Patient Recruiter Sentenced to 40 Months in Prison for His Role in a Fraudulent Diagnostic Testing Scheme
WASHINGTON – A Detroit-area patient recruiter was sentenced today to 40 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 today.
Melvin Young, 57, was also sentenced by U.S. District Judge Patrick J. Duggan in the Eastern District of Michigan to three years of supervised release following his prison term and was ordered to pay restitution, joint and several with co-defendants, in the amount of $533,643. Young pleaded guilty in April 2010 to one count of conspiracy to commit health care fraud.
According to the plea documents, beginning in approximately September 2007, Young and a co-conspirator began recruiting and transporting patients to a clinic called Ritecare LLC. Ritecare was owned and operated by co-conspirators and had locations in Detroit and Livonia, Mich. Young admitted that he and this co-conspirator, Emma King, paid kickbacks to Medicare beneficiaries whom they recruited and transported to Ritecare. According to the plea documents, the owners and operators of Ritecare were the source of the funds used by Young to pay the Medicare beneficiaries he recruited. Young admitted that he would keep part of these funds as a kickback. Typically, the owners of Ritecare would provide $100-$150 per patient Young recruited, with Young retaining $50-$75 of that amount.
According to the plea documents, the patients Young recruited had to subject themselves to medically unnecessary tests to receive the money. Per instructions from the owners and operators of Ritecare, Young admitted that he instructed the patients to claim they had certain symptoms to trigger medically unnecessary tests. Consequently, the patients’ medical records contained false symptoms allowing Ritecare to deceive Medicare as to the legitimacy and medical necessity of the tests it performed.
Young admitted that King and he were responsible for recruiting at least 269 patients to Ritecare. Through his recruitment efforts, Young caused the submission of approximately $940,760 in false or fraudulent billings by Ritecare. Medicare paid approximately $533,643 on those claims.
King pleaded guilty in April 2010 to one count of conspiracy to commit health care fraud and was sentenced on Dec. 14, 2010, to 8 months in prison.
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 850 individuals and organizations that collectively have billed the Medicare program for more than $2.1 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