Feds announce $14.6B major health care fraud takedown

TEXAS, USA — Four North Texans were charged as part of a nationwide health care fraud takedown involving more than $14.6 billion, according to the U.S. Department of Justice (DOJ).

It was the largest DOJ health care fraud takedown in history, the DOJ said, more than doubles prior record of $6 billion.

Federal officials said the national takedown brought charges against 324 defendants, including 96 doctors, nurse practitioners, pharmacists, and other licensed medical professionals, in 50 federal districts and 12 State Attorneys General’s Offices across the United States.

The four North Texans charged accounted for nearly $210 million of fraudulent billing, DOJ officials said.

• Demitrious Gilmore, 46, of Lubbock, was charged by indictment with conspiracy to commit health care fraud in connection with the submission of false and fraudulent medical claims for various benefits, items, and services that were ineligible for reimbursement, not medically necessary, not performed, or not provided, the DOJ said.
• Gary Martin, 62, of McKinney, was charged by indictment with conspiracy to solicit or receive kickbacks for referrals to a federal health care program and solicitation and receipt of kickbacks in connection with the submission of over $73 million in false and fraudulent medical claims to Medicare for over-the-counter COVID-19 tests in 2023. 
• Khadeer Khan Mohammed, 44, a citizen of India, was charged by indictment with health care fraud in connection with a scheme to submit false and fraudulent medical claims to Medicare for genetic testing that was allegedly never requested, ordered and/or performed.
• Olatunbosun Osukoya, 67, of Plano, was charged by indictment with conspiracy to commit health care fraud in connection with the submission of over $25 million in false and fraudulent medical claims to Medicare, TRICARE, and other insurers for electroencephalogram (EEG) testing.

“Health care fraud drains critical resources from programs intended to help people who truly need medical care,” said FBI Director Kash Patel. “Today’s announcement demonstrates our commitment to pursuing those who exploit the system for personal gain. With more than $13 billion in fraud uncovered, this is the largest takedown for this initiative to date. Together, the FBI and our law enforcement partners will continue to hold those accountable who steal from the American people and undermine our health care systems.”

The DOJ said Gilmore and his co-conspirators submitted approximately $19 million in false and fraudulent claims to the Department of Labor Office of Workers Compensation Program which at least approximately $17 million was paid. Over $1 million was seized from bank accounts controlled by Gilmore, the DOJ said.

According to the DOJ, Martin, the owner of medical clinics, conspired with health care providers and other individuals to pay and receive kickbacks based on Medicare reimbursements for OTC COVID-19 tests. In order to bill Medicare for the claims, Martin and his co-conspirators are alleged to have provided Medicare patient information, to which they had access, to co-conspirators without the Medicare beneficiaries’ knowledge or consent and/or notwithstanding that they had not requested any OTC COVID-19 tests, DOJ officials said in a release. In fact, as alleged in the indictment, in numerous instances the beneficiary was deceased, the release stated. Once Medicare paid the claim, Martin’s co-conspirator allegedly paid a kickback based on the reimbursement. Martin’s co-defendant, Damon Heath Roberts, previously pled guilty to conspiracy to pay or offer to pay kickbacks for referrals to a federal health care program in connection with the scheme and is awaiting sentencing.

Mohammed caused the submission of approximately $93 million in false and fraudulent claims, of which approximately $65 million was paid, including payment of approximately $13 million over a single 10-day period in 2023, DOJ officials said. Federal officials said that nearly $6 million was seized from bank accounts controlled by Mohammed.

Osukoya, the owner of Ayo Biometrics, LLC d/b/a Cambridge Diagnostics, allegedly sought out individuals with insurance plans to undergo expensive EEG testing and recruited and paid kickbacks and bribes to physicians and others to refer patients to Cambridge Diagnostics. To conceal the scheme and to make it appear that the services were necessary, Osukoya and his co-conspirators allegedly falsified diagnoses and falsely labeled kickback payments as loans, medical directorships, and consultation fees, among other things, according to the DOJ. Osukoya, through Cambridge Diagnostics, was paid over $5 million for the claims and is alleged to have paid out over $450,000 in illegal kickbacks, the DOJ release stated.

“These individuals lined their own pockets, egregiously stealing beneficiaries’ identities and pillaging the coffers of federal programs,” said Acting U.S. Attorney Nancy Larson.  “We will never tolerate this behavior and will relentlessly pursue prosecution of these offenders to the fullest extent possible. We applaud the tremendous work of our law enforcement partners in this National Takedown, whose diligent efforts dismantled layers of complex financial transactions created by these bad actors attempting to conceal their fraudulent conduct.”

As part of the nationwide takedown, the government seized over $245 million in cash, luxury vehicles, cryptocurrency, and other assets. The DOJ said it also successfully prevented over $4 billion from being paid in response to false and fraudulent claims and that it suspended or revoked the billing privileges of 205 providers in the months leading up to the takedown.