All American Fraud

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When you hear the term ”All-American,” it brings to mind a lot of things that are unique to American culture. Fourth of July fireworks, apple pie, baseball, NASCAR and Elvis are just a few of the iconic images that might pop into your head. Medicare Fraud doesn’t usually top the list, yet the illegal practice is exclusive to the U.S. and occurs on a regular basis. A case recently investigated by the Medicare Strike Force revealed that a Detroit man masterminded a scheme through two home health agencies to bilk the government of nearly $11 million over a two-year period.

A press release from the Detroit Division of the Federal Bureau of Investigation (FBI) states that the 53-year-old man admitted to billing Medicare for home visits that never occurred through two Detroit-based home health companies that he helped finance and establish. He employed several physical therapists and physical therapy assistants to sign medical documents needed for billing Medicare. (As you can guess, the co-conspirators were not actually conducting a vast majority of the visits or treating the patients, as charged.)

The ringleader also admitted to paying cash kickbacks and other benefits to Medicare beneficiaries in exchange for their Medicare numbers and signatures verifying they had received physical or occupational therapy from the health care agencies. In fact, most of the beneficiaries were not in need of any physical therapy services. (Now there’s a surprise.)

The Detroit man was sentenced to 50 months in prison, plus three years of supervised release. He also was ordered to pay nearly $10.8 million in restitution, jointly and severally with his co-defendants.

A big high-five goes out to the judge who ruled on this case and to the joint investigative effort among the FBI, Department of Health and Human Office of Inspector General and the Internal Revenue Service. The Medicare Strike Force once again helped to prevent the loss of millions of dollars from the Medicare system so that those who actually deserve the benefits get them. (Now that’s definitely worthy of being on the top of the ”All-American” list.)

Source: Today’s ”Fraud of the Day” is based on a press release from the Detroit Division of the Federal Bureau of Investigation titled, ”Mastermind of $11 Million Detroit Medicare Fraud Scheme Sentenced to 50 Months in Prison,” released on September 12, 2013.

WASHINGTON—Muhammad Shahab, the mastermind of an almost $11 million Medicare fraud scheme in Detroit, was sentenced today to 50 months in prison.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Robert D. Foley, III of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh, III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office made the announcement.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.