On February 7, 2023, the U.S. Department of Justice announced that twenty-three individuals were charged for their alleged participation in a large Medicare fraud scheme.  The alleged scheme involved patient recruiters, physicians, at least one lab, and two individuals who owned, operated, or otherwise had an interest in several home health agencies.  The government noted that the two individuals, Walid Jamil and Jalal Jamil, allegedly hid their ownership interest in the home health companies through straw-man ownership arrangements, sometimes involving family members.  The Jamils are allegedly key individuals in the scheme.  According to the government, the Jamils allegedly paid bribes to co-conspirators to recruit patients, who did not need home health services, did not otherwise qualify for home health care under Medicare rules, or did not receive the care for which Medicare was billed.  Some individuals who assisted the Jamils with operating the home health agencies allegedly paid patient recruiters and submitted false claims at the direction of the two owners. The government also charged multiple patient recruiters and employees of the home health companies for their role in the scheme. 

A key aspect of many fraud cases involving home health agencies are individual physicians, as a physician referral is usually required for home health services to be covered by Medicare.  Not surprisingly, the government alleges that the Jamils paid a network of physicians for the necessary information to bill Medicare.  For example, the government alleges that a physician, Radwan Malas, ran a company that served as a home-visiting physician company that referred patients to the Jamils for home health services. He also allegedly billed for services not medically necessary or not provided and also required physicians in his office to order medically unnecessary urine drug tests for which he received a fee from the lab.  The government also alleges that several other physicians and lab owners engaged in the scheme by paying kickbacks or providing physician orders for medically unnecessary services.

Overall, the multi-faceted scheme netted millions. The government alleges that the Jamils submitted $50 million in claims and received more than $43 million from Medicare because of their scheme. Mr. Malas submitted $11.5 million in claims and received about $4 million as a result of the alleged scheme.  A lab, which allegedly analyzed the medically unnecessary drug screens, submitted about $2.8 million in claims and was paid more than $730,000. 

The participants’ charges vary and include conspiracy to commit health care fraud (up to 10 years in prison), Health care fraud (up to 10 years in prison), Conspiracy to defraud the United States through payment of illegal health care kickbacks (up to 5 years in prison), Payment of illegal health care kickbacks (up to 10 years in prison), and Specific instances of health care fraud (up to 10 years in prison for each instance).  

As the government noted, all charges and the basis for the charges are allegations.  All defendants are presumed innocent until proven guilty.

The attorneys at Chilivis Grubman represent clients of all types and sizes in connection to health care fraud and white collar criminal matters. If you need assistance with such a matter, please contact us today.