Five Charged in $86M Medicare Billing Scheme

     BROOKLYN (CN) — Five people were indicted on charges of running an $86 million Medicare and Medicaid scam by offering kickbacks for medically unnecessary services for at least eight years.
     The indictment against the four men and one woman was filed under seal last Friday but was unsealed earlier this week by U.S. Magistrate Judge Marilyn D. Go. All of the accused have since been released on bond.
     The federal government accused Aleksandr Pikus, Mark Tsyvin, Maksim Vernik , Denis Satyr and Malvina Yablonskaya of running shell companies to take in ill-begotten gains through bogus medical services they never performed.
     Pikus was the ringleader and “had control over and gave directions to the other defendants” on how to open bank accounts and set up the alleged shell businesses for the sham services, according to the 22-page indictment.
     The alleged scheme ran from 2008 to 2016. The defendants would refer beneficiaries to certain clinics in exchange for “illegal kickback payments,” and would pay ambulance drivers and others to give them business, prosecutors claim.
     They also are accused of “artificially and corruptly” increasing demand for health care services by making cash payments to Medicare and Medicaid beneficiaries to “induce” them to provide the unnecessary services.
     The accused then submitted requests for payment to federal medical services programs for services “that they knew were induced by cash payments to beneficiaries and were not medically necessary,” according to the indictment.
     Prosecutors claim the five defendants made sure that payments were made electronically to cover their tracks, and then sent the funds to their shell companies and took them to check-cashing places for a fee. They also allegedly failed to report the money to the Internal Revenue Service.
     The indictment says Ideal Health submitted $20.2 million in claims to the federal government and got $5.6 million out of it; Handz On submitted $11.3 million in claims and pocketed $3.8 million; Prime Care on the Bay submitted $31.3 million and got $17 million.
     Bensonhurst Mega Medical Center submitted 23.2 million in claims to net $11 million, according to the indictment.
     The alleged culprits face 11 counts that include money laundering and conspiracy to defraud the IRS.
     The shell companies named in the court filing are: Advanced Carrier Opportunity LLC; Bee Nurse Employment Solutions; National Research Group LLC; Project Design A2Z; Sonotech Corp.; Zen Marketing Inc.; MGMS Inc.; Ideal Health; Handz On; Prime Care; Bensonhurst; Medical Management; Surf Consulting Group Inc.; Neptune Consulting Services; REMM Research & Marketing Inc.; BZR Inc.; Tri State Recruiting Services; Prime Collections Solutions Inc.; and BRD Group.

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