Queens Physician Settles Health Care Fraud Claims for $1.3 Million and Enters into Integrity Agreement to Ensure Future Compliance
Today, United States Attorney Breon Peace announced criminal charges against two defendants in connection with alleged Medicare and Medicaid fraudulent billing schemes. The charges filed in federal court in Brooklyn are part of the Department of Justice’s 2023 National Health Care Fraud Enforcement Action. Carlo Elomina Garcia, a licensed occupational therapist, and the owner of Carlo E. Garcia Occupational Therapy in Queens, was arrested and arraigned on June 26, 2023 and released on a $25,000 bond pending trial. Jian Ai Chen, a medical assistant and the owner of two pharmacies in Brooklyn, was arrested and arraigned on June 14, 2023 before Chief United States Magistrate Judge Lois Bloom and released on a $500,000 bond pending trial.
Merrick B. Garland, United States Attorney General; Breon Peace, United States Attorney for the Eastern District of New York; Kenneth A. Polite, Jr., Assistant Attorney General of the Justice Department’s Criminal Division; Michael J. Driscoll, Assistant Director-in-Charge, Federal Bureau of Investigation, New York Field Office (FBI), and Christian J. Schrank, Deputy Inspector General for Investigations, U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), announced the arrests and charges.
“These enforcement actions, including against one of the largest health care fraud schemes ever prosecuted by the Justice Department, represent our intensified efforts to combat fraud and prosecute the individuals who profit from it,” stated Attorney General Garland. “The Justice Department will find and bring to justice criminals who seek to defraud Americans and steal from taxpayer-funded programs.”
United States Attorney Peace stated, “As alleged, the defendants abused the trust placed in them by Medicare and Medicaid by falsely billing these essential programs for their own enrichment. This enforcement action demonstrates our continued commitment to vigorously prosecute healthcare providers who steal from taxpayer-funded programs intended to help those in need.”
“This nationwide enforcement action demonstrates that the Criminal Division is committed to fighting health care fraud and opioid abuse by prosecuting those who allegedly exploit patients and health care benefit programs for personal gain,” stated Assistant Attorney General Polite. “Today’s announcement includes some of the largest and most complex cases that the Department has prosecuted and demonstrates the Department’s commitment to seeking justice for those at all levels of the healthcare industry who put profits above patient care, from professionals in doctors’ offices to executives in corporate boardrooms.”
“In both of these cases, the defendants are alleged to have submitted fraudulent claims to Medicare and Medicaid for services and prescription medicine that were not provided. Abuse of Medicare and Medicaid harms not only the programs but also the everyday people whose tax money is used to fund these healthcare programs. The actions announced today highlight the FBI New York’s commitment to ensuring that those willing to attempt to take advantage of taxpayer-funded healthcare programs are held accountable in the criminal justice system,” stated FBI Assistant Director-in-Charge Driscoll.
“Federal health care programs are designed to provide access to high quality care to patients nationwide. When bad actors attempt to exploit those measures for illicit financial gain, they put greed before the needs and safety of their patients, and take valuable resources away from their intended recipients,” stated HHS-OIG Deputy Inspector General Schrank. “As today’s enforcement action illustrates, HHS-OIG and our law enforcement partners are committed to defending the federal health care system against fraud.”
United States v. Carlo Elomina Garcia
As alleged in the criminal complaint, from May 2017 through June 2021, the defendant, through his company, billed Medicare and Medicaid for over $3.9 million in occupational therapy services and was paid over $1.6 million. Many of those services were not eligible for reimbursement, were not provided as billed or were not provided at all, including repeatedly billing for over 24 hours of one-on-one occupational therapy services in a single day.
The government’s case is being prosecuted by Assistant United States Attorney John Vagelatos.
United States v. Jian Ai Chen
As alleged in the indictment, As alleged in the indictment, Chen is charged with conspiracy to defraud in connection with a scheme to pay over $5 million in kickbacks to Medicare and Medicaid beneficiaries in exchange for bringing their prescriptions to AC Pharmacy Corp. and A Star Pharmacy Inc., which she owned. Chen agreed with others to submit false and fraudulent claims to Medicare and Medicaid plans for dispensing prescription medications that were induced by the payment of kickbacks and not actually dispensed. Chen’s pharmacies received approximately $101 million as a result of the scheme.
The government’s case is being prosecuted by Trial Attorney Andrew Estes of the Brooklyn Strike Force.
The arrests and charges announced today by U.S. Attorney Peace are part of a strategically coordinated, two-week nationwide law enforcement action that resulted in criminal charges against 78 defendants for their alleged participation in health care fraud and opioid abuse schemes that included over $2.5 billion in alleged fraud. The defendants allegedly defrauded programs entrusted for the care of the elderly and disabled, and, in some cases, used the proceeds of the schemes to purchase luxury items, including exotic automobiles and yachts.
The Health Care Fraud Unit’s Strike Forces in Brooklyn, Dallas, Detroit, the Gulf Coast, Houston, Los Angeles, Miami, Newark, and Tampa; the Health Care Fraud Unit’s National Rapid Response Strike Force; the U.S. Attorneys’ Offices for the Middle District of Florida, Southern District of Florida, Southern District of Georgia, District of Idaho, Western District of Kentucky, Eastern District of Louisiana, Middle District of Louisiana, District of New Jersey, Eastern District of New York, Southern District of Ohio, District of South Carolina, Southern District of Texas, Eastern District of Washington, and Eastern District of Wisconsin; and the State Attorney Generals’ Offices for Indiana, New York, and Pennsylvania are prosecuting these cases, with assistance from the Health Care Fraud Unit’s Data Analytics Team. Descriptions of cases involved in today’s enforcement action are available on the Department’s website at www.justice.gov/criminal-fraud/health-care-fraud-unit/2023-national-hcf-court-documents.
The charges are allegations, and the defendants are presumed innocent unless and until proven guilty.
The Fraud Section uses the Victim Notification System to provide victims with case information and updates related to cases charged by the Fraud Section in the National Health Care Fraud Enforcement Action. Victims with questions may contact the Fraud Section’s Victim Assistance Unit by calling the Victim Assistance phone line at 1-888-549-3945 or by emailing firstname.lastname@example.org
CARLO ELOMINA GARCIA
E.D.N.Y. Docket No. 23-MJ-596
JIAN AI CHEN (also known as “Maggie”)
Syosset, New York
E.D.N.Y. Docket No. 23-CR-255 (WFK)
Danielle Blustein Hass
U.S. Attorney's Office