Ten physicians indicted in alleged $250 million fraud scheme

Mar 2 2012

As has been the trend in some recent health care fraud cases, the physicians were not the ringmasters. Instead, the indictments allege that they were fronts for others -; primarily immigrants from the former Soviet Union.

The New York Times: A $250 Million Fraud Scheme Finds A Path To Brighton Beach
The plot involved 10 doctors, 9 separate clinics in New York City and 105 different corporations, all in service of a health care fraud ring that federal authorities say conspired to steal more than a quarter of a billion dollars from insurance companies. And when the details were announced on Wednesday, they cast an unflattering spotlight on how immigrants from the former Soviet Union have often dominated such schemes in the city (Rashbaum, 2/29).

Medscape: Ten Physicians Indicted as Fronts for 'Russian Criminals'
As in many other recent health care fraud cases, physicians are not the ringmasters in this alleged criminal enterprise. Rather, the indictment, unsealed today, states that they are fronts and underlings for a cadre of nonphysicians, primarily "individuals of Russian descent" with Mafia-style nicknames like "Russian Mike," "Fat Mike," "Skinny Mike," "KGB," and "Nose." ... Authorities call the clinics "no-fault clinics" because they were reimbursed by auto insurers under a no-fault law in New York that entitles accident victims to as much as $50,000 in medical benefits regardless of who caused the accident (Lowes, 2/29).

In other news -;

The Associated Press: $375M Health Care Scheme Went Unnoticed For Years
The Texas doctor accused of "selling his signature" to process almost $375 million in false Medicare and Medicaid claims went unnoticed for half a decade by a fraud detection system that some critics say is broken. Authorities say Jacques Roy and six others indicted for health care fraud certified 11,000 Medicare beneficiaries through more than 500 home health providers over five years. Those numbers would have made Roy's Medicare practice the busiest in the country. But an investigation into Roy and his business practices didn't begin until about a year ago, officials said (Merchant, 2/29).

The Dallas Morning News: Home Health Care Advocates Praise Government's Billing Fraud Investigation
Home health care advocates on Wednesday lauded the government's investigation of a Rockwall doctor and six associates accused of masterminding the largest medical billing fraud scheme of its kind in the country. "It is critical that scarce Medicare and Medicaid funds are protected from fraud and abuse schemes," Anita Bradberry, executive director of the Texas Association for Home Care & Hospice, said about the alleged $375 million swindle (Trahan, 2/29).

ABC: Exclusive: Undercover Grandma Catches Medicare Fraud On Tape
In the wake of an ABC News undercover investigation, federal authorities in Texas are investigating how an active 82-year-old grandmother was diagnosed as homebound, with a range of ailments that she did not have, including Type 2 diabetes, opening the door to potentially tens of thousands of dollars in Medicare payments for home health care, supplies and equipment she did not need. A hidden camera recorded the undercover grandmother's visit to a doctor in McAllen, Texas, where she told the doctor and nurses she exercised regularly and, other than some hypertension and arthritis, was in excellent health (Chuchmach and Ross, 3/1).