A Victory in the Fight Against Healthcare Fraud: This Time, Involving Dentists

Topics: Compliance, Financial Crime, Government, Government Fraud

healthcare fraud

Healthcare fraud within the United States continues to constantly evolve and affect different areas of our healthcare system. In fact, one of the most recently affected areas has been the dentistry field.

On July 27, the U.S. Attorney’s Office for the Northern District of Ohio announced that a jury had criminally convicted Edward Hills, Sari Alqsous, Yazan B. Al-Madani, and Tariq Sayegh for their roles in a massive complex scheme to defraud the MetroHealth Hospital System. Hills served as MetroHealth’s Chief Operating Officer and Director, as well as interim President and Chief Executive Officer. The other three men were dentists who worked for MetroHealth.

Between 2008 and 2016, Hills solicited bribes from Alqsous, Madanis, and Sayegh in the forms of cash, checks, a nearly $4,000 Louis Vuitton briefcase, a television, flights, and frequent stays at a downtown apartment. Upon receiving such payments, Hills, in an official capacity, allowed the other defendants to work at their private dental businesses while receiving a full-time salary from MetroHealth. He also ensured that they received full-time salaries even though they did not work full-time; and he referred Medicaid recipients to private dental clinics that were owned by Madani and Alqsous.

The Conspiracy Continues

The conspiracy did not stop there. The defendants had the authority to decide who was accepted into MetroHealth’s residency program, often selecting applicants who attended Jordanian dental school and requiring them to pay “donations” to Alqsous, Sayegh, and Hills.

Alqsous, Madani, and Sayegh were able to hide their corrupt activities by falsely claiming kickback checks written to Hills as consultation and professional fees. By the combined efforts of the FBI, IRS, Ohio Bureau of Criminal Investigation, MetroHealth officials, Ohio Office of the Inspector General, and the United States Attorney’s Office, the four men were ultimately caught. They are currently awaiting their sentencing hearing scheduled for November 27, and the defendants could face up to 20 years in prison for their crimes.

The Implications & Why RICO Matters

As healthcare fraud expands, so do the methods utilized to avoid detection. According to Ryan Korner, IRS Special Agent in Charge, the defendants, upon learning of their discovery, attempted to obstruct the investigation by telling the witnesses not to cooperate with law enforcement. It was clear the defendants were willing to disrupt the investigation as much as possible to avoid conviction, thus making the government’s ability to counter healthcare fraud more difficult.

Law enforcement utilized the Racketeer Influenced and Corrupt Organizations Act (RICO) to charge and convict the defendants. RICO was enacted to allow the government to effectively and efficiently prosecute members of organized crime on a large scale. So, while healthcare fraudsters’ strategies might be changing, the government’s tactics are as well.

In order to tackle healthcare fraud nationwide, the US House Ways and Means Committee has called for a national fraud strategy to identify areas of high fraud risk and to use inter-agency teams to find and prosecute the fraudsters. The recent MetroHealth case symbolizes the necessity for such a strategy and use of resources because the four defendants were able to avoid detection for eight years despite the high level of corruption and potential loose ends.

Ryan L. Korner, Special Agent in Charge in the IRS Criminal Investigation unit (Cincinnati Field Office) stated that the guilty verdicts resulted from the excellent partnership among IRS Criminal Investigation, the U.S. Attorney’s Office, the FBI, the Ohio Bureau of Criminal Investigation, and the Ohio Office of the Inspector General.

The Continued Importance of Inter-Agency Collaboration

Each year, healthcare fraud costs the U.S. approximately $68 billion. This comes as no surprise given the level of sophistication of some of these conspiracies and schemes, such as the one discussed here.

On a national level, the MetroHealth case is indicative of the necessity of inter-agency investigations and represents how beneficial that cooperation can be in the fight against healthcare fraud. The case also illustrates how the efforts of law enforcement — including using RICO and inter-agency task forces — can better address the seriousness and complexity of healthcare fraud.

Maximilian Raileanu, a legal intern at Berliner, Corcoran & Rowe, co-authored this blog post.