Three Doctors And Three Executives Charged In $33 Million Medicare And Medicaid Fraud Scheme

[nitpicker]

https://www.justice.gov/usao-sdny/pr/three-doctors-and-three-executives-charged-33-million-medicare-and-medicaid-fraud

Department of Justice
U.S. Attorney’s Office
Southern District of New York

FOR IMMEDIATE RELEASE
Thursday, January 12, 2017

Three Doctors And Three Executives Charged In $33 Million Medicare And Medicaid Fraud Scheme

Doctors Worked at Eight Fraudulent Medical Clinics in Brooklyn That Paid Elderly People to Act as Patients, and Billed for Unnecessary or Non-Existent Medical Services

Preet Bharara, the United States Attorney for the Southern District of New York, William F. Sweeney Jr., the Assistant Director-in-Charge of the New York Office of the Federal Bureau of Investigation (“FBI”), and Dennis Rosen, Inspector General of the New York State Office of the Medicaid Inspector General (“OMIG”), announced the unsealing today of a superseding indictment charging physicians MUSTAK Y. VAID, PAUL J. MATHIEU, and EWALD J. ANTOINE, as well as health-care executives MARINA BURMAN, ASHER OLEG KATAEV, a/k/a “Oleg Kataev,” and ALLA TSIRLIN with operating a $33 million health care fraud scheme through the operation of eight fraudulent medical clinics in Brooklyn, as well as the operation of related suppliers of medical equipment, tests, and services. As part of the fraud scheme, the defendants’ co-conspirators paid cash kickbacks to elderly and financially disadvantaged patients (the “Paid Patients”) who were insured by Medicare and/or Medicaid, and the defendants and their co-conspirators then billed Medicare and Medicaid for unnecessary medical services, tests, and supplies related to the Paid Patients. [1]
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Aleksandr Burman, an individual with no medical license, established eight medical clinics in Brooklyn (the “Related Clinics”), which operated between 2007 and 2013. For each clinic, Aleksandr Burman hired one of three doctors – VAID, MATHIEU, or ANTOINE – to pose as the nominal owner of the clinic, since New York State law requires that a professional services corporation providing medical care must be owned by a medical professional. In fact, however, VAID, MATHIEU, and ANTOINE were each simply hired by Aleksandr Burman to pose as the owner of one or more of the clinics, and to come to the clinic periodically, in order to sign medical charts falsely stating that the doctor had examined a number of Paid Patients. VAID posed as the owner of one such clinic, while MATHIEU posed as the owner of four others, and ANTOINE posed as the owner of the remaining three. The three doctors were also paid to provide a large number of prescriptions and referrals for medically unnecessary supplies. Such unnecessary prescriptions included referrals for more than $3.5 million worth of durable medical equipment (“DME”), consisting mostly of incontinence supplies such as adult diaper sets ordered from a DME supply company (“USD”) owned jointly by BURMAN and Aleksandr Burman of the Related Clinics.
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Many of the Paid Patients who received such prescriptions and referrals did not need or receive the diapers and other supplies. Instead, BURMAN and USD arranged for the Paid Patients to exchange their diaper prescriptions for valuable merchandise, such as bed linens, tablecloths, dishes, kitchen appliances, and other housewares. BURMAN and USD nonetheless filed Medicaid claims for such DME, seeking more than $3.5 million in reimbursement. BURMAN also transported cash to the Related Clinics to be used to pay kickbacks to the Paid Patients.

VAID, MATHIEU, ANTOINE, and their co-conspirators also provided medical referrals for transportation services to hundreds of Paid Patients, even though such transportation was not medically necessary. This practice generated more than $4 million in losses to Medicaid. In addition, VAID, MATHIEU, and ANTOINE provided referrals and prescriptions for medically unnecessary diagnostic tests, including MRIs, as well as prescriptions for medications such as expensive ointment compounds. The defendants and their co-conspirators then sent such medical referrals to specific medical testing companies, which in turn provided kickbacks to Aleksandr Burman.

In 2012, KATAEV and TSIRLIN became business partners of Aleksandr Burman, and operated as the managers of two of the Related Clinics. Their activity as managers included paying cash kickbacks directly to Paid Patients, and employing MATHIEU and ANTIONE to pose as the owners of the two clinics.
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