23 Charged in $61.5 Million Home Health Fraud Scheme

10 Feb, 2023 F.J. Thomas

                               

Sarasota, FL (WorkersCompensation.com) – Earlier this week the Department Of Justice released indictments on 23 individuals in Michigan, including physicians, medical assistants, and nurse practitioners, for their roles in an alleged complex home health scheme dating back to 2015. 

Walid Jamil, 62, and Jalal Jamil, 69, owned and operated several home health businesses in the Detroit area. Instead of listing themselves as owners, they disguised their ownership through family members and other associates.  In owning the home health businesses, investigators assert that they and their employees conspired to recruit patients from Infinity Visiting Physician Services PLC (Infinity). Infinity then allegedly conspired with Integra Lab Management LLC (Integra) for high-dollar urine drug tests. Investigators believe the Jamils received more than $43 million in reimbursement on fraudulent claims in the course of the scheme. 

Carol Ibrahim was an employee as well as a front owner of one of the home health agencies, and is charged with making illegal payments for referrals to patient recruiters and submitting false claims. Other employees include Delaine Jackson, and registered nurse Ibrahim Sammour, both of which investigators allege submitted claims for services that were either falsely certified or never provided. 

Cass Hawkins, 52, of Wayne County and Mary Smelter-Bolton, 69, of Oakland County were both patient recruiters that were allegedly paid by Jamil home health for referrals. 

Infinity is a home visiting physician company owned by Radwan Malas. Services include home care coordination, physical exams, and lab testing. According to the indictments, Malas allegedly ordered employed physicians to certify patients referred by the Jamils for home health services. Additionally, Malas billed services that were not medically necessary for these patients. Some of the services allegedly billed included 60-minute high-level evaluations, and injections such as B-12, and nonsteroidal anti-inflammatory drug Toradol. Overall, the investigators estimate $11.5 million in fraudulent claims were billed to Medicare, resulting in $4 million reimbursement. It is also alleged that Malas conducted illegal financial transactions in an effort to hide the misappropriated funds.

In addition to physician services, Malas allegedly required employed physicians to order the highest reimbursement level urine drug tests for the patients that had been referred. The investigators contend that Malas received kickbacks from Integra labs for those referrals. 

According to the news release, co-owner of Integra Michael Molloy, and his co-owners allegedly agreed to pay the salary of Infinity employees and made monthly kickback payments to Malas in exchange for  orders of the unnecessary urine drug tests. Investigators estimate that Integra submitted around $2.8 million in medically unnecessary claims to Medicare, netting around $730,000 in ill-gotten reimbursement. 

Charges include conspiracy to commit health care fraud, healthcare fraud, receipt of illegal health care kickbacks, money laundering, and conspiracy to defraud the United States through the payment of illegal health care kickbacks. The total in fraudulent claims is estimated at $61.5 Million.

 

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    About The Author

    • F.J. Thomas

      F.J. Thomas has worked in healthcare business for more than fifteen years in Tennessee. Her experience as a contract appeals analyst has given her an intimate grasp of the inner workings of both the provider and insurance world. Knowing first hand that the industry is constantly changing, she strives to find resources and information you can use.

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