A federal jury found a physician guilty today for her role in a scheme involving approximately $8.9 million in fraudulent Medicare claims for home health care and other physician services that were procured through the payment of kickbacks, were not medically necessary, not actually provided or, in some cases, were provided by the defendant, who was not a licensed physician during the conspiracy.
Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, U.S. Attorney Matthew Schneider of the Eastern District of Michigan, Special Agent in Charge Timothy Slater of the FBI’s Detroit Division and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office made the announcement.
Millicent Traylor, 47, of West Bloomfield, Michigan, was convicted of one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive kickbacks in connection with Medicare beneficiaries, and five counts of health care fraud following a four-day trial. Sentencing has been scheduled for Sept. 27, before U.S. District Judge Robert Cleland of the Eastern District of Michigan, who presided over the trial.
According to evidence presented at trial, from 2011 to 2016, Traylor and her co-conspirators engaged in a scheme to defraud Medicare of approximately $8.9 million through fraudulent home health and physician claims. The evidence showed that Traylor, who was unlicensed at the time, acted as a physician for these companies, providing services that were not medically necessary and that were billed to Medicare as if they were provided by a licensed physician. The evidence further showed that Traylor conspired to cause billing to Medicare for services that were not rendered. To make it appear that these services were medically necessary and were provided, Traylor and her co-conspirators falsified medical records and signed false documents. Additionally, the evidence at trial showed that Traylor and her co-conspirators paid and received kickbacks in exchange for referring Medicare beneficiaries to serve as patients at the clinics. The trial evidence also revealed that Traylor fraudulently signed the names of licensed physicians on prescriptions for opioid medications, such as oxycodone, as a means of inducing patient participation in the scheme.
Four defendants were charged in this matter. Jacklyn Price, 33, of Shelby Township, Michigan, and Muhammad Qazi, 47, of Bloomfield Hills, Michigan, pleaded guilty in April 2017 and are awaiting sentencing. Christina Kimbrough, M.D., 39, of Wayne, Michigan, pleaded guilty in November 2017 and is awaiting sentencing.
This case was investigated by the HHS-OIG and the FBI. Trial Attorneys Stephen Cincotta and Steven Scott of the Criminal Division’s Fraud Section are prosecuting the case.
The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion.
Official news published at https://www.justice.gov/opa/pr/doctor-convicted-89-million-health-care-fraud-scheme