Two South Texas Doctors Sentenced to Prison for Roles in Separate Multi-Million Dollar Medicare Fraud Schemes
Two Houston, Texas physicians were sentenced to 25 and three-year prison terms for their roles in separate schemes to defraud Medicare out of payments for medical services.
Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ryan Patrick of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Dallas Region and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.
US v. Ramirez S.D.T.X. Docket No. 16-cr-00258
John P. Ramirez, 65, of Houston, Texas, a physician, was sentenced to serve 25 years in prison followed by three years of supervised release by U.S. District Judge David Hittner of the Southern District of Texas. Judge Hittner also ordered the defendant to pay $26,729,041.39 in restitution. John Ramirez was convicted at trial in the Southern District of Texas along with his co-defendants Ann Shepherd and Yvette Nwoko.
According to evidence presented at trial, from in or around December 2011 to in or around August 2015, John Ramirez and his co-defendants conspired and schemed to defraud Medicare out of payments for medical services. Co-defendant Ann Shepherd owned and operated Southwest Total Medical Inc., a purported medical clinic doing business as Amex Medical Clinic in Houston. Shepherd, along with Nwoko, sold medical orders and other documents Dr. Ramirez signed to home-health agencies in and around Houston. Dr. Ramirez falsely certified in these medical orders information about the patient’s medical condition and need for medical services. Co-conspirators at home-health agencies then used the false and fraudulent paperwork signed by Dr. Ramirez and sold by Ann Shepherd and Yvette Nwoko to bill to, and receive payment from, Medicare for medical services that were not medically necessary or not provided.
In all, Dr. Ramirez and his co-defendants caused Medicare to pay approximately $17 million on false and fraudulent claims submitted during the charged conspiracy.
Ann Shepherd, 62, of Houston, Texas was also sentenced to 30 years in prison on Jan. 24, by the Honorable David Hittner. Judge Hittner also ordered Shepherd to pay $20.928 million in restitution and to forfeit $250,000. Nwoko will be sentenced on April 18.
U.S. v. Do S.D.T.X. Docket No. 17-cr-00417
Anh Do, M.D., 78, of Houston, Texas was sentenced to serve 36 months in prison followed by three years of supervised release by U.S. District Judge Andrew Hanen of the Southern District of Texas. Judge Hanen also ordered the defendant to pay $1,875,219.00 in restitution and to forfeit $274,213.46. Do pleaded guilty to one count of conspiracy to commit healthcare fraud on Aug. 28, 2018.
As part of his guilty plea, Do admitted to fraudulently signing Plans of Care and other medical documents that falsely and fraudulently certified and re-certified patients for home-health services. Do and his co-conspirators made it appear as if patients qualified for and received home-health services under Medicare when those services were not medically necessary, not provided or both. Medicare paid approximately $10 million on claims for home-health services in which Do was listed as the patient’s attending physician.
Do and his co-conspirators also billed Medicare for diagnostic tests that they knew were not medically necessary, not provided or both. Do and his co-conspirators falsely and fraudulently signed medical documents to make it appear as if the patients both needed and received the diagnostic tests. Medicare paid approximately $2 million on claims for these diagnostic tests.
The FBI, HHS-OIG and the Texas Attorney General’s MFCU conducted both investigations. Trial Attorney Scott Armstrong of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Tina Ansari of the Southern District of Texas are prosecuting the Ramirez case. Trial Attorneys Devon Helfmeyer, Scott Armstrong and Drew Pennebaker of the Criminal Division’s Fraud Section are prosecuting the Do case.
The Criminal Division’s Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 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.