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Latest Legal News from the Criminal Courts in Houston, Texas
June 14, 2007
OWNERS/OPERATORS OF AMERICARE AMBULANCE SERVICE INDICTED FOR MEDICARE/MEDICAID FRAUD
[HOUSTON, TX] – A 38 count indictment returned under seal in May 2007 charging the owners and operators of Americare Ambulance Service with falsely billing Medicare and Medicaid for millions of dollars and paying or offering kickbacks to hemodialysis patients has been unsealed, United States Attorney Don DeGabrielle announced today.
Ayad Fallah, 34, a resident alien residing in Sugarland, TX; Murad Almasri, 29, a naturalized U. S. citizen and Houston resident; Mazen Abdallah,26, a U. S. citizen and Houston resident, and Wesam Abdallah, 31, a naturalized citizen and Houston area resident, were arrested today by agents of the Federal Bureaus of Investigation. The defendants in custody are expected to appear in federal court later today. An arrest warrant has been issued and remains outstanding for a fifth person, Raed Elmasri, 35, a naturalized U. S. citizen, who is also charged in the indictment but remains at large.
Americare Ambulance Service, a Medicare and Medicaid provider, primarily engaged in transporting non-emergency dialysis patients according to the indictment . Dialysis patients suffer from End Stage Renal Disease and need dialysis treatment three times a week. The average reimbursement rate for a round-trip to and from dialysis, with mileage, is about $400-$500.
Defendants Fallah, Elmasri and Almasri operated Americare from 2002 until June 2006, when they sold the company to the Abdallahs. According to the indictment, during this time period the defendants, through Americare, allegedly filed false and fraudulent claims seeking reimbursement for transporting dialysis patients to and from their homes for regularly scheduled dialysis treatments when the transportation was not medically necessary. According to the indictment, Americare billed the federal health care programs for more than $20 million and received approximately $6 million in payments from Medicare and Medicaid.
Ambulance services are paid for by Medicare and Medicaid only when the patient’s condition contraindicates use of other transportation. For example, the patient is bed-confined and must be moved by stretcher only. Additionally, for regularly scheduled transportation to dialysis treatment by ambulance, there must be a prescription from a physician ordering the ambulance transportation. Moreover, the ambulance staff must prepare a “run sheet” that truthfully documents the patient’s medical condition at the time of transport. If the patient can sit, stand or walk, the run sheet must document that condition, and Medicare and Medicaid will not pay for the trip. Where transportation by ambulance is not medically necessary, Medicare and Medicaid will reimburse patients for transportation by other means, such as taxi cab rides, or mileage if they are driven by personal car to dialysis.
The indictment alleges that many of Americare’s ambulance transport patients were ambulatory at the time of transport, but Medicare and Medicaid were falsely billed as if the patients were non-ambulatory. In some claims, according to the indictment, Americare falsely alleged that the patient was found unconscious, in shock and bleeding. The indictment also alleges that some patients rode in personal cars, driven by Americare personnel, to and from dialysis, but the trip was billed as if it was an ambulance transport. Some of the defendants allegedly offered patients or their family members kickbacks in return for allowing Americare to transport the patient to dialysis. From 2002 through the present Americare billed approximately $14 million and was paid approximately $6.4 million in Medicare and Medicaid.
All of the defendants are charged in Counts One of the indictment with conspiracy to commit health care fraud, and if convicted face a maximum sentence of 5 years imprisonment, and a $250,000 fine. Each of the defendants is charged with various specific instances of filing false claims for Medicare/Medicaid reimbursement associated with the transport by ambulance of a dialysis patient to regularly schedule treatments when the patient was ambulatory. The statutory maximum penalties upon conviction for health care fraud is imprisonment for not more than 10 years and a fine of not more than $250,000.
Murad Almasri and Wesam Abdallah are each charged with two separate counts of violating the anti-kickback statute. Mazen Abdallah is charged in one such count. A conviction for violating the anti-kickback statute carries a maximum sentence of 5 years in prison, and a $250,000 fine.
Fallah, Almasri, Elmasri and Mazen Abdallah are charged with conspiracy to commit money laundering, and if convicted of this charge face a maximum penalty of 10 years imprisonment, and a $250,000 fine or twice the value of the property involved in the transaction whichever is greater.
The indictment also includes a notice of intent to forfeit the interest of each of the defendants in the $6.8 million received in payments from the federal health care programs through false claims for reimbursement.
This case was the result of the investigative efforts of the Federa Bureau of Investigation, the Texas Attorney General’s Medicaid Fraud Unit in Houston; the U. S. Health and Human Services Office of Inspector General, Office of Investigations; and the U.S. Attorney’s Office. The case will be prosecuted by Special Assistant United States Attorney Suzanne Bradley.
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