Physician Pleads Guilty For Role in Medicare Fraud Scheme

This case piqued my interest this week because there have been so many cases in the last 24 months related to healthcare fraud, Medicare billing fraud or Medicaid billing fraud. This case was on the website on May 20, 2015. These cases are not exclusive to any one state or jurisdiction in the country. And in almost of all of the cases, the alleged criminal conduct is reported by a low-level often disgruntled employee. Recently there have been a couple of cases in Alabama related to medical billing practices and healthcare fraud.

As to the Detroit case, the licensed physician pleaded guilty today for his role in a $4.2 million health care fraud scheme. Assistant Attorney Caldwell made the announcement.
Hicham 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 Oct. 20, 2015.
Elhorr owned House Calls Physicians P.L.L.C., which was located in Allen Park, Michigan. According to admissions in his plea agreement, from approximately August 2008 to September 2012, Elhorr conspired with others to commit health care fraud by billing Medicare for purported in-home physician services that were not provided by licensed physicians.

Elhorr admitted that he employed unlicensed individuals who held themselves out as licensed physicians and purported to provide physician home visits and other services to Medicare beneficiaries in Michigan. 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. The visits were then billed as if performed by the licensed physicians.

According to court documents, 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 $4.2 million in false and fraudulent claims. This case was investigated by the FBI and HHS-OIG.

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.

There are some glaring and obvious issues from the facts reported to the news. First, Dr. Elhorr only pled guilty to 4.2 million of the $11 million. This leads one to believe that other employees were aware of the billing practices and are likely to be charged soon. Again, I would look to a low level disgruntled employee.

Any time you are a physician, dentist, chiropractor, nurse, or any other medical professional in Alabama, it is important to protect yourself from an investigation. In the event you are contacted by a federal official about billing or work practices, contact a lawyer before you make any statement. It is your right. My office represents professional licensed occupations all the time related to administrative board hearings and federal investigations.