Clifford P. Shoemake, Medicare and TRICARE Fraud and Money Laundering, Guam 2014

Grimy Times has learned that two former owners and an employee of an ambulance services provider headquartered in Guam pleaded guilty to their roles in a health care fraud and money laundering scheme that resulted in a loss to the United States of approximately $10.8 million.

The scheme, which was one of the largest single Medicare ambulance fraud cases prosecuted nationwide, involved the submission of claims for reimbursement for medically unnecessary ambulance services that Guam Medical Transport (GMT) provided to patients with end stage renal disease (ESRD).

According to court documents, from approximately March 11, 2010, to approximately March 21, 2014, the defendants, Clifford P. Shoemake, 63, of Guam; Casey C. Conner, 60, of Saipan; and Nicholas A. Shoemake, 31, of Guam, engaged in a conspiracy to defraud Medicare and TRICARE by submitting claims for reimbursement for medically unnecessary ambulance services that GMT provided to patients with ESRD.

The defendants admitted they were aware that many of GMT's patients were not bed-confined, and did not have acute medical conditions that would otherwise qualify them for ambulance transportation. As part of the scheme, the defendants directed GMT employees to remove from internal documents references to GMT patients' ability to walk because they knew that Medicare and TRICARE would not provide reimbursement for the patients.

The conspiracy resulted in improper payments to GMT of approximately $10.8 million, the defendants admitted. They further admitted to conspiring to engage in money transactions involving the proceeds of their health care fraud scheme, using the proceeds to pay for personal expenses, such as vacations, personal income taxes, a personal residence and other items.

To date, five former GMT owners and employees have pleaded guilty to their roles in defrauding Medicare and TRICARE in this scheme. The defendants are scheduled to be sentenced on January 29, 2020.

The case was investigated by the FBI's Honolulu Field Office, IRS Criminal Investigation's Seattle Field Office, and the U.S. Department of Health and Human Services Office of the Inspector General's Los Angeles Regional Office. Assistant Attorney General Brian A. Benczkowski of the Justice Department's Criminal Division and U.S. Attorney Shawn N. Anderson of the Districts of Guam and the Northern Mariana Islands made the announcement.

Source: https://www.justice.gov/usao-gu/pr/guam-ambulance-company-executives-plead-guilty-medicare-and-tricare-fraud-and-money