FBI ARRESTS 10 IN HOME HEALTH AIDE MEDICAID FRAUD BILLING FOR SERVICES NOT RENDERED, KICKBACKS.

Hits: 311

WPCNR FBI WIRE. From the Federal Bureau of Investigation. (EditedDecember 17, 2020:

Audrey Strauss, the Acting United States Attorney for the Southern District of New York, and William F. Sweeney Jr., the Assistant Director-in-Charge of the New York Office of the Federal Bureau of Investigation (“FBI”), announced today the unsealing of an Indictment charging

MARIANNA LEVIN, TETYANA GOLYAK, ELENA LOKSHIN, SVITLANA ROHULYA, MARINA ZAK, ALINA KUPTSOVA, MALIHA IJAZ, MAKHINBONU NARZULLAEVA, NATALYA SHVARTS, and INNA GEKELMAN with conspiracy to commit mail, wire and healthcare fraud; substantive counts of mail fraud, wire fraud, and healthcare fraud; and conspiracy to violate the Anti-Kickback Statute, in connection with a  scheme to fraudulently bill Medicaid for home-health and personal-care services that were not actually rendered. 

In recent years, home-health costs in New York have ballooned.  In or about January 2020, New York’s State budget director announced, in substance and in part, that spending on MLTCs tripled between the 2013 and 2019 fiscal years, representing a $4.8 billion increase.

The 10 defendants worked for 2 Agencies employing approximately 3,000 home-health and personal-care aides (the “Aides”).  Most of the Aides were licensed to provide home-health aide services and personal-care services.

Manhattan Acting U.S. Attorney Audrey Strauss said:  “These ten defendants allegedly attempted to swindle the managed healthcare system by billing for no-show cases, where aides provided no actual assistance to patients.  Now more than ever, the Medicare system is critical for so many Americans who depend on its services for their well-being. Conduct such as the alleged scheme today not only beleaguers the healthcare system, it unfairly penalizes those who depend on it most – the patients.”

As alleged in the Indictment unsealed today in Manhattan federal court[1]:

Since in or about 2015, the defendants have been engaged in a widespread fraud scheme through which the defendants defrauded Medicaid for home-health and personal-care services that were not actually rendered. 

At all times relevant to the Indictment, the defendants worked at or were otherwise associated with one of two affiliated licensed homecare service agencies based in Brooklyn, New York (“Agency-1”, “Agency-2”, collectively referred to as the “Agencies”), that provide home-health and personal-care services to patients residing in all five boroughs of New York City and Nassau County. 

Home care is a health service provided in the patient’s home to promote, maintain, or restore health or lessen the effects of illness and disability.  Home care includes personal-care services, administered by Aides, including housekeeping, meal preparation, bathing, toileting, and grooming.

At all times relevant to this Indictment, eligible Medicaid beneficiaries in New York were able to seek government-funded home-health and personal-care services through managed long-term care plans (“MLTCs”).  In turn, MLTCs received Medicaid funding to pay for their beneficiaries’ home-health and personal-care services. 

The Agencies administer home-health and personal-care services to Medicaid beneficiaries enrolled in New York MLTCs.  From in or about 2015 to in or about December 2020, Medicaid reimbursed the Agencies hundreds of millions of dollars for home-health and personal-care services. 

A significant portion of the Agencies’ billings were fraudulent. 

In particular, the Agencies billed Medicaid for “no-show” cases in which Aides claimed to be performing home-health or personal-care services when they were not.  At times when Aides falsely claimed to be performing home-health or personal-care services, they in fact, stayed home, ran personal errands, vacationed, and socialized with family and friends. 

For example, on or about September 9, 2017, TETYANA GOLYAK was at a vineyard and winery in New Jersey at a time she claimed to be performing personal-care services for a patient residing in Brooklyn, New York; in or about January 2019, NATALYA SHVARTS was on a Caribbean cruise at a time she claimed to be performing personal-care services for a patient residing in Brooklyn, New York; and, on or about March 1, 2019, MALIHA IJAZ was at a Brooklyn restaurant at a time IJAZ claimed to be performing personal-care services.  These no-show arrangements caused the Agencies to submit false Medicaid claims to MLTCs. 

With no-show cases at the Agencies, an Aide’s fraudulently-obtained wages were often split between the no-show Aide and the no-show patient.  In addition to paying kickbacks to no-show patients, no-show Aides sometimes paid kickbacks to conspirators who referred no-show cases to Aides at the Agencies.   

The defendants are each charged with one count of conspiracy to commit mail, wire, and healthcare fraud, which carries a maximum sentence of 20 years in prison, one count of mail fraud, which carries a maximum sentence of 20 years in prison, one count of wire fraud, which carries a maximum sentence of 20 years in prison, one count of healthcare fraud, which carries a maximum sentence of 20 years in prison, and one count of conspiracy to violate the Anti-Kickback Statute, which carries a maximum sentence of five years in prison.  The maximum potential sentences and minimum sentence in this case are prescribed by Congress and are provided here for informational purposes only, as any sentencings of the defendants will be determined by the judge.

*                      *                     *

Ms. Strauss praised the outstanding investigative work of the New York FBI, New York City Police Department, and the Office of Medicaid Inspector General for New York State. 

This case is being handled by the Complex Frauds and Cybercrime Unit.  Assistant United States Attorneys Nicholas Folly, Nicholas W. Chiuchiolo and Daniel G. Nessim are in charge of the prosecution.

The charges contained in the Indictment are merely accusations, and the defendants are presumed innocent unless and until proven guilty.       

Comments are closed.