Defendants Allegedly Recruited Patients from Homeless and Low-Income Population;
Ordered Unnecessary Medical Tests and Procedures, Then Billed Insurers
Acting Brooklyn District Attorney Eric Gonzalez, together with United States Health and Human Services Office of the Inspector General New York region Special Agent in Charge Scott J. Lampert, New York City Department of Social Services Commissioner Steven Banks, New York State Medicaid Inspector General Dennis Rosen and New York State Department of Financial Services Superintendent Maria T. Vullo today announced that four doctors are among 34 defendants – 20 individuals and 14 corporations – named in an 878-count indictment that alleges that they participated in a massive scheme to defraud Medicaid, Medicare and other publicly-funded insurance providers of approximately $146 million over three years.
Acting District Attorney Gonzalez said, “These defendants allegedly exploited the poorest among us to divert millions of dollars from publicly-funded insurance programs these same vulnerable people rely on. Some of the defendants then used the stolen funds to maintain a lavish lifestyle consisting of multi-million dollar homes, expensive handbags and luxury travel. This massive scheme, which provided no patient care at all, wasted millions of taxpayer dollars dedicated to Medicaid and Medicare, which serve as a lifeline for so many Americans – our families, our friends, our neighbors. I cannot and will not allow this type of corruption and fraud to take place in Brooklyn and will spend every resource to stop it.”
Special Agent in Charge Lampert said, “Yet another fraudulent scheme involving doctors and other providers charged with fleecing vital government health programs serving vulnerable individuals. Criminals who place personal greed over patient care will be held accountable and prosecuted. Together, with our law enforcement partners, we will ensure that justice is done.”
Commissioner Banks said, “To prey on those most in need of help by pocketing the funds desperately needed for their medical care is a betrayal of everything that social services and medical professions stand for. I am grateful for the hard work of everyone at the Kings County District Attorney’s Office, our partners in the State and Federal government, and our own Office of Medicaid Provider Fraud and Abuse Investigations for their diligent work investigating these serious allegations.”
Inspector General Rosen said, “This collaborative investigation and resulting indictment send an unmistakable message to those who seek personal gain by preying upon vulnerable New Yorkers and exploiting the Medicaid program: ‘you will be identified and held fully accountable.’ My office will continue to work closely with our partners in the Brooklyn District Attorney’s Office, U.S. Health and Human Services Office of the Inspector General, NYC Human Resources Administration, NYS Department of Health, and other state and federal agencies to protect Medicaid recipients and save taxpayer dollars by rooting out fraud, waste and abuse in the Medicaid program.”
Superintendent Vullo said, “These defendants allegedly created a criminal enterprise to systemically pickpocket programs meant for those who can least afford healthcare, bilking publicly funded health insurance providers for tens of millions of taxpayer dollars. As the regulator of New York State health insurers and the enforcement agency charged with rooting out insurance fraud, DFS is proud to have partnered with the Brooklyn DA’s office in investigating these defendants, and helping to bring them to justice.”
The Acting District Attorney identified Kristina Mirbabayeva, 35, of Bridge Street, in Downtown Brooklyn, as the alleged leader of the scheme. Other alleged high-level members of the enterprise include Dr. Kevin Custis, 53, of Belle Meade, New Jersey, who was Mirbabayeva’s alleged business partner; Vladislav Yakubov, 46, of Brighton Beach, Brooklyn, who allegedly managed recruiting clinics with Kamal Zafar, 49, of South Huntington, New York; and Natan Yusufov, 54, of Ocean Parkway, Brooklyn, Igor Shamayev, 47, of Midwood, and Vitalik Ifraimov, 58, of Ocean Parkway, alleged money launderers. Some of the defendants were arraigned before Brooklyn Supreme Court Justice Danny Chun this morning on an indictment in which they are variously charged with enterprise corruption, first-degree scheme to defraud, first-, second-, third- and fourth-degree money laundering, first, second- and fifth-degree health care fraud, first-degree falsifying business records, first-degree offering a false instrument for filing, first-, second- and fourth-degree grand larceny and first-degree scheme to defraud. The defendants are being arraigned throughout the day and bail set in varying amounts.
If convicted, they face up to 25 years in prison on the top count. See addendum for identities of other defendants charged in this indictment.
The investigation began following a referral from HHS-OIG and was conducted using multiple investigative techniques, including undercover detectives, intercepted communications, surveillance and financial analysis.
The Acting District Attorney said that, according to the indictment, between January 1, 2015 and November 30, 2017, the defendants – four of whom are doctors – engaged in a criminal enterprise by intentionally participating in a pattern of criminal activity through the fraudulent operation of medical clinics and the submission of fraudulent claims to Medicaid, Medicare and Managed Care Organizations. In addition to doctors, one of whom signed off on the test referrals and three of whom signed off on test readings, the defendants include office staff, recruiters, managers, billers and money launderers.
The Acting District Attorney said that, according to the indictment, the enterprise fraudulently billed for more than $146 million over the period covered by the indictment in a scheme in which recruiters for the enterprise went out to low-income areas and approached people on the street, including outside of a soup kitchen in East New York and a job center in Bushwick, and offered them cash, usually $30 to $40, if they could produce a Medicaid or Medicare card and would agree to be transported to and examined at a medical clinic. If the person agreed, they were taken to one of the participating clinics, which were located in Bedford-Stuyvesant, Canarsie and Crown Heights. Recruiters were paid anywhere from $30 to $50 per patient.
Once there, patients cycled through a battery of medically unnecessary tests done by technicians, according to the investigation, including allergy tests, cardiograms, ultrasounds, and nerve tests. Reading doctors, i.e., those who analyzed the tests, were paid $25 to $50 per test read. Referring doctors, i.e., those who signed relevant paperwork for the testing, were paid varying amounts.
In one instance, for example, an undercover officer was recruited and paid $30 to undergo testing at a clinic, where he spent less than an hour undergoing a few medical tests with no doctor present, yet records show that Mirbabayeva’s billing companies billed for 18 separate tests for that visit. Had those tests been performed, according to the investigation, they would have taken more than 12 hours to complete.
In another egregious example, one of the doctors charged in the case, Dr. Hamid Alam, is allegedly heard in an intercepted phone call saying that he’s falling behind and has 15,000 tests to sign off on. Clearly, this would be unacceptable if these were valid tests for which patients were waiting for a diagnosis.
Finally, it is alleged, the defendants laundered the fraudulently obtained funds through the 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 investigation revealed that the defendants allegedly used the laundered proceeds to purchase expensive 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 Yakubov. Mirbabayeva also allegedly used the money to fund shopping sprees at high-end retailers such as Hermes, Tourneau and Bulgari.
The Acting District Attorney said that asset forfeiture proceedings have been commenced against the defendants seeking approximately $146 million. Eleven properties worth more than $10 million and more than 100 bank accounts allegedly belonging to the defendants have been frozen.