$13.8 Million Health Care Fraud Scheme Unraveled in Detroit

A Detroit-area resident has pleaded guilty to his role in managing a massive $13.8 million psychotherapy fraud scheme, announced federal authorities.

Jawad Ahmad, 42, pleaded guilty today before U.S. District Judge Gerald E. Rosen in Detroit to one count of conspiracy to commit health care fraud. At his sentencing, scheduled for November 28, 2012, Ahmad faces a maximum potential penalty of 10 years in prison and a $250,000 fine.

According to court documents, Ahmad managed numerous aspects of the fraud at Physicians Choice Home Health Care LLC, including delivering kickbacks to beneficiary recruiters who obtained Medicare beneficiaries’ information needed to bill Medicare for home health services.

In exchange for kickbacks, Medicare beneficiaries pre-signed forms and visit sheets that were later falsified to indicate they received home health services they had never received. Ahmad delivered the pre-signed beneficiary paperwork to various medical professionals to create and/or sign fictitious patient files.

From January 2009 through March 2010, Medicare paid more than $5 million for fraudulent home health care claims submitted by Physicians Choice. The scheme involved multiple home health care companies, including Phoenix Visiting Physicians PLLC, where Ahmad worked with unlicensed ‘doctors’ to meet and purportedly examine non-homebound Medicare beneficiaries.

The investigation was led by the FBI’s Detroit Field Office, with assistance from the HHS Office of Inspector General’s Chicago Regional Office and the U.S. Attorney’s Office for the Eastern District of Michigan.

Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division praised the efforts of the investigative team, saying, ‘This case highlights the importance of holding accountable those who seek to exploit our health care system.’

The case is a reminder of the need for vigilance in protecting our health care system from fraud and abuse. It also serves as a warning to those who would seek to engage in such activities: you will be caught and you will be held accountable.

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