Another Detroit-Area Physician Convicted in $17.1 Million Medicare Fraud Scheme

May 8, 2017 - A third Detroit-area physician was convicted today for his role in a $17 million Medicare fraud scheme involving medically unnecessary physician visits.

Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Daniel L. Lemisch of the Eastern District of Michigan, Special Agent in Charge David P. Gelios of the FBI’s Detroit Division and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office made the announcement.

Gerald Daneshvar, M.D., 40, of West Bloomfield, Michigan, was convicted of one count of conspiracy to commit health care fraud after a jury trial lasting approximately two weeks. Daneshvar was a physician for Lake MI Mobile Doctors, a home visiting physician service based in Chicago, with an office in Southfield, Michigan, from 2012 to 2013. Daneshvar was also acquitted of two counts of health care fraud today.

The evidence at trial showed that Daneshvar visited patients who did not qualify for visiting physician services, and these visits were then billed to Medicare at the highest billing codes. For example, the evidence showed that Daneshvar billed Medicare for home visits that required complex, 40- or 60- minute examinations, but would instead rush through as many as 22 home visits per day, averaging about 15 minutes or less with each patient, so he could make more money. The evidence also showed that he ordered unnecessary tests, in order to receive larger bonuses.

In connection with this case, Leonard Van Gelder, M.D., 69, of Caledonia, Michigan, and Stephen Mason, M.D., 46, of Indianapolis, each pleaded guilty to one count of conspiracy to commit health care fraud in March 2017 and December 2016, respectively. As part of their guilty pleas, Van Gelder and Mason admitted to seeing patients who did not need their services and for whom bills were submitted to Medicare at the highest billing codes. Both Van Gelder and Mason testified at trial.

Lake MI Mobile Doctors billed Medicare approximately $17.1 million as a result of the scheme in which these doctors participated, the evidence showed.

The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan. Fraud Section Trial Attorneys Amy Markopoulos and Stephen Cincotta prosecuted the case.

The Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 3,000 defendants who have collectively billed the Medicare program for more than $11 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

source: Dept. of Justice press release