Seven individuals, including four doctors, have been sentenced to federal prison for their roles in a $6 million health care fraud scheme that involved fraudulent billing for diagnostic testing at three clinics in Houston, Texas.
The scheme, which ran from September 2008 to May 2010, involved paying patients to come to the clinics and then billing Medicare for tests that were either not performed or not medically necessary. The clinics were owned by Zaven Pogosyan and Edvard Shakhbazyan, who admitted to opening the clinics with the intention of defrauding Medicare.
Pogosyan and Shakhbazyan hired doctors, including Giam Nguyen, D.O., Benjamin Martinez, M.D., and Donovan Simmons, M.D., to review patient files and perform tests. Patients were brought to the clinics by recruiters who were paid for each patient they delivered. The recruiters testified that they were paid in cash for each patient they referred to the clinics.
The scheme was uncovered after a law enforcement agent reviewed patient files seized during the searches of the clinics. The agent testified that 730 of the 1229 patients reported their chief complaint as back pain, but were given ultrasounds of their kidneys, abdomens, thyroids, carotid arteries as well as allergy tests and anorectal tests. An expert witness also testified that the anorectal manometry and EMG of the anal or urethral sphincter test results in the patient files were physiologically impossible and therefore could not have been done.
The defendants were sentenced as follows:
- Zaven Pogosyan, 38, was sentenced to 87 months in prison and ordered to pay restitution in the amount of $2.6 million.
- Edvard Shakhbazyan, 41, was sentenced to 87 months in prison and ordered to pay restitution in the amount of $3.3 million.
- Seryan Mirzakhanyan, 32, was sentenced to 28 months in prison and ordered to pay restitution of $1.48 million.
- Giam Nguyen, 47, was sentenced to 87 months in prison and ordered to pay restitution in the amount of $3.3 million.
- Benjamin Martinez, 35, was sentenced to 28 months in prison.
- Donovan Simmons, 43, was sentenced to 15 months in prison.
- Anna Bagoumian, 44, was sentenced to 51 months in prison.
- Frank Montgomery, 67, was sentenced to 17 months in prison.
The case was investigated by the FBI and the Office of the Inspector General for the U.S. Department of Health and Human Services.
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- Shannon Tecoko Mays, Conspiracy to Commit Wire Fraud, Texas, 2012 · Kansas
Key Facts
- State: Texas
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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