Twenty-three Michigan residents have been charged for their alleged involvement in two schemes to defraud Medicare of more than $61.5 million by paying kickbacks and billing CMS for unnecessary medical services at physician clinics that were not provided, the Justice Department said Feb. 7.
Walid and Jalal Jamil, 62 and 69, operators of several home health agencies in the Detroit area, allegedly concealed their ownership interest in these agencies and submitted about $50 million in fraudulent home healthcare claims to CMS, according to court documents.
The two allegedly made quid pro quo relationships with physician clinics to receive the information to fraudulently bill CMS. Prosecutors said reimbursement for the fraudulent claims totaled more than $43 million.
They allegedly paid bribes to co-conspirators to recruit patients. The patients did not need home healthcare or qualify for it, and many times were not provided the care for which CMS was billed, according to the report.
Prosecutors also allege that since at least 2015, Radwan Malas, 43, operated Southfield, Mich.-based Infinity Visiting Physician Services as a home visiting physician company and ordered physicians to certify patients referred by Walid and Jalal Jamil for medically unnecessary services that were billed and never performed.
Mr. Malas allegedly told physicians to order the highest-reimbursing urine drug test for patients so he could receive a referral fee from the lab that processed the samples. He is also accused of laundering the misappropriated funds through illegal financial transactions.
Physicians, a nurse and a medical assistant employed by Infinity were also charged in connection with the scheme.
Read more about the defendants and the charges here.