Four Charged in $32 Million Health Care Fraud Scheme | OPA

A medical director, operator and two unlicensed practitioners at a Texas medical clinic are now in custody on charges related to their alleged participation in a $32 million health care fraud scheme.

Farrah Forough Farizani, D.O., 57, Hamid Reza Razavi, 60, Elie Hanna Hajjar, 48, and Juan Acuña, 64, all of Houston, made their appearances today before U.S. Magistrate Judge Christina Bryan.

Farizani and Razavi are the medical director and operator, respectively, of Hillcroft Physicians, while Hajjar and Acuña were former unlicensed practitioners there.

The indictment, unsealed today, charges all four with one count of conspiracy to commit health care fraud. Farizani, Razavi and Hajjar are also charged with five counts of making false statements relating to health care matters.

The indictment alleges the defendants participated in a health care fraud scheme. They allegedly submitted false and fraudulent claims to Medicaid and Medicare for services that were not provided as billed or were not provided by a licensed, qualified and enrolled provider. Farizani, Razavi, Hajjar, and Acuña allegedly misled patients and staff to believe that Hajjar and Acuña were licensed to practice medicine in Texas.

According to the indictment, Farizani and Razavi directed Hajjar and Acuña to pose as licensed medical professionals. Hajjar and Acuña then allegedly examined, diagnosed, treated, referred and prescribed drugs for patients, many of whom were non-English speaking Medicaid clients unfamiliar with the American medical system. Farizani and Razavi allegedly directed Hillcroft Physicians’ billing staff to submit false claims to Medicaid and Medicare as though Farizani had seen and treated the patients, even when Farizani was out of the country.

The indictment alleges that the defendants submitted or caused the submission of approximately $31 million in claims to Medicaid for which Medicaid paid approximately $12.2 million. They also submitted approximately $600,000 in claims to Medicare for which Medicare paid approximately $250,000.

Acting Assistant Attorney General Nicholas L. McQuaid of the Justice Department’s Criminal Division; Acting U.S. Attorney Jennifer B. Lowery of the Southern District of Texas; Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office; Special Agent in Charge Miranda Bennett of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Region; and Stormy Kelly of the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.

The FBI, HHS-OIG and Texas Attorney General’s MFCU conducted the investigation. U.S. Immigration and Customs Enforcement’s Homeland Security Investigations assisted with the arrests.

Trial Attorney Devon Helfmeyer of the Criminal Division’s Fraud Section and Special Assistant U.S. Attorney Kathryn Olson of the Southern District of Texas are prosecuting the case.

The Fraud Section leads the Health Care Fraud Strike Force. Since its inception in March 2007, the Health Care Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

An indictment is merely an allegation and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.