Articles Posted in Medical Fraud

Why did you commit healthcare fraud in Southern California?

Now that you’ve been investigated (or, perhaps, arrested), your life path certainly doesn’t seem fully rational. After all, you now face massive jail time, thousands (or millions) of dollars in forced restitution, public humiliation, the loss of your medical, dental, or chiropractic license (or other professional credentials), and problems with your relationships and self-esteem.

So… why did you do it?

The Los Angeles Weekly recently ran a fantastic, compelling, and extremely disturbing story on Medicare fraud in Los Angeles and beyond. Entitled: “How Medicare fraud became the nation’s most lucrative crime,” the story blisteringly attacks a system of corruption that’s so deep and so diverse, it’s almost unbelievable.

It’s no secret that healthcare fraud in Southern California and beyond costs taxpayers $100 billion a year (some say that figure is as high as $300 billion). The Obama administration has clearly made it a priority to crack down on fraud, and the new awareness of the problem has undoubtedly led to improved policing.

Right?

Many Los Angeles Medicare and Medicaid fraud cases end in disaster for all stakeholders. For a tragic “rags to riches to rags” story, take a look at the disaster that befell the Scooter Store.

If you’ve ever watched daytime TV, you’ve no doubt seen commercials for the Scooter Store. The vendor of power wheelchairs (based in New Braunfels, Texas) sold its products to consumers by pummeling the airwaves with advertisements. But a blockbuster CBS News investigative piece about the company led to a federal government investigation and ultimately an FBI raid. Doctors and salespeople alleged that the company followed a diabolical playbook. Salespeople would contact doctors’ offices and badger physicians to prescribe power wheelchairs and scooters to patients, even if patients did not need the products. They then relied on Medicare and Medicaid errors and bureaucratic snafus to approve the bad claims.

After the FBI raid, the company furloughed every employee and then laid off 1,000 workers.

A 50-year-old Calabasas man, Dr. Pezhman Ebrahimzadeh, was sentenced to three and a half years behind bars for falsely billing Medicare for over $3 million.

As penance for perpetrating healthcare fraud in Los Angeles, Dr. Ebrahimzadeh has been ordered to pay over $3 million in restitution, for his part in billing Medicare for medical services that he never performed. In many cases, these services involved patients who were no longer alive. Ebrahimzadeh – also known as Pez Abrahams – owns a cosmetic clinic called the Winnetka Medical Group, which provides liposuction and radiofrequency laser treatments.

Federal prosecutors say he collected information from beneficiaries to bill Medicare for never-performed procedures. He also collected information from 25 Medicare patients who were dead when they supposedly “got treated,” and then he changed medical records to conceal the Los Angeles Medicare fraud. He claimed he performed a bunch of pricey procedures, including radiotherapy catheter placement, bone tumor ablation, and revascularization, even though he lacked the equipment to do these procedures.

Even “straightforward” Los Angeles Medicare fraud schemes often become surprisingly dynamic.

Perhaps you and an associate billed the state or federal government for wheelchairs that you never delivered to patients. Or maybe you constructed a scheme to collect Social Security numbers and patient data and then use that information to purchase pharmaceuticals to sell to a third market supplier.

Even the most carefully wrought, well-protected plans have a funny way of coming undone and leading to surprises not only for investigators but also for defendants themselves.