Article - June 13, 2007 - Fort Bend Now

Sugar Land Man Busted For Alleged Multimillion-dollar Ambulance Scam
by Bob Dunn

A Sugar Land man and three Houston residents were arrested by FBI agents Wednesday and charged with billing Medicare and Medicaid for millions of dollars, while paying or offering kickbacks to dialysis patients.

Those arrested were Ayad Fallah, 34, a resident alien living in Sugar Land; Murad Almasri, 29, Houston; Mazen Abdallah, 26, Houston; and Wesam Abdallah, 31, also of Houston, according to a statement from the Southern District of Texas U.S. Attorney’s Office. A warrant remains outstanding for Raed Elmasri, 35, who was also charged in the case but remains at large.

The arrests came as the result of a 38-count indictment returned under seal in May 2007, charging the owners of Americare Ambulance Service of Houston with making millions of dollars in false billings to Medicare and Medicaid, U.S. Attorney Don DeGabrielle announced Wednesday.

Fallah, Almasri and Elmasri operated the ambulance company from 2002 until June 2006, the U.S. Attorney’s Office statement said, when they sold the company to the Abdallahs. The five were expected to appear in federal court on Wednesday.

According to the indictment, the defendants, through Americare, allegedly filed false claims seeking reimbursement for transporting dialysis patients to and from their homes for dialysis treatments when the transportation “was not medically necessary.” Americare billed Medicare and Medicaid for more than $20 million and received about $6 million in payments before the scheme was uncovered.

Americare Ambulance Service is a Medicare and Medicaid provider whose main business was to transport “non-emergency dialysis patients,” the federal indictment stated. Fallah and the other defendants couldn’t be reached for comment Wednesday. Some phone numbers listed for the company had apparently been disconnected, while another returned only a busy signal on Wednesday afternoon.

Patients using the service suffered from suffer from End Stage Renal Disease – associated with kidney damage – and needed dialysis treatment three times a week, the indictment said. The average reimbursement rate for a round-trip to and from dialysis, with mileage, is about $400-$500, according to the U.S. Attorney’s Office.

The indictment alleges that many of Americare’s ambulance transport patients were ambulatory at the time of transport, but Medicare and Medicaid were falsely billed as if the patients were non-ambulatory.

In some claims, according to the indictment, “Americare falsely alleged that the patient was found unconscious, in shock and bleeding.” The indictment also alleges that some patients rode in personal cars, driven by Americare personnel, to and from dialysis, but the trip was billed as if it was an ambulance transport.

Some of the defendants allegedly offered patients or their family members kickbacks in return for allowing Americare to transport the patient to dialysis, according to the U.S. Attorney’s office.

All five people were charged in the indictment with conspiracy to commit health care fraud, and if convicted face a maximum sentence of 5 years imprisonment, and a $250,000 fine, the U.S. Attorney’s Office said in a statement.

Each of the defendants also has been charged with “various specific instances of filing false claims for Medicare/Medicaid reimbursement associated with the transport by ambulance of a dialysis patient to regularly schedule treatments when the patient was ambulatory,” the U.S. Attorney’s Office statement said.

Also, Almasri and Wesam Abdallah each were charged with two separate counts of violating a federal anti-kickback statute. Mazen Abdallah was charged in one such count.

Fallah, Almasri, Elmasri and Mazen Abdallah also were charged with conspiracy to commit money laundering, the U.S. Attorney’s Office said. If convicted of those charges, they could face a maximum penalty of 10 years imprisonment, and a $250,000 fine, “or twice the value of the property involved in the transaction, whichever is greater.”

The indictments and arrests came as the result of an investigation involving the FBI, the Texas Attorney General’s Medicaid Fraud Unit in Houston, the U.S. Health and Human Services Office of Inspector General, and the U.S. Attorney’s Office.