A cardiologist, a neurologist, and others in New York have been arrested on charges that allege the group fraudulently billed public health care programs and private insurance companies of more than $50 million.
According to a press release from the United States Attorney's office for the Southern District of New York, the charges are for criminal and civil actions relating to a 12-year scheme to defraud Medicaid, Medicare, and other private health insurance companies out of more than $50 million. The defendants include: Asim Hameedi, M.D., a board-certified interventional cardiologist who was the president and owner of City Medical Associates (CMA), a cardiology and neurology clinic based in Bayside, New York; Emad Soliman, M.D., a board-certified neurologist with his own practice in Westchester, New York; and four others who were either employed or associated with Hameedi’s organization.
In addition to the federal charges, prosecutors are “seeking treble damages and civil penalties under the False Claims Act for the fraudulent claims for reimbursement submitted by City Medical Associates to Medicare and Medicaid between 2003 and November 2015,” per the press release.
The multi-faceted scheme included, among other things: (1) making false representations to insurance providers, including providers paid through Medicaid and Medicare, about the medical condition of patients in order to obtain preauthorization for medical tests and procedures; (2) submitting false claims to insurance providers for tests and procedures that were not performed and/or medically unnecessary, as well as for drug items not used or provided; (3) paying exorbitant kickbacks to local primary care medical offices in exchange for lucrative referrals from these offices; (4) and accessing, without authorization, electronic health records (EHRs) of patients at a particular hospital based on Long Island, New York (“Hospital-1”), in violation of the Health Insurance Portability and Accountability Act of 1996 “HIPAA) in order to identify patients to be recruited to CMA.
Indeed, to hide from the insurance providers the huge volume of claims, including fraudulent claims, being submitted by CMA, the defendants from the organization submitted claims to the insurance providers falsely representing that medical tests had been ordered or performed by doctors who did not work at CMA and who had not ordered or performed the tests. These doctors included Emad Soliman, who knowingly participated in the scheme to allow CMA to submit false claims to the insurance providers in his name, as well as two other doctors who did not know that their identities were being used to further the fraud, the prosecutors allege.
In a statement, Manhattan U.S. Attorney Preet Bharara said: “As alleged, these defendants that included a cardiologist and neurologist ran a medical practice that for years billed public health care programs and private insurance companies of more than $50 million. Thanks to the hard work of federal and state investigators, this fraud has been revealed and the alleged perpetrators forced to face the consequences of their actions.”
FBI Assistant Director-in-Charge William F. Sweeney Jr. stated: “Public health insurance programs, like Medicare and Medicaid, are not a personal pocketbook for criminals seeking to exploit a program designed to help those who need these programs the most. As alleged, the six defendants carried out a massive healthcare fraud scheme against these programs and private insurance companies for over twelve years and submitted more than $50 million in fraudulent claims. The FBI is committed to working with our law enforcement partners to bring to justice those who defraud taxpayer funded programs.”
