WASHINGTON – A medical assistant was sentenced today to 46 months in prison for his role in a conspiracy to defraud the Medicare program, the Departments of Justice and Health and Human Services (HHS) announced. Mohammed El-Fallal was also sentenced by U.S. District Judge Denise Page Hood in the Eastern District of Michigan to two years of supervised release following his prison term and was ordered to pay $2.8 million in restitution.
El-Fallal, 56, pleaded guilty in June 2010 to one count of conspiracy to commit health care fraud. El-Fallal admitted that he was responsible for submitting or causing the submission of approximately $2.8 million in false or fraudulent claims to the Medicare program between July 2008 and April 2009. According to court documents, El-Fallal, an unlicensed physician, was approached in July 2008 by co-defendant Muhammad Shahab, the owner and/or operator of two home health agencies, Patient Choice Home Healthcare Inc. and All American Home Care Inc. Patient Choice and All American purported to provide home health services, including physical and occupational therapy services, to Medicare beneficiaries, which were then billed to Medicare.
To bill Medicare for home health services, a home health agency must have a physician’s order. El-Fallal admitted in court documents that he entered into an agreement with Shahab under which El-Fallal would sign physician’s orders for Patient Choice and All American using the identity of a licensed physician. El-Fallal worked as a medical assistant with the physician who was suffering from mental illness at the time. According to court documents, El-Fallal was paid approximately $100 by Shahab for therapy orders he signed as the licensed physician. By signing the orders using the physician’s identity, El-Fallal facilitated the ability of Patient Choice and All American to bill Medicare for home health visits that either were not done or were medically unnecessary.
According to court documents, El-Fallal, using the physician’s identity, signed orders that caused approximately $2,802,461 in home health claims by Patient Choice and All American.
Today’s 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.
The case was prosecuted by Assistant Chief John K. Neal and Trial Attorney Gejaa T. Gobena of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG, and 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 825 individuals and organizations that collectively have billed the Medicare program for more than $2 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 Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov/ .