“No-Show” Doctor Pleads Guilty In Connection With $13 Million Health Care Fraud Scheme

BROOKLYN, NY – Connecticut resident Dr. Okon Umana, 67, pleaded guilty today in federal court in the Eastern District of New York to conspiring to defraud the United States in connection with his role as a “no show” doctor in a $13 million health care fraud scheme. Dr. Umana is the last of nine defendants charged to plead guilty in connection with the scheme at the Cropsey Medical Care PLLC clinic in Bensonhurst, Brooklyn.

Today’s guilty plea was announced by Loretta E. Lynch, United States Attorney for the Eastern District of New York; Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division; George Venizelos, Assistant Director-in-Charge, Federal Bureau of Investigation (FBI), New York Field Office; and Thomas O’Donnell, Special Agent-in-Charge, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG).

“Dr. Umana dishonored his medical license when he fraudulently billed Medicare and Medicaid at the taxpayers’ expense,” stated United States Attorney Lynch. “Dr. Umana is the final defendant to be convicted in connection with the government’s investigation of the Cropsey Medical Care clinic, which submitted more than $13 million in fraudulent claims to Medicare and Medicaid. We will continue to investigate and prosecute fraud to protect the integrity of these vital health care programs.” U.S. Attorney Lynch extended her grateful appreciation the Federal Bureau of Investigation and the Department of Health and Human Services, Office of Inspector General, for their outstanding work on the investigation.

According to court documents, from 2009 to 2012, Umana was the medical director of the Cropsey Medical Care clinic. Patients at Cropsey Medical received medically unnecessary physical therapy, diagnostic testing and other services, which were provided by a physician assistant who was acting without supervision. Such purported medical services were then fraudulently billed by Cropsey Medical to Medicare and Medicaid under Dr. Umana’s provider number. From approximately November 2009 to October 2012, Cropsey Medical submitted more than $13 million in claims to Medicare and Medicaid, seeking reimbursement for a wide variety of fraudulent medical services and procedures, including physician office visits, physical therapy and diagnostic tests that were not medically necessary and often did not even occur.

Dr. Umana pleaded guilty before U.S. District Judge John Gleeson. At sentencing on April 15, 2015, Dr. Umana faces a maximum penalty of five years in prison, a fine of over $250,000, restitution of up to $6,429,330 and forfeiture of $6,550,036.

The case was investigated by the FBI and HHS-OIG, brought as part of the Medicare Fraud Strike Force, and supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of New York. The case is being prosecuted by Assistant U.S. Attorney Shannon C. Jones of the Eastern District of New York and Trial Attorney Sarah M. Hall of the Criminal Division’s Fraud Section.

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 prevent and deter fraud and enforce anti-fraud laws around the country. Since its inception in March 2007, the Strike Force, now operating in nine cities, has charged nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare & 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 Team (HEAT), go to: www.stopmedicarefraud.gov

The Defendant:

OKON UMANA

Age: 67

West Haven, Connecticut

E.D.N.Y. Docket No. 12 CR 617 (S-1)