in prison with three years supervision upon his release. Haber must also pay $6.4 million in restitution and forfeit $99,000 in bank assets he possesses.
In Illinois, Dr. Jaswinder R. Chhiber was found guilty of filing false insurance claims for unnecessary nerve conduction tests, falsifying medical records, and providing false diagnostic codes to payers. Chhibber was sentenced to 30 months in federal prison and fined $15,000.
In California, David J. Garrison/Scott Medical Clinic was found guilty of performing medically unnecessary tests and giving kickbacks to recruiters for providing the office with Medicare numbers used to submit false claims. Garrison stole the identities of physicians to order nerve conduction tests from fraudulent diagnostic testing companies, who then paid kickbacks to Scott Medical Clinic. Garrison has been sentenced to six years in prison and faces an additional trial on drug charges related to forged prescriptions.
After less than a day of deliberations, a federal jury in Los Angeles convicted Dr. Owusu Ananeh Firempong of five counts of health care fraud. In just 7 months, Firempong submitted over $1 million in fraudulent bills to Medicare, and repeatedly lied about nerve conduction tests he claimed to have provided. Prosecutors presented evidence that Firempong had received information about Medicare beneficiaries who were not his patients and had used that information to bill Medicare. In addition, his patient files contained many inconsistences and improbably identical results that appeared to have been a “copy-and-paste” job. Firempong, who is already serving a lengthy sentence in a narcotics case, awaits sentencing on the fraud charges.
UPDATE: Three Additional High-Profile Fraud Cases
Case One: EMG Fraud
An Austin Texas neurologist has been charged in a 20 count indictment alleging a conspiracy to defraud Medicare by billing for EMG procedures on 429 patients in just two months. Each of the counts carries a maximum penalty of 10 years in federal prison and a $250,000 fine. Dr. Dennis Benson, along with his clinic administrator Dario Juarez, billed Medicare for seeing more than 100 patients on 13 different days.
If convicted, these healthcare "professionals" face the real-life consequences of, among other issues, civil fines and penalties, loss of their right to bill CMS for services, and a spot on the OIG exclusion list under the status titled "indefinite exclusion."
Case Two: Money Laundering and Nerve Conduction Fraud
In a second case, Leonid Zalkind of Philadelphia, Pennsylvania, has entered a guilty plea to charges of Medicare fraud and money laundering at a clinic in Brooklyn, New York. Over $13 million in false claims, including charges for nerve conduction testing, were submitted for payment. The illegally obtained funds were then laundered via various shell companies operated by Zalkind. He awaits sentencing.
Case Three: Billing for IOM Not Performed
In Milwaukee, a neurosurgeon has admitted guilt in billing for intraoperative monitoring (IOM) that was never performed. Dr. Cully White paid another physician to prepare fake report so he could bill private insurance companies for the service and submitted over $250,000 in bogus insurance claims.
Although initially declaring himself innocent, White changed his plea after the state’s medical board, who had requested a competency assessment, brokered a deal for White to voluntary surrender his license in the wake of complaints about substandard surgeries. White awaits sentencing, which could include 130 years in prison and more than $3 million in fines.
Learn more about EDX fraud and abuse and how to prevent it