Two physicians part of Medicare fraud scheme, an ‘astonishing abuse of our health care system’

Two physicians are among 23 defendants charged with two schemes that allegedly bilked Medicare out of more than $61.5 million, according to the U.S. Department of Justice (DOJ).

The schemes involved bribes, kickbacks, and medically unnecessary services and treatments ordered by a visiting physician service around Detroit, Michigan. The defendants face various charges including health care fraud and conspiracy, and money laundering, with potential prison sentences up to 10 years.

“The alleged actions of these defendants is an astonishing abuse of our health care system,” Eastern District of Michigan U.S. Attorney Dawn N. Ison said in a news release. “By allegedly submitting fraudulent claims and paying illegal kickbacks, these defendants looted Medicare in order to line their own pockets at great cost to taxpayers.”

How it happened

Citing court records, the federal investigators said Walid Jamil, 62, and Jalal Jamil, 69, both of Oakland County, Michigan, owned and operated several home health agencies in the Detroit metropolitan area.

Concealing their ownership, they used straw owners to submit about $50 million in billing to Medicare. “These patients did not need home health care, did not qualify for home health care under Medicare rules, and in many instances were not actually provided the care for which Medicare was billed,” the DOJ summary said.

They also bribed co-conspirators to recruit patients, a violation of the Federal Anti-Kickback Statute, and entered quid pro quo relationships with physician clinics to obtain information for the fraudulent billing. The Jamils allegedly received $43 million from Medicare for their own benefit, according to DOJ.

Physicians involved

Another defendant, Radwan Malas, 43, of Oakland County, Michigan, operated Infinity Visiting Physician Services as a home visiting physician company. Malas allegedly ordered his employees to certify patients referred by Walid Jamil and Jalal Jamil for medically unnecessary home health services.

The workers included physicians Alejandro Mataverde, 79, of Oakland County, Michigan, and Cornelius Oprisiu, 82, of Livingston County, Michigan, and licensed nurse practitioner Shafiq Rehman, 59, of Wayne County, Michigan. “They allegedly provided medically unnecessary services to Medicare beneficiaries or submitted claims to Medicare for medical services that were not provided to the patients,” according to DOJ.

Billed services included 60-minute complex visits that never happened, or services such as B-12 and Toradol injections that were not necessary. Malas ordered the physicians to order the highest-reimbursing urine drug tests for patients, which were not necessary, then collected a referral fee from the laboratory that tested the samples, according to DOJ.

“As part of this scheme, the defendants billed Medicare over $11.5 million in fraudulent claims for which they were paid nearly $4 million, which they misappropriated for their personal benefit,” according to DOJ. “Malas is also alleged to have laundered the misappropriated funds by conducting illegal financial transactions.”

Additional defendants were employees of the Jamils, a co-owner of the laboratory, and an employee of Malas. There were 10 additional people charged by criminal information for their alleged participation in the fraud, according to DOJ.

DOJ and the U.S. Department of Health and Human Services – Office of the Inspector General (HHS-OIG) investigate claims of health care fraud. In December, HHS-OIG announced health care fraud could approach $4 billion for the fiscal year ended Sept. 30, 2022.