Doctor Gets 3 Years Prison for $100M Medicare Fraud Scheme

A federal judge hit a New Jersey doctor with three years jail time for taking part in a scheme to defraud Medicare and private insurers for more than $100 million.

Ahmed E.S., who also practiced medicine in Staten Island, New York, was accused of taking part in a Medicare fraud plot that included bribery. Ahmed pled guilty to allegations that he referred blood samples to Biodiagnostic Lab Services, Inc. in exchange for money from lab employees.

Biodiagnostic has since gone out of business after pleading guilty to violating the Anti-Kickback Statute and the Federal Travel Act, as well as to money laundering charges. According to court documents, lab employees offered cash to doctors in exchange for fraudulent referrals for blood and other biological material. Ahmed, say attorneys for the government, generated a great deal of business for the lab of at least $650,000.

In addition to Medicare fraud, the doctor admitted to charges under the Anti-Kickback Statue, Federal Travel Act, and honest services wire fraud statute. After serving his sentence, Ahmed will spend an additional three years under supervised release and pay a $7,500 fine.

According to court documents, the scheme involved sending blood samples to a Biodiagnostics along with a fraudulent Medicare or private insurance referral. The lab would then provide a kickback to the referring doctor.

Over 50 people have been prosecuted for the Medicare fraud, said the government who stated that the scheme includes “the largest number of medical professionals ever prosecuted in a bribery case.”

Biodiagnostics was ordered to turn over all its assets. So far, say representatives for the government, $13 million of the $100 million lost in the Medicare fraud scheme has been recovered.

Medicare Fraud

Medicare fraud harms both taxpayers and Medicare recipients. It increases the cost of care for recipients and makes it even more difficult for the government to administer important public health programs targeted at the elderly, children, and low-income individuals.

Medicare fraud includes making false representations to the government that result in overpayment by the government for services not rendered.

The government tries to monitor health care providers to ensure Medicare fraud isn’t happening, but investigations can take many years and require resources. Sometimes, employees who have evidence that their employer is committing Medicare fraud are the best situated to stop the activity and bring the fraudsters to justice.

Employees should know that they are entitled to protection under the False Claims Act if they have evidence that their employer is guilty of Medicare fraud. In addition to protecting the employee from retaliation, the statute provides 15 and 30 percent of any damages or settlement awards as a result of a successful lawsuit to the employee.

Employees who suspect their employer is a part of a Medicare fraud scam should contact the experienced attorneys at Bradley/Grombacher. They can help you navigate the False Claims Act and protect your legal rights.