Doctor, along with seven other defendants who participated in a $30 million scheme to defraud Medicare and Medicaid, have all been sentenced. They worked for a healthcare facility that was unlawfully owned by a businessperson.
Compliance Perspective – Fraud:
The Compliance Officer will review the facility’s policies and procedures with the Administrator and the Compliance Committee to verify that appropriate policies are in place regarding the facility’s interactions with other healthcare providers, i.e., hospitals, physicians, pharmacy or device representatives, venders, etc. The facility should use all available means to ensure that no excluded or sanctioned entity or individual is providing services to the residents. An audit should be conducted periodically to ensure that healthcare providers being used by the facility have been screened for exclusions and/or sanctions by the OIG. To enhance communications between the facility and the residents, educational information could be shared through the Residents’ and Family Councils. This will help raise awareness about potential fraud and encourage them to audit their Medicare statements or statements from other reimbursement programs for any discrepancies regarding services or devices they may not have received or needed.
A doctor, Ewald J. Antoine, who pleaded guilty January 11, 2018, to healthcare fraud and conspiracy to commit healthcare fraud, mail fraud and wire fraud, was sentenced in August to one year and one day in prison and three years of supervised release. He was also ordered to pay restitution of $1,825,544 and forfeit $269,412 in ill-gotten gains.
Antoine participated in a $30 million scheme to defraud Medicare and the New York State Medicaid Program by posing as the owner of two medical clinics when they were owned by a corrupt businessman instead of a medical professional as New York State Law requires. Antoine also falsely claimed that he had examined and treated hundreds of patients when he had not seen them.
Between 2007 and 2013, Aleksandr Burman owned and operated six medical clinics including the two clinics Antoine fraudulently claimed
as his. All six of the clinics were involved in the $30 million scheme. They fraudulently billed Medicare and Medicaid for medical services and supplies that were not provided, were provided without regard to medical necessity or were otherwise fraudulently billed.
Burman was not a medical professional and circumvented the New York State law requiring medical clinics to be owned and operated by a medical professional by hiring doctors like Antoine to pose as the nominal owners of each of the clinics. These doctors would agree to sign fraudulent documents that represented to banks, Medicare and Medicaid and others that they were the sole owners of the clinics.
Antoine was the eighth defendant, and the second physician, to be sentenced after pleading guilty in this and a related case. The other defendants include: Aleksandr Burman, the leader of the scheme, who was sentenced in a related case on May 8, 2017, to 10 years in prison; Marina Burman, the former wife of Aleksandr Burman and the owner of a related medical supply company, sentenced on May 17, 2018, to three years in prison; Mustak Y. Vaid, a physician sentenced on August 1, 2018, to 18 months in prison; Asher Oleg Kataev, a Burman business partner, sentenced on May 31, 2018, to three years in prison; Alla Tsirlin, a Clinic office manager, sentenced on June 5, 2018, to one year and one day in prison; and Edward Miselevich and Ivan Voychak, Burman’s partners who jointly ran a related ambulette company, sentenced on June 12 and July 19, 2018, respectively, each to three years in prison.
