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Compelling Advice

Senior Director of Strategic Alliances
LexisNexis Risk Solutions - Government

No matter how great the advice is, there will be those who don’t listen. Especially if they didn’t ask for it. And fraudsters never ask for advice. Imran Sham was convicted of Medicare and Medicaid fraud in separate 1990 and 2001 cases in New York and California, respectively. After each conviction, Sham was excluded from participation in Medicare and all federal health care programs. The Department of Health and Human Services Office of Inspector General (HHS-OIG) advised Sham to submit a written application to be considered for reinstatement in federal health care programs. Great advice for most people. Shams never sought reinstatement. Yet he continued to operate health care clinics in New York that billed federal health care programs! In November 2017, Shams also pleaded guilty to conspiracy to pay and receive health care kickbacks and other charges in the Eastern District of New York related to his operation of these clinics.

By 2018, Shams was an owner, operator, and manager of Matias Clinical Laboratory, doing business for Health Care Providers Laboratory (HCPL), a clinical testing laboratory that billed Medicare and other federal health care programs. In order to maintain HCPL’s status as a Medicare provider and enable it to receive payments from Medicare for its testing services, Sham should have submitted a written application to be reinstated in the federal health care programs. Too much paperwork. Instead, Sham concealed his role in HCPL from Medicare, submitting false documentation to Medicare identifying another person as HCPL’s sole owner and managing officer. Between August 2018 and April 2022, HCPL fraudulently billed Medicare approximately $234 million. Medicare paid HCPL approximately $31.7 million based on these fraudulent claims. All while Shams was on federal court supervision following his prior convictions.

Shams pleaded guilty in the Central District of California on Jan. 24, 2023, to conspiracy to commit health care fraud and concealment of his exclusion from Medicare. Courts advise this time is to Sham in prison for a very long time.

Today’s Fraud of The Day is based on article “Medical lab operator sentenced to prison for $234M Medicare con” published by ASC Review on January 31, 2024

A California medical lab operator was sentenced to 10 years in prison for conspiring to conceal his role in a billing scheme that defrauded Medicare of approximately $234 million.

Imran Shams, 65, of Glendale, was previously convicted of Medicare and Medicaid fraud on two separate occasions in 1990 and 2001, after which he was prohibited from participating in federal healthcare programs until he submitted an application for reinstatement, according to a Jan. 30 news release from the Justice Department.

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