Participants in Alleged $97 Million Medicare Fraud Scam Arrested in Houston

The United States Department of Justice has announced the filing of charges against two owners of Spectrum Care P.A., a Houston mental health care company, for their alleged role in a $97 million scam against Medicare. In addition, other employees of the health care provider have also been charged with various counts of health care fraud, conspiracy to defraud the United States and make health care kickbacks, and payment and receipt of health care kickbacks.

Those originally charged in December 2011 include: Cyrus Sajadi, 64, Mansour Sanjar, 79, and Chandra Nunn, 34. Four others were arrested in July, including: Shokoufeh Hakimi, 65, Adam Main, 31, Shawn Manney, 50 and Sharonda Holmes, 38. The charges were filed in the U.S. District Court for the Southern District of Texas in Houston.

The indictment alleges that from 2006 to 2011, Sajadi and Sanjar planned and carried out a scheme to defraud Medicare. The two owned Spectrum, which ostensibly provided “partial hospitalization program” (PHP) services for severe mental illness. A PHP is a type of intensive outpatient treatment. Sajadi, Sanjar, Moore and Main are alleged to have signed admission papers and medical progress notes claiming that their Medicare patients were eligible for Medicare when they weren’t or that the Medicare beneficiaries needed PHP when they didn’t. It was also alleged that Sanjar and Sajadi submitted reimbursement claims to Medicare for PHP services when in reality the patients were playing games, watching movies or drawing in coloring books. Medicare does not reimburse for those activities.

The indictment further alleges that Sajadi, Sanjar and Hakimi paid kickbacks to Holmes, Nunn, Manney and others, including patient recruiters and group care home operators, in return for sending the ineligible Medicare patients to Spectrum. Sometimes, the patients also received kickback money. The alleged fraud added up to approximately $97 million in Medicare billings for medically unnecessary services or non-existent services.

Health care schemes involving a provider’s fraudulent billing of Medicare often come to light when facility doctors or employees feel compelled to report it. It takes courage to alert authorities to abuses by fellow physicians, coworkers or one’s employer. To encourage potential whistleblowers to report what they know, the qui tam provisions of the federal False Claims Act permit such individuals to claim a share in the government’s recovery.

Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.

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