Used Unneeded Tests To Dupe Medicare
Federal agents cuffed last Wednesday, Dec. 3, 10 people indicted for a multi-million Medicare and Medicaid fraud scheme in which poor people were paid to undergo unnecessary tests at clinics in Elmhurst, Jamaica and Brooklyn, prosecutors announced.
According to U.S. Attorney for the Southern District of New York Preet Bharara, the alleged conspirators filed more than $70 million in fraudulent health insurance claims and received $25 million in payments.
The suspects were identified as Victor Lipkin, 49, of Jackson Heights; Vadim Zubkov, 46, of Brooklyn; Eduard Zavalunov, 33, of Rego Park; Nikoloz Chochiev, 39, of Brooklyn; Anatoliy Fatakhov, 57, of Fresh Meadows; Mariana Swaffar, 49, of Ridgewood; Jacqueline Pinez, 30, of Queens; Jonathan Oliver, 51, of Jamaica; Jason Brissett, 30, of Brooklyn; and Gilbert Trotman, 50, of Queens.
All were charged with conspiracy to commit mail fraud, wire fraud and health care fraud; Lipkin, Zubkov and Zavalunov- the alleged ringleaders-were additionally indicted for conspiracy to launder the proceeds from the scheme.
If convicted, each suspects faces up to 20 years behind bars, three years’ probation and fines of $250,000 or twice the illegal gain, whichever is greater.
“As alleged, these defendants corrupted financially strapped people and fleeced Medicare and Medicaid to the tune of tens of millions of dollars,” Bharara said. “The scheme enriched the defendants and burdened Medicare and Medicaid, but the scheme has been exposed and ended.”
“Adding insult to injury, the defendants preyed upon vulnerable members of our community, exploiting the less fortunate in furtherance of their criminal activity,” added George Venizelos, assistant director-incharge of the FBI’s New York office. “Health care fraud wastes tax dollars, increases costs for the public and destroys the integrity of our health care system.”
“Thanks to the collaborative efforts of our investigators, along with our federal partners, this criminal network was dismantled and its members will be held accountable for their actions,” said Police Commissioner William J. Bratton.
“Kickbacks and medically unnecessary services have no place in the Medicare and Medicaid systems,” said Thomas O’Donnell, special agent-incharge of the U.S. Department of Health and Human Services’ (HHS) New York office. “The Office of Investigations will continue to vigorously pursue those that defraud these programs for their personal gain.”
Federal prosecutors said the scheme occurred at clinics secretly owned by Likpin and Zubkov located on Elmhurst Avenue in Elmhurst, Hillside Avenue in Jamaica and Avenue V in Brooklyn.
Beginning in 2005, authorities stated, Lipkin and Zubkov recruited and paid a licensed doctor to act as the nominal owner and physician for the clinics. In their capacity as behind-the-scenes owners of the clinics, it is alleged, they collected proceeds from the operation and laundered them through shell companies that they owned and controlled.
Over the past nine years, federal agents said, the two secret owners along with Zavalunov, Chochiev and three “runners”- Oliver, Brissett and Trotman-recruited patients with Medicare and Medicaid insurance to act as phony patients. The runners reportedly found many of them at local soup kitchens and welfare offices.
Prosecutors stated the runners coached the “phony patients” into filling out information on medical forms later sent to their insurance companies as fraudulent proof of the necessity of the prescribed tests.
After the runners obtained the patients’ health insurance information, authorities noted, they passed it onto Swafaar and Pinez, who then contacted the insurance companies to confirm the patients’ coverage. Once the companies advised the two suspects that the patients were eligible for the tests, prosecutors noted, Swafaar and Pinez allegedly directed the runners to bring the patients to the clinics for the exams.
Many of the tests-including sleep and stress tests-were reportedly conducted by unlicensed technicians. In one example cited by prosecutors, Fatakhov allegedly administered the tests without proper supervision from a licensed physician.
After the tests were completed, authorities noted, each patients received a cash payment, and the participants in the scheme filed reimbursement claims with Medicaid and Medicare.
Bharara thanked the NYPD, the FBI’s New York Health Care Fraud Task Force, the HHS, the city’s Human Resources Administration, the state Office of the Medicaid Inspector General and the state Attorney General Medicaid Fraud Control Unit for their roles in the investigation.
Assistant U.S. Attorneys Timothy Howard and Daniel Therani of the U.S. Attorney’s Office’s Complex Fraud and Cybercrime Unit are prosecuting the case; Assistant U.S. Attorney Carolina Fornos is handling the asset forfeiture proceeding.