$146 million fraud scheme involved 4 doctors targeted homeless, poor

Defendants used the stolen funds to buy lavish multi-million dollar homes, expensive handbags and luxury travel.
By Beth Jones Sanborn
03:42 PM
healthcare fraud

Four doctors are among 20 individuals and 14 corporations named in a lengthy indictment that describes an alleged massive and intricate and fraud operation that sought to bilk Medicaid, Medicare and other publicly funded insurance providers of approximately $146 million over three years, according to New York’s Kings County District Attorney.

This scheme actually provided no patient care at all. The defendants used the stolen funds to buy lavish multi-million dollar homes, expensive handbags and luxury travel.

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Kristina Mirbabayeva, 35, of Brooklyn was identified as the alleged leader of the scheme, which also included four physicians from New York and New Jersey. Other players were involved in alleged money laundering, patient recruiting, running the clinics and billing. The charges against them include varying degrees of enterprise corruption, scheme to defraud, money laundering, health care fraud, falsifying business records, offering a false instrument for filing, grand larceny and scheme to defraud. If convicted, they face up to 25 years in prison on the top count.

Citing the indictment, the DA said between Jan. 1, 2015 and Nov. 30, 2017, the defendants, which also included a number of corporations, fraudulently operated medical clinics and submitted false claims to Medicaid, Medicare and Managed Care Organizations that totaled more than $146 million over the period covered by the indictment.

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The DA said the scheme hinged on recruiters going out to low-income areas, approaching people on the street and offering cash if the individual could produce a Medicare or Medicaid card and was willing to report or be transported to a medical clinic. The locations included outside a soup kitchen in East New York and a job center in Bushwick. Cash offered to potential patients was usually $30 to $40. Recruiters were paid $30 to $50 per patient.

If the person agreed, they were taken to one of the participating Brooklyn clinics and put through various medically unnecessary tests performed by technicians that included allergy tests, cardiograms, ultrasounds, and nerve tests. Doctors who analyzed the tests were paid $25 to $50 per test read. Doctors who signed relevant paperwork for the testing were paid different amounts, the DA said.

The indictment also alleges that the defendants laundered the money made through the alleged scheme through bank accounts of a series of shell companies including ones in China, Singapore, Lithuania, Pakistan, Taiwan, and Turkey, until they were transferred to certain defendants.The proceeds were used to purchase pricey real estate, such as a $3.25 million apartment in Downtown Brooklyn purchased in cash by Mirbabayeva, and a $2.8 million Brighton Beach apartment purchased by another defendant. Mirbabayeva also allegedly used the money to fund shopping sprees at high-end retailers, the DA’s office said, citing the investigation. So far, 11 properties worth more than $10 million and more than 100 bank accounts allegedly belonging to the defendants have been frozen, the DA’s Office said.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com