SOUTHFIELD, Mich. – A total of 23 residents and 16 companies from Michigan have been linked to a pair of intertwined health care bribery and fraud schemes centered in Wayne and Oakland counties.
Officials said as part of the schemes, Medicare beneficiaries were referred to certain companies through kickbacks and bribes. False and fraudulent Medicare claims were then submitted based on purported services provided to those beneficiaries, court records show.
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In reality, the services outlined in those reimbursement claims were medically unnecessary, didn’t qualify for reimbursement, and/or weren’t provided, according to authorities.
The money made in the multimillion-dollar schemes was for the personal use and benefit of those involved, federal officials said.
“The alleged actions of these defendants is an astonishing abuse of our health care system,” United States Attorney Dawn N. Ison said. “By allegedly submitting fraudulent claims and paying illegal kickbacks, these defendants looted Medicare in order to line their own pockets at great cost to taxpayers.”
13 people named in indictment
Of the 23 people charged, 13 residents from Oakland, Wayne, and Livingston counties were named in two indictments, which were both filed Feb. 1.
Walid Jamil, 62, and Jalal Jamil, 69, both of Oakland County, owned and operated several home health agencies in Metro Detroit, court documents allege.
Officials said the Jamil home health agencies included Premier Home and Health Care, Great Lake Home Care, Divined Home Health Care, Reflex Home Care, Community First Homecare, Trillium Home Care Solutions, and Legend Home Care.
Carol Ibrahim, 45, of Oakland County, and Delaine Jackson, 48, of Wayne County, were employed by and operated at least one of the Jamil home health agencies, authorities said.
Ibrahim Sammour, 62, of Wayne County, was a registered nurse employed by the Jamil home health agencies.
Mary Smelter-Bolton, 69, of Oakland County, and Cass Hawkins, 52, of Wayne County, are accused of being recruiters paid by various Jamil home health agencies to refer Medicare beneficiaries.
Radwan Malas, 43, of Oakland County, was the owner, controller, and operator of Infinity Visiting Physician Services in Southfield, according to the indictment. He also owned and operated Pegasus Management Associates in West Bloomfield, according to officials.
Alejandro Q. Mataverde, 79, of Wayne County, was a physician licensed in Michigan and enrolled as a participating provider with Medicare for Infinity starting in February 2016, court records show.
Cornelius Oprisiu, 82, of Livingston County, was a physician licensed in Michigan and enrolled as a participating provider with Medicare for Infinity starting in April 2017, authorities said.
Michael Molloy, 50, of Wayne County, was a minority owner of Integra Lab Management in Florida and performed marketing services on its behalf, according to officials.
Shafiq Ur Rehman, 59, of Wayne County, was a physician’s assistant licensed in Michigan and enrolled as a participating provider with Medicare for Infinity from May 2016 through May 2019, the indictment says.
Montaha Hogeige, 39, of Wayne County, was a medical assistant working on behalf of Infinity from early 2016 to 2020, according to court records.
Federal officials said 10 other Michigan residents were charged by criminal information for their alleged participation in the fraud schemes.
One indictment also references two Oakland County residents as “Individual 1″ and “Individual 2.”
“Individual 1″ controlled, owned, and operated seven home health agencies in Michigan, while “Individual 2″ controlled, owned, and operated one of those agencies alongside “Individual 1.”
Overview of Jamil health agencies scheme
Officials said Walid and Jalal Jamil hid their ownership of several home health agencies around Metro Detroit by using “straw owners” -- typically family members or other associates.
During the scheme, they submitted about $50 million worth of fraudulent home health care claims to Medicare, according to federal authorities.
They would bribe others to recruit patients who didn’t need home health care and didn’t qualify for it under Medicare rules, court records show. In many instances, those patients weren’t even provided the care outlined in the Medicare claims, officials said.
“Walid and Jalal Jamil allegedly entered into quid pro quo relationships with physician clinics to receive the necessary information to fraudulently bill Medicare,” a federal release says. “Based on their fraudulent claims, Walid and Jalal Jamil received more than $43 million from Medicare, which they misappropriated for their personal benefit.”
Ibrahim and Jackson both made illegal payments to patient recruiters and submitted false claims to Medicare, according to authorities.
Ibrahim was also a straw owner of one of the Jamil home health agencies, officials said.
Sammour fraudulently billed Medicare for home health services that he never actually provided, court records show. He would then falsely certify patients as “homebound,” authorities said.
Smelter-Bolton and Hawkins are accused of being recruiters for the Jamil home health agencies, referring Medicare beneficiaries for services that were then billed to Medicare. Those claims weren’t eligible for reimbursements, court documents say.
Straw owners for Jamil home health agencies
Walid and Jalal Jamil are accused of using their straw owners to control the health agencies while failing to reveal that they were the actual owners of the companies.
Their ownership of the companies was hidden through misrepresentations and omissions in corporate filings with the state of Michigan and in enrollment applications and claims submitted to Medicare, an indictment says.
Walid Jamil, Jalal Jamil, Ibrahim, Jackson, and others bribed recruits with checks, cash, and electronic transfers in exchange for the referrals of Medicare beneficiaries to the health agencies, according to authorities.
Officials said the exchanges also included Medicare beneficiary information that helped those involved in the scheme support false claims to Medicare.
Bribing ‘Company 1′
Court documents say Walid Jamil, Jalal Jamil, Ibrahim, and “Company Owner 1″ devised a plan to send beneficiaries to “Company 1.” There, the beneficiaries would be certified for home health care by medical providers who worked for the company.
Then, those beneficiaries would be referred back to the Jamil home health agencies, according to the indictment.
In turn, the Jamil home health agencies would bill Medicare for services it claimed to have provided for those beneficiaries, authorities said.
Walid Jamil, Jalal Jamil, Ibrahim, Jackson, and Sammour are accused of falsifying, fabricating, and altering medical records, such as home health certifications, plans of care, nursing visit notes, evaluations, re-certifications, and discharges.
Fraudulent Medicare claims
Walid Jamil, Jalal Jamil, Ibrahim, and Jackson were linked in the indictment to specific false Medicare claims.
Walid Jamil and Jackson are accused of billing Medicare $1,001,01 on July 1, 2020, and $2,500.01 on Sept. 11, 2018.
Walid Jamil is accused of billing Medicare $4,250.01 on Nov. 16, 2019.
Walid Jamil and Ibrahim are accused of billing Medicare $3,050.01 on Aug. 31, 2020, and $2,200.01 on Sept. 29, 2020.
Jalal Jamil is accused of billing Medicare $3,500.01 on July 23, 2019.
Bribing patient recruiters
Walid Jamil, Ibrahim, Jackson, and others are accused of paying kickbacks and bribes to “patient recruiters” who would refer Medicare beneficiaries to the Jamil home health agencies.
Smelter-Bolton and Hawkins were among those patient recruiters who received bribes, according to authorities.
Walid Jamil told Jackson, Ibrahim, and others to pay bribes to Hawkins on Nov. 24, 2017, and June 8, 2020, court records say. Hawkins gave them Medicare beneficiary information in return, and that information was used to bill Medicare for services, according to the indictment.
Specifically, a $3,600 claim was made Feb. 22, 2019, for services purportedly provided through Great Lake, Divined, and Trillium, court documents claim.
Walid Jamil told others to pay bribes to Smelter-Bolton on May 16, 2016, and April 9, 2019, for Medicare beneficiary information, officials said.
That information was used to bill Medicare $500 on April 5, 2019, for services purportedly provided by Reflex and Community First, according to authorities.
Overview of scheme involving Malas, 5 others
Malas operated Infinity Visiting Physician Services as a home visiting physician company and ordered his physicians to certify patients referred by the Jamils for medically unnecessary home health services, according to court documents.
Malas is accused of billing Medicare for services that were never actually provided to patients -- including 60-minute complex patient visits -- and other services that weren’t medically necessary -- including B-12 and Toradol injections.
“Malas also allegedly demanded that physicians in his office order the highest-reimbursing urine drug test for patients, which was medically unnecessary, but for which Malas allegedly received a referral fee from the laboratory that processed the samples,” a federal release says.
As part of this scheme, Medicare was billed more than $11.5 million through fraudulent claims, court records show. Nearly $4 million worth of claims was paid, and that money was misappropriated for the personal benefit of those involved in the scheme, authorities said.
Mataverde, Oprisiu, and Rehman are accused of providing medically unnecessary services to Medicare beneficiaries and submitting claims for services that weren’t provided to patients.
Molloy’s lab in Florida processed the high-reimbursing and medically unnecessary urine tests submitted by Infinity, according to federal officials. He and his co-owners paid the salaries of Infinity employees and made monthly payments to Malas in exchange for the orders, court records show.
Integra submitted about $2.8 million worth of fraudulent claims to Medicare as a result of the scheme, and got paid more than $730,000, according to the indictment.
Misrepresenting Infinity ownership
Officials said Malas and others incorporated Infinity in January 2014. The next month, they certified to Medicare that the company would comply with all rules and regulations, which includes agreeing not to violate the Federal Anti-Kickback Statute.
After Infinity was incorporated, Malas and others disguised his ownership of the company through misrepresentations and omissions in corporate filings with the state of Michigan and in enrollment applications and claims submitted to Medicare, the indictment says.
From January 2014 through October 2018, Malas lied to Medicare, saying other physicians were the sole owners of Infinity, authorities said. In reality, Malas held exclusive ownership interest and ownership over the company during that period of time, court records show.
Urine test kickbacks
Malas, Mataverde, Oprisiu, Rehman, and others are accused of submitting false claims for medically unnecessary services that they claimed had been provided by Infinity.
Malas and Malloy helped devise a scheme to pay Malas illegal kickbacks in exchange for referring orders signed by Infinity providers for medically unnecessary urine drug tests, according to authorities. Mataverde and Oprisiu are among the providers involved, the indictment says.
The referrals would be sent to Integra, which would then bill Medicare for performing those unnecessary services, officials said.
Home health agencies
“Individual 1″ and “Individual 2″ would send Medicare beneficiaries who didn’t qualify for reimbursement of home health services to Infinity to be certified for home health care, according to the indictment.
Court records show those beneficiaries had been obtained through illegal kickbacks and bribes.
Officials said Mataverde, Oprisiu, and others would certify those beneficiaries so the home health agencies could bill Medicare for services.
This was done for seven agencies, which are referred to only as “Home Health Agency 1-7″ in the indictment. All seven were in Michigan.
The indictment says Malas, Mataverde, Oprisiu, Molloy, Rehman, “Individual 1,” “Individual 2,” and others caused about $37 million worth of fraudulent claims to Medicare.
Health care fraud charges
Malas, Mataverde, Oprisiu, and Rehman are each facing health care fraud charges linked to three specific instances in 2018, 2019, and 2020, according to the indictment.
Malas is named in all three counts, while Mataverde, Oprisiu, and Rehman are each facing one count.
A $375 claim was made to Medicare by Malas and Rehman on Feb. 14, 2018, for a “60-minute established patient visit,” court records show.
A $100 claim was made to Medicare by Malas and Mataverde on Oct. 2, 2019, for the “certification of Medicare covered home health care,” the indictment says.
A $100 claim was made to Medicare by Malas and Oprisiu on April 23, 2020, for the “certification of Medicare covered home health care,” according to authorities.
Defrauding US for kickbacks
Malas, Molloy, and Hogeige are accused of creating a scheme to pay and/or receive illegal kickbacks and bribes in exchange for the referral of urine samples and physician orders for urine drug testing to Integra so the company could bill Medicare.
They agreed to “facilitate and conceal the payment of kickbacks and bribes from Integra to Infinity, in the form of Integra’s payment of salaries of Infinity employees, including Hogeige, in exchange for urine samples and physician orders from Infinity to be sent to Integra for the purpose of submitting claims to Medicare,” the indictment reads.
Molloy and others paid Hogeige’s salary as if she was employed by Integra, but in reality, she was employed by Infinity, according to authorities.
“Hogeige agreed with Malas, Molloy, and others to receive salary payments from Integra for work performed exclusively on behalf of Infinity,” the indictment says.
Malas and Molloy hid the kickbacks and bribes from Integra to Malas by routing payments through Pegasus, court records show.
From June 2017 through March 2019, the urine drug testing scheme between Integra and Infinity led to the former being paid about $686,000 by Medicare.
The indictment shows Hogeige accepted $1,200 payments from Molloy, on behalf of Integra, 21 times between June 16, 2017, and April 6, 2018.
Malas accepted $10,800 payments from Molloy, on behalf of Integra, in exchange for urine samples and physician orders for definitive urine drug testing. Malas accepted 12 of those payments between March 30, 2018, and March 13, 2019, officials said.
March 2019 bribe charges
Molloy is charged with one count of payment of kickbacks in connection with a federal health care program for a bribe he paid to Malas, according to the indictment.
Officials said the payment in question happened March 13, 2019. Molloy gave Malas a $10,800 check from Integra to Pegasus.
The indictment says Malas was being paid to refer someone to Integra for a service that could trigger a reimbursement request to Medicare.
Malas is facing one count of receipt of kickbacks in connection with a federal health care program for accepting that bribe, authorities said.
Money laundering
Malas is also accused of money laundering when he made a $200,000 transfer from an Infinity bank account to a Pegasus bank account on Sept. 9, 2020.
The indictment says the transaction included money that was obtained “from a specified unlawful activity” -- specifically health care fraud and conspiracy to commit health care fraud.
Charges
Walid Jamil is facing one count of health care fraud conspiracy, five counts of health care fraud, one count of conspiracy to defraud the United States and to pay and receive health care kickbacks, and two counts of payment of kickbacks in connection with a federal health care program.
Jalal Jamil is facing one count of health care fraud conspiracy and one count of health care fraud.
Ibrahim and Jackson are both facing one count of health care fraud conspiracy, two counts of health care fraud, one count of conspiracy to defraud the United States and to pay and receive health care kickbacks, and one count of payment of kickbacks in connection with a federal health care program.
Sammour is facing one count of health care fraud conspiracy.
Hawkins and Smellter-Bolton are both facing one count of conspiracy to defraud the United States and to pay and receive health care kickbacks and one count of receipt of kickbacks in connection with a federal health care program.
Malas is facing one count of health care fraud conspiracy, three counts of health care fraud, one count of conspiracy to defraud the United States and to pay and receiving health care kickbacks, one count of receipt of kickbacks in connection with a federal health care program, and one count of money laundering.
Mataverde, Oprisiu, and Rehman are each facing one count of health care fraud conspiracy and one count of health care fraud.
Molloy is facing one count of health care fraud conspiracy, one count of conspiracy to defraud the United States and to pay and receive health care kickbacks, and one count of payment of kickbacks in connection with a federal health care program.
Hogeige is facing one count of conspiracy to defraud the United States and to pay and receive health care kickbacks.
If convicted, they must all forfeit any money or property that can be traced back to the scheme.
Maximum sentences for each charge
Here are the maximum sentences for each of the charges above.
- Conspiracy to commit health care fraud -- 10 years
- Health care fraud -- 10 years
- Payment/receipt of illegal healthcare kickbacks -- 10 years
- Money laundering -- 10 years
- Conspiracy to defraud the United States through the payment/receipt of illegal health care kickbacks -- 5 years
Companies referenced in indictments
Here are all of the companies referenced in the two indictments:
Jamil home health agencies (all in Michigan):
- Premier Home and Health Care, Inc.
- Great Lake Home Care, LLC
- Divined Home Health Care, Inc.
- Reflex Home Care, LLC
- Community First Homecare, LLC
- Trillium Homem Care Solutions, LLC
- Legend Home Care, Inc.
Businesses owned and operated by Radwan Malas:
- Infinity Visiting Physician Services, PLLC -- Southfield
- Pegasus Management Associates, LLC -- West Bloomfield
Unnamed home health agencies (all in Michigan):
- “Home Health Agency 1″
- “Home Health Agency 2″
- “Home Health Agency 3″
- “Home Health Agency 4″
- “Home Health Agency 5″
- “Home Health Agency 6″
- “Home Health Agency 7″
Business co-owned by Michael Malloy:
- Integra Lab Management LLC -- a Florida company doing business in Michigan