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March 25, 2013 Healthcare Fraud

Extensive Medicare Fraud Investigation Results in a List of Charges for Five Defendants

The Department of Justice, the FBI and the Department of Health and Human Services (HHS) have announced that five individuals have been charged for their participation in an elaborate Medicare fraud scheme involving purported home health and psychotherapy services. Court documents unsealed in the Eastern District of Michigan revealed that the scheme involved more than $24.7 million in fraudulent medical claims, which were submitted to Medicare for home healthcare and psychotherapy services that were medically unnecessary and/or never actually performed.

Details of the Healthcare Fraud Lawsuit

Mohammed Sadiq, Jamella Al-Jumail, Firas Alky, Clarence Cooper, and Beverly Cooper allegedly participated in the Medicare fraud scheme from January 2007 through April 2012, operating a large network of home health care and psychotherapy companies in the Detroit area through which they conspired to defraud Medicare. Each of the defendants is an operator, employee or marketer formerly associated with the healthcare clinics.

According to the Department of Justice, all five defendants are charged with one count of conspiracy to commit healthcare fraud. Additional charges include Sachin Sharma with five counts of health care fraud; Sachin Sharma, Abdul Malik Al-Jumail, Williams, Sadiq, Alky and Clarence Cooper with one count of conspiracy to pay and receive healthcare kickbacks; and Jamella Al-Jumail with one count of destruction of records in a federal investigation. The government is also seeking forfeiture from all five defendants.

According to official court documents, the defendants used home health care, psychotherapy and other medical service companies as a means to carry out the Medicare fraud. These clinics included Reliance Home Care, LLC; First Choice Home Health Care Services Inc.; Associates in Home Care Inc.; Haven Adult Day Care Center LLC; Swift Home Care LLC; ABC Home Care Inc.; Accessible Home Care Inc.; and Be Well Home Care LLC.

The defendants and their co-conspirators allegedly submitted Medicare enrollment applications for each clinic so that they could legally bill Medicare for reimbursement of services. Additionally, Sachin Sharma, Abdul Malik-Al-Jumail and others allegedly paid kickbacks to patient recruiters for obtaining the personal information of Medicare beneficiaries. In order to submit a claim to Medicare, the defendants needed the personal information of each Medicare beneficiary. The clinic operators allegedly paid kickbacks to patient recruiters to obtain this information. The stolen patient information was then used to file false claims against the Medicare program for psychotherapy and home healthcare services, even though the services were not medically necessary and, in many cases, never actually provided to the patients.

Additional Medical Fraud

Beverly Cooper, a former registered nurse, worked directly with Reliance Home Care LLC, First Choice Home Health Care Services Inc. and Accessible Home Care Inc. According to the DOJ, Cooper routinely fabricated nursing notes and other documentation, giving Medicare the impression that home healthcare services were being provided to patients. These fabricated documents were the basis of and supported the fraudulent claims submitted to Medicare for reimbursement. Cooper also signed the nursing visit forms for multiple home healthcare visits that were made by unlicensed individuals, giving the false impression that she actually provided the services. Cooper later admitted to investigators that she understood the documents would be used to support the fraudulent claims that were submitted to Medicare.

Additionally, the defendants and their co-conspirators each participated in staged home healthcare visits during Medicare-supervised inspections. The co-conspirators posed as home health care employees for each company, treating fake patients in order to convince the Medicare inspectors that the companies were legitimate and the services were being provided.

According to the United States government, the defendants and their co-conspirators caused Reliance, First Choice, Associates, Haven, Swift, ABC, Accessible and other medical companies to submit approximately $24.7 million in fraudulent claims to Medicare. In addition, Jamella Al-Jumail is charged with destroying records that relate to Accessible’s Medicare billing tactics after learning about the arrest of Abdul Malik Al-Jumail, her co-conspirator and father. Clarence and Beverly Cooper, Sadiq and Jamella Al-Jumail were each arrested at a later date.

Fraud Section Assistant Chief Gejaa T. Gobena and Trial Attorney William G. Kanellis are prosecuting the extensive Medicare fraud case. The investigations were conducted jointly by the FBI and HHS-OIG, as part of the Medicare Fraud Strike Force, which is supervised by the U.S. Attorney’s Office for the Eastern District of Michigan and the Criminal Division’s Fraud Section.