From the Files, Some Fraudulent “Beauties”

Owner of Durable Medical Equipment Companies Admits Role In $16 Million Dollar Kickback Scheme

Albert Davydov, 28, of Rego Park, New York, pleaded guilty by videoconference before U.S. District Judge Kevin McNulty to an indictment charging him with conspiring to violate the Anti-Kickback statute.

Davydov, the owner of a group of related durable medical equipment (DME) companies admitted his role in a conspiracy to pay kickbacks in exchange for durable medical equipment on November 13, 2020.

According to documents filed in this case and statements made in court: Davydov, the owner of nine DME companies, participated in a scheme to pay kickbacks in exchange for doctors’ orders for medically unnecessary orthotic braces. Once Davydov and his conspirators received the completed doctor’s orders, they billed Medicare and other federal and private health care benefit programs for the braces. Davydov concealed his ownership of the DME companies by falsely reporting to Medicare that various straw owners owned the companies.

As part of his plea agreement, Davydov agreed that the improper benefit conferred was over $16 million for the charged conspiracy to violate the federal Anti-Kickback statute. The conspiracy charge to which Davydov pleaded guilty carries a maximum penalty of five years in prison and a fine of $250,000, or twice the gross grain or loss from the offense, whichever is greatest. Sentencing is scheduled for March 25, 2021.

Texas Man Sentenced to Prison for Fraudulently Billing Government Medical Insurance Programs

Prosecution Is Part of Effort Against Fraudulent ‘Telehealth’ Scams

Patrick Siado, 39, of Houston, was sentenced to 51 months in federal prison and ordered to pay $50,075 in restitution by U.S. District Court Chief Judge J. Randal Hall after pleading guilty to one count of Conspiracy. After completion of his prison sentence, Siado must serve three years of supervised release.

As described in court documents and testimony, Siado admitted that he and unindicted co-conspirators hired individuals to solicit information and take DNA swabs from low-income and elderly residents. The individuals were paid $150 for each “patient,” with the information used by other conspirators to submit fraudulent claims to Medicare and Medicaid. Siado would then receive an illegal

The Essential Resource for The Insurance Fraud Professional

Zalma’s Insurance Fraud Letter – Page 10 kickback ranging from $100 to $575 per test accepted for billing, which typically generated a claim to Medicaid of more than $30,000 each.

The Southern District of Georgia has now charged 30 individuals and companies as part of the nationwide crackdown on fraudulent genetic testing, and prescribing of orthotic braces and pain creams, identifying more than $1.5 billion in losses to Medicare and Medicaid.

Inglewood Women Plead Guilty to Running Scheme to bill Medi-Cal For Substance Abuse Counseling

Mesbel Mohamoud, 47, and her mother-in-law, Erlinda Abella, 66, also of Inglewood, pleaded guilty to one count of health care fraud in separate hearings before United States District Judge Philip S. Gutierrez.

The Inglewood, California woman and her mother-in-law, who both ran a South Los Angeles drug and alcohol abuse treatment program, each pleaded guilty today to a health care fraud charge for fraudulently submitting more than $500,000 in claims for services that did not qualify for reimbursement or were never provided.

Mohamoud was the owner and executive director of The New You Center Inc. (TNYC), located in the Vermont Knolls neighborhood of South Los Angeles. Abella, who co-founded TNYC with Mohamoud in 2005, was the company’s program director.

TNYC had contracts to provide medically necessary substance abuse treatment services through the Drug Medi-Cal program to adults and teenagers in Los Angeles County.

According to Mohamoud’s and Abella’s plea agreements, from January 2009 to December 2015, TNYC submitted false and fraudulent bills for counseling sessions that were not conducted at all, were not conducted at authorized locations, or did not comply with Drug Medi-Cal regulations regarding the length of sessions or the number of clients.

Mohamoud and Abella also allegedly caused TNYC to bill for clients who did not have a substance abuse problem, to falsify documents related to services supposedly provided to clients, and to forge client signatures on documents such as sign-in sheets.

For example, in September 2013, TNYC submitted a fraudulent claim for Medi-Cal reimbursement in the amount of $62.15 for a three-hour counseling session for a client on August 17, 2013 – the same day when the client was hospitalized and did not receive any counseling from TNYC.

In court documents, Mohamoud further admitted she knew that among the acts Abella directed TNYC counselors to engage in included enrolling clients in TNYC’s substance abuse treatment program even if the clients had used drugs or alcohol only occasionally or even just once.

Mohamoud and Abella admitted that TNYC submitted approximately $527,313 in false and fraudulent claims for group and individual substance abuse counseling services and was paid $260,101 on those claims.

Texas Physician Sentenced to Five Years for Multi-Million Medicare Fraud Scheme Yolanda Hamilton, M.D., 57, of Harris County, Texas, the physician-owner and operator of HMS Health and Wellness Center, PLLC, was sentenced by U.S. District Judge Keith P. Ellison of the Southern District of Texas. Judge Ellison also ordered the defendant to pay $9.5 million in restitution.

Hamilton, a Texas physician was sentenced to five years in prison November 18, 2020 for her role in a multi-million Medicare fraud scheme.

Hamilton was convicted by a federal jury of one count of conspiracy to commit health care fraud, one count of conspiracy to solicit and receive health care kickbacks, and two counts of false statements relating to health care matters in October 2019. According to the evidence presented at trial, from January 2012 to August 2016, Hamilton conspired with others to defraud Medicare by signing false and fraudulent home healthcare paperwork that was used to submit fraudulent claims to Medicare.

Hamilton and her co-conspirators made it appear that the patients qualified and received home healthcare services, when they often did not. In fact, members of the conspiracy paid the patients to receive the home healthcare services, which were often medically unnecessary, not provided, or both. The evidence also showed that Hamilton required home healthcare agencies to pay an illegal kickback, which Hamilton disguised as a “co-pay,” in exchange for Hamilton certifying and recertifying patients for home healthcare services.

Hamilton typically would not release the home healthcare paperwork until the home healthcare companies or their marketers paid her the kickback, the evidence showed. The scheme resulted in approximately millions in false and fraudulent claims for home-health services to Medicare and in Hamilton receiving over $300,000 in kickbacks.

All defendants are presumed innocent until convicted beyond a reasonable doubt in a court of law. To date, several co-conspirators including marketers, patient recruiters along with doctors, and nurses who purchased plans of care and other signed medical documents from Hamilton have been charged, found guilty, or pleaded guilty to conspiracy to commit health care fraud and/or paying or receiving kickbacks.