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Monday, May 18, 2015

Administrator and Biller of Illinois Physician Group Convicted in $4.5 Million Medicare Fraud Scheme

A federal jury in Chicago on May 15, 2015, convicted the administrator and biller of a Schaumburg, Illinois, in-home visiting physician group for their participation in a $4.5 million health care fraud scheme that included billing Medicare for services rendered to patients who were dead and services rendered by medical professionals who worked over 24 hours in a day.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Zachary T. Fardon of the Northern District of Illinois, Special Agent in Charge Robert J. Holley of the FBI’s Chicago Division and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Chicago Regional Office made the announcement.

According to evidence presented at trial, Rick E. Brown, 58, of Rockford, Illinois, the President of Home Care America Inc., controlled the daily operations of a physician practice, Medicall Physicians Group Ltd.  Mary C. Talaga, 54, of Elmwood Park, Illinois, was the company’s biller who submitted Medicall’s Medicare claims and was employed by Home Care America.  Brown and Talaga falsely billed Medicare for services that were never provided to patients.  The services fraudulently billed included services rendered to patients who were actually dead, as well as services purportedly provided by medical professionals after they had ended their employment and by medical professionals who worked over 24 hours per day.  Evidence showed that Brown forged physician signatures on medical documents, and Talaga directed physicians to create false documentation after she had billed for services that had not been documented or provided.

Brown and Talaga were each found guilty of one count of conspiracy to commit health care fraud, six counts of health care fraud and three counts of false statements relating to a health care matter.  They were charged in a superseding indictment returned on March 25, 2015.  Medicall submitted approximately $12 million in claims to Medicare, approximately $4.5 million of which were shown to be fraudulent at trial.

The sentencing hearing for Brown is scheduled for Aug. 10, 2015, and the sentencing hearing for Talaga is scheduled for Aug. 7, 2015. 

The investigation was conducted jointly by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Northern District of Illinois.  The case is being prosecuted by Trial Attorney Brooke Harper and Senior Trial Attorney Jon Juenger of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,100 defendants who have collectively billed the Medicare program for more than $6.5 billion.  In addition, the 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: stopmedicarefraud.gov.

Healthcare Fraud
Updated May 18, 2015