Bold Step against Medicare Fraud Scheme - U.S. Department of Justice Imprisons Detroit-Area Physical Therapist for 62 Months

• Date: April 06, 2010
• Source: Admin

Sterling Heights, Mich., resident Solomon Nathaniel was sentenced today to 62 months in prison for his role in a wide-ranging conspiracy to defraud the Medicare program, announced Assistant Attorney General Lanny Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena 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's (HHS-OIG) Chicago Regional Office. U.S. District Judge Sean F. Cox also ordered Nathaniel to pay $2,875,000 in restitution and to serve a three-year term of supervised release following his incarceration.

Nathaniel pleaded guilty on Oct. 19, 2009, in the Eastern District of Michigan to conspiracy to commit health care fraud. According to information contained in plea documents, Nathaniel, a licensed physical therapist, admitted that he began working in approximately December 2003 as a contract therapist for co-conspirator Suresh Chand, who also pleaded guilty in connection with this case. Chand owned and controlled several companies operating in the Detroit area that purported to provide physical and occupational therapy services to Medicare beneficiaries. According to his plea documents, Nathaniel admitted that he, Chand and others created fictitious therapy files appearing to document physical and occupational therapy services provided to Medicare beneficiaries, when in fact no such services had been provided. According to court documents, the fictitious services reflected in the files were billed to Medicare through sham Medicare providers controlled by co-conspirators.

Nathaniel also admitted that during the course of the scheme he signed approximately 1,250 fictitious physical therapy files, indicating that he had provided physical therapy services to Medicare beneficiaries, when in fact he had not. Nathaniel admitted that he was paid between $90 and $110 for each file he falsified. Nathaniel also admitted that between approximately December 2003 and July 2006, he falsified physical therapy files that supported claims to the Medicare program totaling approximately $6,250,000. Medicare paid approximately $2,875,000 on those claims. Nathaniel admitted that throughout the conspiracy he was fully aware that Medicare was being billed for physical therapy services that he falsely indicated he had performed.

Chand pleaded guilty on Sept. 28, 2009, before U.S. District Judge Sean F. Cox to one count of conspiracy to commit health care fraud and one count of conspiracy to launder money.

This case was prosecuted by Senior Trial Attorney John K. Neal of the Criminal Division's Fraud Section and by Special Assistant U.S. Attorney Thomas W. Beimers of the Eastern District of Michigan. The FBI and HHS-OIG conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division's Fraud Section and the U.S. Attorney's Office for the Eastern District of Michigan.

Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 500 individuals who collectively have falsely billed the Medicare program for more than $1.1 billion. In addition, HHS's Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov

Source: Biotech Week, 7 April 2010