Federal authorities conducted predawn raids across Southern California on Thursday, busting suspected fraudsters, including a cardiothoracic surgeon, accused of stealing nearly $2 billion through sham substance abuse programs, unnecessary surgeries and phony hospice care.
In total, 15 people, including six medical professionals, were charged over $1. 8 billion in fraudulent claims submitted to government and private health insurance programs, the Justice Department said.
“These charges include the largest sober home fraud scheme the Department has ever prosecuted and a scheme involving unnecessary invasive procedures that was detected through data analytics,” said Assistant Attorney General Colin McDonald of the Justice Department’s National Fraud Enforcement Division.
FBI ADDS 2 FUGITIVES TO ‘MOST WANTED FRAUDSTERS’ LIST AMID HISTORIC $6.5B HEALTHCARE TAKEDOWN: PATEL
“Our message is simple: if you steal health care dollars from the American taxpayer or abuse your position to harm patients, we are coming for you — and the data will lead us to you.”
Among the defendants are Dr. Harold Tabaie, 78, of Anaheim, a cardiothoracic surgeon, and his business partner, Hany Malek, 61, a Tarzana chiropractor.
Both are charged in an alleged $135 million scheme to bill Medicare for medically unnecessary atherectomies, invasive arterial procedures using a bladed catheter to clear plaque.
Prosecutors allege Malek posed as a medical doctor to diagnose patients with arterial disease and recommend atherectomies, even though the patients did not have the condition.
Tabaie then performed the procedures, sometimes repeatedly on patients for whom previous operations had already failed, according to officials. Authorities noted that several patients suffered extreme pain and discomfort as a result.
Malek also faces charges for allegedly submitting fraudulent Paycheck Protection Program (PPP) loan applications in 2021. He allegedly fabricated a 25% revenue loss for his business to secure loan funds, which he then spent on personal expenses, family credit cards, other ventures and rare coins.
In a separate case, Nathan Young, 39, and his father, David Young, 71, were charged with operating a $1.6 billion substance abuse scam.
Authorities allege the father-son duo trafficked drug addicts from across the nation to dozens of Los Angeles rehab centers. Federal prosecutors said the vulnerable patients were recruited by “body brokers” Honey Phipps, 42, and Cody Phipps, 36, both of Greenville, Texas.
Body brokerage is the illegal practice of receiving kickbacks to refer insured individuals to specific rehab facilities. Once patients arrived, no actual treatment was provided.
Instead, the Youngs allegedly recycled patients through their facilities to continuously bill insurance companies, even ordering staff to drug patients with sedatives to “knock them out” if they attempted to leave.
The duo also allegedly offered drugs to patients, cut them off from communication with family members, prevented them from accessing their belongings and physically blocked them from leaving the facilities to continue billing their insurance policies.
When Nathen Young was informed that a patient wanted to leave detox so he could smoke marijuana, Young instructed that the patient should be given what he wanted, off-site from the detox, to keep him there, prosecutors said.
“It is especially egregious when doctors and other health care professionals, who pledged to do no harm, resort to petty greed and criminality,” said First Assistant United States Attorney Bill Essayli. “Every dollar drained out of our private and public health insurance systems is one less dollar available to those who truly need it.”
The sweep also targeted several other major healthcare fraud schemes across the region. In one instance, defendants were charged with stealing more than $140 million by falsely certifying non-terminally ill patients for hospice care.
In a separate prescription fraud scheme, Christina Mareik, 61, of Whittier, was charged for her role in allegedly submitting thousands of bogus prescriptions for high-reimbursement generic drugs to Medi-Cal, California’s Medicaid program.
Additionally, Dr. Hassan Badday, 48, of Los Angeles, and Dr. Robby Ayoub, 52, of Huntington Beach, were charged with taking illegal kickbacks from a Houston laboratory marketer in exchange for ordering unnecessary Medicare genetic tests.