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Texas Business reports: DALLAS—Twelve defendants were arrested on various charges, outlined in five indictments, regarding their respective roles in several unrelated health care fraud conspiracies involving more than $100 million in fraudulent billings to Medicare, announced U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.
Two additional defendants that are named in the indictments are already in federal custody. Defendants will begin making their initial court appearances this afternoon.
“With the indictments unsealed today, over the last 18 months the Medicare Fraud Strike Force in Northern District of Texas has charged defendants with close to one half billion dollars of fraud and have sent a clear message that we will protect taxpayers’ dollars and the Medicare program,” said U.S. Attorney Saldaña.
“Today’s indictments are part of a nationwide effort by HHS-OIG, the FBI, the state Medicaid Fraud Control Unit and U.S. Attorney’s offices to crack down on the most virulent form of health care fraud, fraud using stolen identities,” said Special Agent in Charge Mike Fields of the Dallas Regional Office of HHS’s Office of the Inspector General. “In one of the cases charged today, the defendants submitted claims for services to Medicare patients whose only connection to the defendants were that their names happened to be on a list of stolen Medicare ID numbers the defendants had obtained. The patients never visited the defendants’ business and never received any of the diagnostic tests and office visits for which their Medicare benefits were charged.”
“The success of today’s Strike Force operation can be attributed to the combined investigative resources of the Health Care Fraud Prevention and Enforcement Action Team (HEAT),” said FBI Dallas Special Agent in Charge Diego G. Rodriguez. “Continued efforts of these multi-agency teams reduce fraud, recover taxpayer dollars and remove fraudsters from abusing our Medicare and Medicaid programs.”
Lawrence Dale St. John, et al.
Lawrence Dale St. John, his son Jeffrey Dale St. John and Dr. Nicolas Alfonso Padron are each charged with one count of conspiracy to commit health care fraud and 13 substantive counts of health care fraud. Lawrence St. John, 65, of Grand Prairie, Texas, owned, operated and oversaw every aspect of A Medical House Calls and his son, Jeffrey St. John, 40, of Dallas, ran A Medical’s daily operations. A Medical, which provided physician home visits to Medicare beneficiaries, was also known as A+ Medical House Calls and ANM Physician House Calls. Its primary purpose was to certify and re-certify Medicare beneficiaries for home health services. A Medical did not provide primary care physician services to Medicare beneficiaries; although many patients believed the company was a real physician practice and attempted to get care, often to no avail. Dr. Padron, 53, of Garland, Texas, who served as its medical director, supplied his Medicare provider number to Lawrence and Jeffrey! St. John so that A Medical could submit claims to Medicare.
The indictment alleges that from May 2010 through January 5, 2012, the defendants conspired together to bill Medicare for care plan oversight, by Dr. Padron, for numerous beneficiaries when Dr. Padron was out of town, including dates when he was out of the country and on a cruise.
Dr. Padron has been in federal custody since his arrest in June 2012 on charges related to his role in a conspiracy to illegally distribute and dispense hydrocodone.
U.S. v. Pamela Adenuga, et al.
Pamela Adenuga, 38, and her husband, Kahinde Adenuga, 45, both of Arlington, Texas, are each charged with one count of conspiracy to commit health care fraud and seven substantive counts of health care fraud. From November 2007 through the present, Pamela Adenuga was the director and officer of finance for a durable medical equipment (DME) company called His Grace Medical Supply & More and Katahinde Adenuga was the owner and managing director of His Grace.
The indictment alleges that since November 2007, Pamela and Kahinde Adenuga conspired together to defraud Medicare and Medicaid by submitting claims for DME that was either not provided or not prescribed.
U.S. v. Olalekan Sorunke, et al.
Olalekan Sorunke, 40, of Rowlett, Texas, is charged with four counts of health care fraud stemming from his operation of Lincoln Medical Supply, Inc., a DME business he owned and operated in Dallas.
According to the indictment, Sorunke billed Medicare for power wheelchairs, hospital beds for home use and related accessories and other DME that was not medically necessary, and in some cases, was never provided to the Medicare beneficiaries. The indictment alleges that he engaged in up-coding wheelchairs, billing for but failing to provide wheelchairs, and forging doctors’ signatures on required documentation for the wheelchairs.
U.S. v. Joseph Megwa, M.D., et al.
A physician, Joseph Megwa, 58, of Arlington, and two registered nurses Ferguson Ikhile and Ebolose Eghobor, who were associated with PTM Healthcare Services, Inc., a home healthcare agency, are each charged with one count of conspiracy to commit health care fraud and three substantive counts of health care fraud arising from their association with a home health agency. In addition, Dr. Megwa is charged with four counts of making false statements relating to healthcare matters.
According to the indictment, Dr. Megwa, a Medicare provider, owned and operated Raphem Medical Practice in Arlington. He provided home health certifications so that home healthcare agencies could bill Medicare for home health services that were not medically necessary and not rendered. He and others at Raphem performed unnecessary home visits and ordered unnecessary medical services for Medicare beneficiaries he had certified for home health. From 2006 through 2011, Dr. Megwa signed approximately 33,000 prescriptions, allegedly signing stacks of documents without reviewing them, for more than 2,000 unique Medicare beneficiaries for home health services provided by more than 230 home health agencies. During the same time period, through Raphem, Dr. Megwa billed approximately $10 million to Medicare for unnecessary home visits and unnecessary medical services.
Ikhile, 54, of Irving, Texas, owned PTM and Eghobor, 47, of Grand Prairie, was PTM’s director of nursing. According to the indictment, nearly 25% of PTM’s patients were certified for home health care services by Dr. Megwa. From January 1, 2006 through December 31, 2010, PTM submitted approximately $4,825,251 in claims to Medicare for services for Medicare beneficiaries that had been certified by Dr. Megwa.
Dr. Megwa solicited payments from PTM and other home health agencies in exchange for his agreement to sign plans of care, regardless of medical necessity, and then billed unnecessary services for those beneficiaries. PTM purported to provide skilled nursing services to beneficiaries who did not need them. The indictment also alleges that Dr. Megwa submitted claims for services he rendered at beneficiaries’ homes while he was, in fact, out of the country.
U.S. v. Ovsanna Agopian, et al.
This indictment supersedes an indictment filed on October 19, 2011, that charged Ovsanna Ogopian, 57, of Houston, Texas, formerly of Grenada Hills, California, Tolulope Labeodan, 27, of Dallas and another individual, who has since pleaded guilty, with conspiracy to commit health care fraud and multiple counts of health care fraud.
Agopian operated two clinics, Euless Healthcare Corporation, in Hurst, Texas, and Medic Healthcare Incorporated, in Houston, Texas. Through these two clinics, according to the indictment, Agopian billed for office visits and diagnostic tests that were never performed. Labeodan, and four of the five new defendants charged, Godwin Umotong, 58, Leslie Omagbemi, 56, Munda Massaquoi, 68, and Comfort Gates, 45, all of Houston; were employees of one or both of the clinics. Defendant Vagharshak Smbatyan, 60, of Grenada Hills, is Agopian’s husband.
The superseding indictment charges Agopian, Labeodan, Umotong, Omagbemi, Massaquoi and Gates each with one count of conspiracy to commit health care fraud and six substantive counts of health care fraud. Smbatyan is charged with one count of making a false statement to a government agency for representing that he was Medic’s owner, when he knew that his wife, who was barred from the Medicare program because of two prior health care fraud convictions, was the true owner.
Euless Healthcare and Medic Healthcare falsely and fraudulently billed Medicare for $2,836,388 and were paid $1,413,616.
An indictment is an accusation by a federal grand jury, and a defendant is entitled to the presumption of innocence unless proven guilty. If convicted, however, the maximum statutory penalty for each count of conspiracy to commit health care fraud, and each substantive count of health care fraud, is 10 years in prison, a $250,000 fine and restitution. Each false statement charge carries a maximum statutory sentence of five years in prison and a $250,000 fine. The government also seeks to forfeit the money made by the defendants through the alleged schemes.
The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. Since their inception in March 2007, strike force operations in nine locations have charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
The cases are being prosecuted by Assistant U.S. Attorneys Michael C. Elliott, Michael McCarthy, Katherine E. Pfeifle, Mindy Sauter and John DeLaGarza, and Trial Attorney Ben O’Neil of the Criminal Division’s Fraud Section. The investigation is being conducted by HHS-OIG, the FBI and the Texas Attorney General's Medicaid Fraud Control Unit.