She Paid a Nurse for Patient Secrets — Then Billed Medicare $1.6 Million for Care That Never Came: Michigan Home Health Owner Convicted

A Michigan home health care agency owner has been convicted of running a Medicare fraud scheme that prosecutors said siphoned about $1.6 million from the program.

“Patients Never Saw Her. Doctors Never Approved It. But Medicare Paid $1.2 Million Anyway: Michigan Home Health Owner Guilty in Fraud Scheme”A federal jury in the Eastern District of Michigan found Ruby Scott, 55, of Farmington Hills, guilty of health care fraud, conspiracy to defraud the United States and pay illegal kickbacks, and multiple kickback counts. Prosecutors said Scott owned and operated Delta Home Health Care LLC and used the company to submit false claims for patients who were not properly qualified for home health services.

According to evidence presented at trial, Scott paid a discharge nurse at a Detroit hospital to identify Medicare patients and send their confidential records to Delta without the patients’ knowledge. Prosecutors said she initially built the relationship while working with the nurse at another home health company, then expanded the arrangement by paying the nurse additional money for each patient referred to Delta. Authorities said Scott paid more than $130,000 through payment apps, checks and cash.

Scott then used those patient records to bill Medicare for services that were not medically justified. Prosecutors said many of the claims falsely stated that doctors had certified patients as homebound and eligible for home health care, even though no doctor had examined them for those services. In some cases, Scott allegedly used real doctors’ identities to make it appear the patients had been evaluated when they had not.

Trial testimony also showed that Delta lacked proper patient files for more than one-third of the patients tied to its Medicare claims, even though the company collected more than $1.2 million for those patients alone. One witness testified that a patient linked to the scheme never received any services from Delta.

Scott is scheduled to be sentenced on Sept. 24 and faces up to 10 years in prison on each health care fraud count, up to 10 years on each kickback count, and up to five years on the conspiracy charge. A federal judge will determine her sentence later, taking into account the federal sentencing guidelines and other factors.

Fancy Meals, Speaker Fees, and Antidepressants: Takeda Pays $13.7 Million to Settle Allegations It Bribed Doctors to Push Trintellix

Takeda Pharmaceuticals will pay $13.67 million to resolve allegations that it improperly paid physicians to boost prescriptions of its antidepressant Trintellix, federal officials said.

The civil settlement concerns allegations that, from 2014 to 2020, the company offered kickbacks in the form of speaker fees, meals and other benefits to health care providers to induce them to prescribe the drug, which is used to treat major depressive disorder. Prosecutors said some doctors received repeated speaking opportunities and expensive meals with little educational value, while the company sought to influence prescribing decisions through financial incentives.

The Assistant Attorney General Brett A. Shumate of the Justice Department’s Civil Division said, “Such conduct can erode the trust that patients place in their healthcare providers and lead to higher drug costs for American taxpayers.”
“This settlement demonstrates the continued commitment of my office to ensure that patients’ best interests remain paramount,” said U.S. Attorney Eric Grant for the Eastern District of California. “Prescribing decisions should not be influenced by drug companies’ payments or side perks made available to physicians.”
“Alleged kickback schemes such as those described in this matter undermine the trust that patients place in their providers and federal health care programs,” said Acting Deputy Inspector General for Investigations Scott J. Lampert of the U.S. Department of Health and Human Services, Office of Inspector General (HHS OIG).

The Justice Department said the alleged conduct violated the federal Anti-Kickback Statute, which bars offering or paying anything of value to induce referrals or prescriptions covered by Medicare, Medicaid, TRICARE and other federal health programs.

The agreement resolves claims but does not include an admission of liability.

He Never Treated Them — But He Signed the Lies : 79-Year-Old Surgeon Headed to Prison for Billing Medicare $7 Million for Therapy That Never Happened

A Metro Detroit surgeon has been sentenced to a year in federal prison for his role in a Medicare fraud scheme that prosecutors said generated more than $7 million in false claims for psychotherapy services that were never provided.

Mustafa Hares, 79, of West Bloomfield, was sentenced Wednesday by U.S. District Judge Gershwin A. Drain to 12 months in prison, followed by three years of supervised release, according to the U.S. Attorney’s Office for the Eastern District of Michigan. He was also ordered to pay $4.8 million in restitution.

Prosecutors said Hares was part of a broader scheme that ran from 2019 through 2023 and involved fraudulent billing for psychotherapy services. Court records show that Hares and co-defendant Mohammed Kazkaz signed patient progress notes that prosecutors said were not written by medical providers, but by employees in Mexico.

Jennifer Runyan, Special Agent in Charge of the FBI Detroit Field Office said, “The defendant’s sentencing for this multimillion-dollar healthcare fraud scheme reflects the significant impact of his actions, which drained critical resources from a program designed to serve those in need and undermined trust in the medical professionals who follow the law. I commend the dedicated members of FBI Detroit, alongside our partners at the U.S. Department of Health and Human Services Office of Inspector General, whose work ensured those involved were brought to justice. Together, we remain committed to protecting the integrity of our healthcare system and those who depend on it.”
United States Attorney Gorgon stated, “This physician abused his medical license and position of trust as a doctor to facilitate a massive health care fraud scheme at the expense of the American taxpayer. We must eradicate fraud.”
“Patients place enormous trust in their medical providers, and schemes like this not only defraud Medicare but also betray that trust in deeply harmful ways,” said Mario Pinto, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).

Kazkaz was previously sentenced to 7 1/2 years in prison for his role in the case.

Federal officials said the scheme exploited Medicare by billing for services that were never rendered, draining money from a program intended to provide care for patients who need it. Prosecutors said Hares used his medical license and position of trust to help sustain the fraud.