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Wednesday, August 11, 2010
Detroit-area Clinic Operator Sentenced to 56 Months in Prison for Role in Fraudulent Diagnostic Testing Scheme

WASHINGTON – An operator of a Detroit-area medical clinic was sentenced Tuesday to 56 months in prison for his role in a conspiracy to defraud the Medicare program, the Departments of Justice and Health and Human Services announced today. Carlos Grana, a Miami resident, was also sentenced by U.S. District Judge Lawrence P. Zatkoff in the Eastern District of Michigan to three years of supervised release following his prison term and was ordered to pay $2 million in restitution.

Grana, 36, pleaded guilty in April 2010 to one count of conspiracy to commit health care fraud. According to the plea documents, Grana managed the day-to-day operations of Careplus LLC, a medical clinic in Livonia, Mich. Grana admitted that while he managed Careplus, he paid patient recruiters for Medicare beneficiary referrals. According to court documents, the recruiters were expected to find and transport Medicare beneficiaries to Careplus. Grana admitted he paid the recruiters between $100 and $150 per patient referral, and instructed the recruiters to pay the patients $50 from that amount. According to court documents, nearly all of the patients treated at Careplus were secured through the payment of kickbacks.

Grana further admitted that in exchange for the payments, he and his co-conspirators expected the Medicare beneficiaries who received kickbacks to subject themselves to medical examinations and to medically unnecessary diagnostic tests. Grana told the recruiters to instruct the patients to feign certain symptoms when they arrived at Careplus, which led to the patients’ medical records containing information about false symptoms. The falsified records then helped Careplus deceive Medicare about the legitimacy and medical necessity of the tests it performed. Between approximately February 2008 and October 2009, Grana and his co-conspirators at Careplus submitted approximately $2.2 million in claims to the Medicare program for unnecessary medical and testing services that were procured through the payment of kickbacks. Medicare paid approximately $2 million of those claims.

This sentence was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (OIG) Chicago Regional Office.

This case was prosecuted by Assistant Chief John K. Neal, Trial Attorney Gejaa T. Gobena and Special Trial Attorney Stephanie M. Hays of the Criminal Division’s Fraud Section. The FBI and the HHS Office of Inspector General (HHS-OIG) conducted the investigation. The case was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.

Since its inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 810 individuals and organizations that collectively have billed the Medicare program for more than $1.85 billion.  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the HEAT team, go to: www.stopmedicarefraud.gov.

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