The administrator, medical director, and an employee of a Schaumburg-based in-home visiting physician group were indicted on federal charges for their alleged roles in a $12 million health care fraud scheme, federal law enforcement officials announced Tuesday. The defendants operated or were employed by a home visiting physician practice, Medicall Physicians Group, Ltd., that allegedly billed Medicare for patient services that were never provided. The defendants allegedly fraudulently obtained approximately $4.7 million in Medicare payments from January 2007 to December 2011.
A 10-count indictment that was returned by a federal grand jury last Wednesday was unsealed Tuesday following the arrest of RICK E. BROWN, 56, of Rockford, the president of Home Care America, Inc., which controlled the daily operations of Medicall. Brown pleaded not guilty and was released on a $10,000 unsecured bond at his arraignment Tuesday before U.S. Magistrate Judge Mary Rowland in Federal Court in Chicago.
Also indicted were Dr. ROGER A. LUCERO, 62, of Elmhurst, a physician and the medical director of Medicall, and MARY C. TALAGA, 53, of Elmwood Park, a Medicall and Home Care America employee who submitted claims to Medicare on behalf of Medicall and the medical professionals who were employed by Medicall. Lucero and Talaga were not arrested and will be arraigned on dates yet to be determined.
Brown and Lucero were each charged with one count of conspiracy to commit health care fraud and multiple counts of health care fraud. All three defendants were charged with three counts each of making false statements relating to health care matters. The indictment also seeks forfeiture of more than $4.49 million from Brown and Lucero.
According to the indictment, Brown and Lucero operated Medicall, and Talaga submitted the company’s bills to Medicare, totaling more than $12 million. Brown instructed employees to bill Medicare for patient oversight and other services that were never provided, and Lucero created backdated records in an effort to conceal the fraudulent billings, the indictment alleges. Talaga allegedly billed Medicare for these services, even though she knew they were not documented, a practice that required her to fabricate the information submitted to Medicare.
The arrest and charges were announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; Robert J. Shields Jr., Acting Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation; and Lamont Pugh III, Special Agent-in- Charge of the Chicago Regional Office of the U.S. Department of Health and Human Services Office of Inspector General.
Health care fraud conspiracy and each count of health care fraud each carry a maximum penalty of 10 years in prison and a $250,000 fine, while each count of making false statements relating to health care matters carries a maximum penalty of five years in prison and a $250,000 fine. If convicted, restitution is mandatory and the court must impose a reasonable sentence under federal statutes and the advisory United States Sentencing Guidelines.
An indictment contains merely charges and is not evidence of guilt. The defendants are presumed innocent and are entitled to a fair trial at which the government has the burden of proving guilt beyond a reasonable doubt.
The investigation was conducted jointly by the FBI and HHS-OIG and brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office. The case is being prosecuted by Trial Attorney Brooke Harper of the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in Chicago and eight other cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: stopmedicarefraud.gov.
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