Home Health & Hospice Week

Wheelchair fraud enforcement actions continue to rack up.

Prosecutors are revealing the bones of a massive fraud scheme based in Harris County, TX - the epicenter of Operation Wheeler Dealer enforcement.

A 68-count indictment against two Houston-area physicians and two durable medical equipment companies has been unsealed, says Texas U.S. Attorney Michael Shelby. The charges, including health care fraud, money laundering, wire fraud and conspiracy, accuse the defendants of bilking Medicare of a staggering $40 million in a mere 17 months.

According to prosecutors, the scheme worked like this: 1st Choice Medical Equipment and Supply owner Harold Horatio Iyalla and Horizon Medical Supply owner Pius James Ekiko paid kickbacks to recruiters who enlisted "thousands of Medicare beneficiaries" in the wheelchair scam. Recruiters transported the beneficiaries to be seen by physicians Charles Frank Skripka, Jr. and Jayshree Patel. 

Dr. Lewis Gottlieb, who has already pled guilty in the scheme, hired Skripka and Patel at his clinic "solely to authorize motorized wheelchairs for Medicare beneficiaries who clearly did not meet the Medicare guidelines to receive such a device," Shelby charges. From February 2002 to June 2003, the physicians "routinely approved wheelchairs for as many as thirty to fifty patients a day using a written script given to them by Dr. Gottlieb."

The suppliers paid the physicians a kickback for each false certificate of medical necessity, prosecutors charge, and delivered a scooter instead of a more expensive wheelchair to the beneficiary. The physicians also allegedly billed Medicare for unnecessary office visits and medical services.

"DME fraud is a major and increasingly serious problem," Federal Bureau of Investigations Special Agent in Charge Tim Menke says in the release. The FBI, the Department of Health and Human Services and the HHS Office of Inspector General cooperated in the investigation.

This spring, authorities froze $1.25 million in a bank account for Ekiko and Horizon, and $758,000 in an account for Iyalla and 1st Choice. The government is seeking $21 million in forfeitures from the three physicians and two suppliers. Gottlieb already has forfeited $1.6 million (see Eli's HCW, Vol. XIII, No. 14, p. 106).

The maximum penalties for the charges are decades of jail time and hundreds of thousands of dollars in fines. The indictment remains under seal because more defendants are slated for arrest under the charges, Shelby says.

In other fraud enforcement news: A Coeur d'Alene, ID jury July 28 convicted a former Hayden, ID-based wheelchair company owner of 30 counts of health care fraud, nine counts of money laundering and two counts of obstruction of justice, reports the Spokane, WA Spokesman-Review. Most of the charges centered on Back 'N Action former owner Christopher Close billing Medicare for $6,000 power wheelchairs from 1998 to 2001, but furnishing $2,000 scooters or nothing at all.

Prosecutors [...]