Top Prescriber Of Adult Diapers in NY Charged

Brooklyn, NY (WorkersCompensation.com) – A New Jersey physician and a New York physical therapist have been found guilty in a $30-million scheme to defraud Medicare and Medicaid. Both were convicted  of conspiracy to commit health care fraud, mail fraud, and wire fraud, as well as conspiracy to make false statements and substantive offenses of health care fraud, mail fraud, and wire fraud, following a six-week trial.

According to a statement from the United States Justice Department, the fraudulent activity occurred between 2007 and 2013 and involved more than 15 defendants, including included business partners and owners, fellow physicians, occupational therapists, a bookkeeper, and office manager.

Due to a New York state requirement for clinics to be owned by a licensed medical provider, Paul J. Mathieu, M.D., was said to have fraudulently presented himself as the owner of six clinics that were in fact owned by co-conspirator Aleksandr Burman, who is not licensed. From 2007 to 2013, the clinics fraudulently billed Medicaid and Medicare more than $30 million for items and services not medically necessary, or that were not even provided.

Mathieu wrote an extremely large number of prescriptions for adult diapers and other incontinence items to the extent that he was commonly the largest prescriber in the state. The items would be filled by the medical supply company Universal Supply Depot, which was owned by business partner Burman’s wife, Marina Burman who was charged in May of last year. The filled prescriptions were medically unnecessary, and often were not even dispensed as billed.

Starting around 2010, authorities said Mathieu participated directly in the scheme by visiting the clinics on a weekly basis to sign off on fake or falsified medical charts, issue referrals that were not needed, and referred patients to fellow co-conspirator, Hatem Behiry for physical therapy. Mathieu never actually saw or treated patients during his visits, the authorities said.

Throughout this same time period, Behiry was said to have pretended to give physical therapy to the same patients that Mathieu had referred, most of whom were getting kickbacks for going to the clinic. Additionally, Behiry oversaw the billing of false medical claims, going so far as to fabricate medical records and never actually evaluating the patients who were not in on the scheme.

Several other defendants have pled guilty and are awaiting sentencing. Prosecution is being managed by Office’s Complex Frauds and Cybercrime Unit with Assistant U.S. Attorneys David Raymond Lewis, Stephen J. Ritchin, and Timothy V. Capozzi as prosecutors.

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