The Department of Justice (DOJ) Tuesday released a statement that it charged 23 Michigan residents, in two separate cases, for allegedly defrauding Medicare for $61.5 million. The illegal schemes involved paying bribes and billing Medicare for unneeded medical treatments that were never provided.
First, a brief background on how this type of Medicare works. A home health care agency, which provides nursing services to patients in their home, submits a claim to Medicare for the money needed to treat its patients. If the claim qualifies under Medicare’s covered services, then it will pay the home health care agency the money for the patient’s care.
In the first case initiated by the DOJ, US v. Jamil, et al., Walid and Jalal Jamil owned multiple home health care agencies under the guise of straw owners. They submitted over $50 million worth of fraudulent claims to Medicare for home health care services that they never provided to patients. Additionally, they bribed coconspirators to recruit patients who did not require, nor even qualify for, home health care services, violating the Federal Anti-Kickback Statute. After Medicare granted the claims based on false patient information, Walid and Jalal allegedly pocketed over $43 million that they used for their own benefit.
In the second case, US v. Malas, et al., Radwan Malas owned a home visiting physician company where he employed multiple doctors who would visit patients at home. Malas allegedly worked in cahoots with the Jamils by having his doctors certify medically unnecessary services for patients referred to him by Walid and Jalal Jamil. Malas billed Medicare $11.5 million for claims based on fraudulent information. Of that, Malas allegedly received and pocketed $4 million.
The DOJ charged 10 other individuals in connection with the case, but it has not revealed their identities.
