April 14, 10

NEWS / Patient Recruiter Pleads Guilty for Role in Fraudulent Medicare Testing Scheme

Beneficiaries Paid to Fake Symptoms to Justify Nearly $1 Million in Fraudulent Medicare Billing

Detroit-area resident Emma King pleaded guilty today to engaging in a fraudulent medical testing scheme, announced the Departments of Justice and Health and Human Services (HHS).

King, 61, pleaded guilty today to one count of conspiracy to commit health care fraud before U.S. District Court Judge Patrick J. Duggan in the Eastern District of Michigan. King faces a maximum penalty of 10 years in prison and a $250,000 fine. A sentencing date has not yet been scheduled.

According to the plea documents, be ginning in approximately September 2007, King began recruiting and transporting patients to a clinic called Ritecare LLC. Ritecare, was owned and operated by co-conspirators and had locations in Detroit and Livonia, Mich. King admitted that she and a co-conspirator paid kickbacks to Medicare beneficiaries that she recruited and transported to Ritecare. According to the plea documents, the owners and operators of Ritecare were the source of the funds used by King to pay the Medicare beneficiaries she recruited. King admitted that she would keep part of the funds she received from the owners and operators of Ritecare to secure patients as a kickback for referring the Medicare beneficiaries she recruited. Typically, the owners of Ritecare would provide $100-$150 per patient King recruited, with King retaining $50-$75 of that amount for the referral.

According to the plea documents, the patients King recruited had to subject themselves to medically unnecessary tests to receive the money. Per instructions from the owners and operators of Ritecare, King admitted that she instructed the patients to claim they had certain symptoms to trigger medically unnecessary tests. Consequently, the patients’ medical records contained false symptoms allowing Ritecare to deceive Medicare as to the legitimacy and medical necessity of the tests it performed.

King admitted that she was responsible for recruiting at least 269 patients to Ritecare. Through her recruitment efforts, King caused the submission of approximately $940,760 in false or fraudulent billings by Ritecare. Medicare paid approximately $533,643 on those claims.

Today’s guilty plea was announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (OIG) Chicago Regional Office.

The case was prosecuted by Senior Trial Attorney John K. Neal and Trial Attorney Gejaa T. Gobena of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan.

Since their inception in March 2007, Strike Force operations in seven districts have obtained indictments of more than 500 individuals who collectively have falsely billed the Medicare program for approximately $1.1 billion. In addition, 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.

http://www.justice.gov/opa/pr/2010/April/10-crm-406.html

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