12 Charged in Chicago in Largest-Ever Medicare Fraud Sweep

By BETH DALBEY (Patch Staff) and MORGAN SEARLES (Patch Staff)

Twelve Northern Illinois health care workers, including a River Forest man, have been arrested and charged as part of a $712 million fraud and kickback scheme that federal officials are calling the “largest national Medicare fraud takedown in history.”

A total of 243 individuals in six states, including 46 doctors, nurses and other licensed medical professionals, bilked the government out of $712 million in false billings, the government said.

The cases, which span 17 federal jurisdictions, include allegations of anti-kickback statutes, money laundering and identify theft. Arrests were made in Michigan, Florida, Texas, California, New York and Louisiana.

Twelve defendants were charged in four local cases as part of the national package, according to Zachary T. Fardon, United States Attorney for the Northern District of Illinois.

“The defendants include doctors, patient recruiters, home health-care providers, pharmacy owners and others,” U.S. Attorney General Loretta Lynch said in a statement announcing the sweep by the Medicare Fraud Strike Force. “They billed for equipment that wasn’t provided, for care that wasn’t needed and services that weren’t rendered.”

• Money laundering carries a maximum penalty of 20 years in prison and a $500,000 fine.
• Health care fraud and conspiracy to commit health care fraud carry a maximum penalty of 10 years in prison and a $250,000 fine and restitution is mandatory.
• Making a false statement in a health care matter carries a maximum penalty of five years in prison and a $250,000 fine.

Home health services were involved in three of the cases and nine of the defendants in the Northern District of Illinois.

“Health care fraud extracts a huge toll on our nation’s health care system,” stated U.S. Attorney Fardon in announcing the cases charged in the Northern District of Illinois. “We will continue to aggressively pursue those health care providers that take advantage of not only the system, but the patients they are entrusted to care for.”

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team, a joint initiative announced in May 2009 between the Departments of Justice and Health and Human Services to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.

This is the first time districts outside of Strike Force locations have gotten involved in a national takedown. Those districts contributed 82 defendants charged in this takedown.

According to the FBI, the following cases are being prosecuted by the Northern District of Illinois:

United States vs. Janet Guerrero, et.al: Seven individuals who worked at three related home health care companies—Donnarich Home Health Care, Inc., Josdan Home Health Care Inc., and Pathways Home Health Services LLC—were charged by superseding indictment yesterday with conspiracy to commit health care fraud, health care fraud, false statements, and money laundering.

The indictment alleges a $45 million fraud at the three home health care companies, starting as early as 2008 and continuing into 2014. The fraud as alleged included paying illegal bribes and kickbacks to obtain Medicare beneficiaries; ignoring doctors who refused to certify beneficiaries as “homebound” and eligible for care; enrolling patients who did not need or want the care; subjecting patients to pre-planned cycles of discharges and re-enrollments, regardless of their medical needs; and falsifying medical records to make patients appear to be homebound or sicker than they actually were, according to the government.

The newly-charged defendants include Josephine Tinimbang, an owner and operator of the companies; Dr. Jose Calub, the medical director; Sharon Gulla, a registered nurse and a former supervisor; and Marilou Lozano, Ronald Malalis, Mary Pilar Mendoza, and Isabelita Sabejon, registered nurses who enrolled non-homebound beneficiaries and fabricated medical records. Two defendants were charged in an earlier indictment: Sherwin Cubelo, a patient recruiter who received illegal kickbacks; and Janet Guerrero, an office manager who administered the kickbacks.

United States vs. Barry Fischer: Barry Fischer, 70, of River Forest, was indicted for health care fraud on Wednesday in a 20-count federal indictment for allegedly billing Medicare for unnecessary home visits, for falsely certifying patients for home health services, and for putting false information in patient charts.

Fischer allegedly signed orders in which he falsely certified patients as “confined to the home,” under his care, and requiring skilled nursing services, the government said. According to the indictment, as a result of Fischer’s false certifications, Medicare suffered losses in the form of payments to the company Fischer worked for and various home health agencies.

United States vs. Zenaida Dimailig: Zenaida Dimailig, 78, of Bensenville, was charged by complaint with health care fraud for allegedly causing Medicare to be billed for home health services for patients who were not home bound and for services that were not rendered. Dimailig allegedly paid cash kickbacks to Medicare-covered patients who, in turn, allowed their Medicare information to be used to bill Medicare for home-health services that these individuals did not need, the government said.

Dimailig then passed on this Medicare information and records that falsely suggested that certain services were provided to Medicare beneficiaries to home health care agencies for the purpose of billing Medicare.

United States vs. Omeed Memar: Omeed Memar, 46 of Chicago, a dermatologist, was indicted for health care fraud last week in a 16-count federal indictment for allegedly billing cosmetic treatments fraudulently as the destruction of large numbers of pre-cancerous lesions.

According to the indictment, the defendant falsely diagnosed patients with actinic keratosis, or precancerous lesions that are typically rough, dry or scaly, and then billed public and private health insurers for medically unnecessary treatments. According to the indictment, between 2007 and January 2013, Memar falsely diagnosed patients with actinic keratosis, ordered his staff to provide intense-pulsed light treatments for his patients, and instructed his staff to document the procedures falsely as the destruction of 15 or more precancerous lesions.