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Healthcare Fraud

December 5, 2008                                                    Bulletin 2008-No. 11

 

On December 3, 2008, United States Attorney Rebecca A. Gregory announced that a Port Arthur medical billing business, Medic Management, PA, and three employees, Ashely Collins Walkes of Houston, Isam Nazmi Anabtawi of Groves, and Kristi Rose of Bridge City have been indicted and charged with 150 counts of health care fraud related violations in the in the United States District Court for the Eastern District of Texas.

 

According to the indictment, from September 2004 until March 2008, Medic Management, under the direction of Ms. Walkes, Mr. Anabtawi, and office manager Ms. Rose, fraudulently billed Medicaid, Medicare, and private insurance for thousands of physical therapy sessions, despite the fact that (according to the indictment) Medic Management never employed a licensed physical therapist, and treatment was provided by unsupervised personnel who had no physical therapy training.  It is alleged that all the physical therapy sessions were billed as if they were performed by Dr. Anabtawi.

 

In total, Medic Management billed Medicaid, Medicare, and private insurance nearly $7.5 million for physical therapy and was paid nearly $4.2 million.  Also, Medic Management billed Medicaid, Medicare, and private insurance for thousands of office visits claiming each patient was seen by Dr. Anabtawi for approximately 25 minutes, when allegedly each patient was only actually seen for five minutes or less.  From September 2004 until March 2008 Medic Management billed the government approximately $2.5 million for office visits and was paid $633,749.51.

 

The case was jointly investigated by the Texas Attorney General's Office and the Federal Bureau of Investigation and is being prosecuted by Special Assistant United States Attorney Christopher Tortorice.

 

The Beaumont Enterprise reported on December 3, 2008, that when patient Jeanetta Booth would visit the Medic Management pain treatment center in Groves she felt lucky to see the doctor for more than five minutes.  The doctor,  Isam Nazim Anabtawi, is accused of claiming that brief visits with patients like Ms. Booth lasted up to 25 minutes.  According to the Texas Medical Board Isam Nazim Anabtawi was a physician with specialties in thoracic surgery and general surgery.  His license expired on November 30, 2008.

 

"He ran people in and out of there like crazy," said Booth, who for the past three weeks has been trying to determine how she can get copies of her records now that the Port Arthur facility is closed.

 

According to the The Beaumont Enterprise Medicaid and Medicare payments Ms. Walkes, Mr. Anabtawi, and  Ms. Rose are accused of taking fraudulently are relatively small drops in a multi- billion dollar bucket.  Based on some government estimates, Medicaid fraud alone costs taxpayers at least $25 billion a year.

 

Ms. Walkes, Mr. Anabtawi, and  Ms. Rose face up to 10 years in prison on the charges.  The trio are also accused of charging the government $2.5 million and receiving about $633,000 for office visits they claimed lasted 25 minutes, but actually lasted only 5 minutes, according to the U.S. Attorney's Office.

 

Rebecca Gregory with the U.S. Attorney's Office Eastern District of Texas said she could not comment on the case specifically, but noted that Medicaid fraud and Medicare fraud are wide-spread.  "The national numbers the U.S. Attorney's Office has been provided with reflect that between 10 to 15 percent of all claims filed have a fraudulent component," she reportedly said.  Ms. Gregory said that in Jefferson County she "wouldn't say we bring these cases with frequency," but they occur often enough to keep investigators busy.

 

In 2004, according to a report by the Government Accounting Office, Medicaid spending totaled more than $250 billion.

 

It is important to note that an Indictment should not be considered as evidence of guilt and that all persons charged with a crime are presumed innocent until proven guilty beyond a reasonable doubt.

 

 

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