ATLANTA – The Department of Justice (DOJ) and the Department of Health and Human Services (HHS) announced an unprecedented nationwide sweep led by the Medicare Fraud Strike Force in 36 federal districts, resulting in criminal and civil charges against 301individuals, including 61 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving approximately $900 million in false billings. Twenty-three state Medicaid Fraud Control Units also participated in the arrests. In addition, the HHS Centers for Medicare & Medicaid Services (CMS) also suspended a number of providers using its suspension authority provided in the Affordable Care Act. This coordinated takedown is the largest in the history of the Medicare Fraud Strike Force, both in terms of the number of defendants charged and loss amount.
“This exemplifies the ongoing commitment to investigate and prosecute those who steal tax dollars that provide essential healthcare to the elderly and low-income families,” said U.S. Attorney John A. Horn. “Those who commit healthcare fraud through filing of false claims, payment or receipt of bribes, or fraudulent medical practices will be held accountable for defrauding the U.S. government.”
“As this takedown should make clear, health care fraud is not an abstract violation or benign offense – it is a serious crime,” said U.S. Attorney General Loretta Lynch. “The wrongdoers that we pursue in these operations seek to use public funds for private enrichment. They target real people – many of them in need of significant medical care. They promise effective cures and therapies, but they provide none. Above all, they abuse basic bonds of trust – between doctor and patient; between pharmacist and doctor; between taxpayer and government – and pervert them to their own ends. The Department of Justice is determined to continue working to ensure that the American people know that their health care system works for them – and them alone.”
“This indictment demonstrates our office’s continued commitment to protect crucial Medicaid dollars from fraud and abuse,” said Georgia Attorney General Sam Olens. “I would also like to thank our federal partners for their work and cooperation in this case.”
“The FBI, in working with the U.S. Department of Justice and the U.S. Health and Human Services Office of Inspector General, brought these investigative cases forward for federal prosecution as part of a national coordinated effort to firmly and aggressively protect the much needed federal funds that make up the Medicare program. Those individuals that engage in Medicare fraud are not only stealing from the federal taxpayer but also from those individuals who are counting on Medicare and Medicaid for their healthcare needs,” said J. Britt Johnson, Special Agent in Charge, FBI Atlanta Field Office.
“These actions send a strong message to those who allegedly steal from Medicare and Medicaid: The Office of Inspector General will continue to work hard with our law enforcement partners to eliminate the financial bleeding of our health care system,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services, Office of Inspector General in Atlanta.
Specifically, the Northern District of Georgia case announced as part of the nationwide Medicare Strike Force takedown include:
United States v. Otis Shannon, et. al., Case No. 1:16-CR-218
According to U.S. Attorney Horn, the indictment, and other information presented in court: From on or about 2013 until 2015, Otis Shannon was employed with the Georgia Department of Behavioral Health and Developmental Disabilities. In this position, Shannon was tasked with reviewing mental health provider applications to verify that prospective mental health providers met requisite minimum staffing levels and had proper credentials and licenses to provide proper care to Georgia Medicaid beneficiaries.
According to the indictment, Shannon solicited and accepted bribes from applicants to accept falsified and forged documents. Matthew Harrell, Denise Dixon, Geovon Martin, Marion Simpson, Sharon Zellner, Derrick McDow, and Cortim Martin were owners, operators or employees of health care providers that paid bribes to Otis Shannon to gain approval to provide mental health services to Georgia Medicaid beneficiaries. These mental health providers were approved to bill Georgia Medicaid without meeting program requirements that were in place to ensure that beneficiaries were obtaining quality care. These unqualified providers improperly billed Georgia Medicaid for over $6.6 million and Georgia Medicaid paid the providers over $5.9 million.
The following defendants have been charged by indictment with conspiracy to commit health care fraud and conspiracy to commit bribery:
- Otis Shannon, 42, of Stone Mountain, Georgia.
- Matthew Harrell, 40, of Atlanta, Georgia.
- Denise Dixon, 40, of Fayetteville, Georgia.
- Geovon Martin, 39, of Mableton, Georgia.
- Marion Simpson, 66, of Austell, Georgia.
- Sharon Zellner, 58, of McDonough, Georgia.
- Derrick McDow, 46, of Greensboro, North Carolina.
- Cortim Martin, 31, of Smyrna, Georgia.
The case is being investigated by the Georgia State Attorney General’s Medicaid Fraud Control Unit, FBI, and U.S. Department of Health & Human Services, Office of the Inspector General. Assistant United States Attorney Jeffrey Brown and Special Assistant United States Attorney Robin Daitch are prosecuting this case. Including the enforcement actions, nearly 1,200 individuals have been charged in national takedown operations, which have involved more than $3.4 billion in fraudulent billings.
Members of the public are reminded that the indictment only contains charges. The defendants are presumed innocent of the charges and it will be the government’s burden to prove the defendants’ guilt beyond a reasonable doubt at trial.
The court documents for each case will posted online, as they become available, here: http://www.justice.gov/opa/documents-and-resources-june-2016-medicare-fraud-strike-force-press-conference.
For further information please contact the U.S. Attorney’s Public Affairs Office at USAGAN.PressEmails@usdoj.gov or (404) 581-6016. The Internet address for the U.S. Attorney’s Office for the Northern District of Georgia is http://www.justice.gov/usao-ndga.