Physician Pleads Guilty for Role in Detroit-Area Medicare Fraud Scheme
A licensed physician who worked for a Detroit-area medical practice pleaded guilty today for his role in a $2.4 million health care fraud scheme.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge David P. Gelios of the FBI Detroit Division and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office made the announcement.
Ali Elhorr, M.D., 47, of Dearborn, Michigan, pleaded guilty before U.S. District Judge Nancy G. Edmunds of the Eastern District of Michigan to one count of conspiracy to commit health care fraud. A sentencing hearing is scheduled for Aug. 16, 2016.
Elhorr worked at House Calls Physicians P.L.L.C., which was located in Allen Park, Michigan. According to admissions in his plea agreement, from approximately September 2009 to September 2012, Elhorr conspired with others, including his brother, Dr. Hicham Elhorr, to commit health care fraud by agreeing to serve as a “supervising” physician for unlicensed individuals purportedly providing in-home physician services. The unlicensed individuals prepared medical documentation that Elhorr and other licensed physicians signed as if they had performed the visits when, in fact, Elhorr and the other licensed physicians had not treated the beneficiaries, he admitted. The visits were then billed as if performed by the licensed physicians, according to the plea.
Elhorr admitted that between approximately March 2008 and September 2012, House Calls Physicians billed Medicare more than $11.5 million for the cost of physician home services. Of that amount, Elhorr admitted that he caused the submission of approximately $2.4 million in false and fraudulent claims.
The FBI and HHS-OIG investigated the case, which was 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 Eastern District of Michigan. Former Assistant Chief Catherine K. Dick and Trial Attorneys Matthew C. Thuesen, F. Turner Buford and Shubhra Shivpuri of the Fraud Section prosecuted the case.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,300 defendants who have collectively billed the Medicare program for more than $7 billion. In addition, the HHS’s 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 Action Team (HEAT), go to www.stopmedicarefraud.gov.