TRENTON
- Attorney General Anne Milgram and Criminal
Justice Director Deborah L. Gramiccioni announced
that an Atlantic County surgeon, his office
manager, and the treatment center he owned
were indicted on charges they defrauded Medicare,
Medicaid and private insurance carriers of
more than $8.5 million.
According to Acting Insurance
Fraud Prosecutor Riza Dagli, Dr. Khashayar
Salartash, 42, of Linwood; his office manager,
Farah Iranipour Houtan, 51, of Egg Harbor
Township; and the treatment center owned by
Salartash, The Center for Lymphatic Disorders
LLC, were variously charged in a state grand
jury indictment returned yesterday with second-degree
conspiracy, three counts of second-degree
health care claims fraud, and two counts of
third-degree Medicaid fraud. Salartash and
Houtan were also charged with second-degree
misconduct by a corporate official.
According to Gramiccioni,
the indictment alleges that between August
2002 and June 2007, Salartash and Houtan billed
Medicare, Medicaid and private insurers for
services that were not provided as claimed.
“We charge that these
defendants collected $8.5 million through
false billing, including nearly $5 million
from Medicare and half a million dollars from
Medicaid,” said Attorney General Milgram.
“It’s outrageous that a doctor
would fraudulently take millions of dollars
from programs that pay for medical care for
the elderly and those who can’t afford
health insurance. In addition, by defrauding
private insurers, he contributed to the high
cost of health insurance.”
The Center for Lymphatic Disorders
was opened by Salartash on Central Avenue
in Egg Harbor Township in August 2002 to treat
patients with lymphedema, which is blockage
of the lymph vessels that causes accumulation
of fluid and swelling of the arms or legs,
and occasionally other parts of the body.
Before it closed in 2006, the center opened
four additional offices in Atlantic City,
Manahawkin, Haddon Heights, and Galloway Township.
As a result of alleged fraudulent
billing, the Center for Lymphatic Disorders
was paid approximately $8,564,622, including
$593,363 by Medicaid, $4,703,935 by Medicare,
and $3,267,324 by private carriers.
The defendants allegedly submitted
claims as though Salartash had either personally
provided services or directly supervised licensed
personnel who rendered services. In fact,
services were performed by a physical therapist,
a licenced practical nurse or a massage therapist,
with essentially no supervision.
In addition, Salartash and
Houtan allegedly billed for surgery when only
physical therapy services were rendered. Salartash
allegedly represented in some claims that
services were performed in an outpatient hospital
facility, when the procedures were performed
in a doctor’s office.
In order to support the claims, Salartash
certified that the services provided were
medically necessary, even though the services
were provided for a time period far in excess
of what is normal and customary for lymphedema
therapy. A normal course of treatment for
lymphedema is four weeks, or in very complex
cases, eight to 12 weeks. However, an auditor
for the Medicaid program determined that most
patients of the Center for Lymphatic Disorders
were treated for between 1 ½ years
and nearly 3 years.
Salartash and Houtan allegedly
used inappropriate modifiers to billing codes
to bill for multiple procedures within a short
amount of time, and made written and verbal
misrepresentations to Medicare, Medicaid and
private insurance carriers in order to support
claims for payment.
The joint investigation into this matter was
conducted by the Medicaid Fraud Control Unit
of the Office of Insurance Fraud Prosecutor,
the Office of Inspector General of the U.S.
Department of Health and Human Services, and
the Federal Bureau of Investigation. The investigation
started after analysts contracted by Medicare
to monitor billing identified unusual billing
by Salartash.
“This is an outstanding
example of state and federal authorities working
together, with assistance from the insurance
industry, to investigate a complex, multi-million
dollar fraud,” said Director Gramiccioni.
“We will continue to dedicate the resources
necessary to uncover this type of fraud, which
costs the Medicare and Medicaid programs and
the private insurance industry millions of
dollars each year in New Jersey.”
The late Sgt. Daniel O’Keefe,
Detective Anthony Butler, Analysts James Reilly,
B’leia Williams and Bethany Schussler,
Auditor Kim Geis, Legal Assistant Mona Patel,
Deputy Attorney General Sherry L. Wilson,
and Deputy Attorney General William Hoyman
Jr. were assigned to the investigation. Deputy
Attorneys General Wilson and Hoyman presented
the case to the state grand jury. Assisting
in the investigation were Special State Investigators
John Vella of the Office of Inspector General
of the U.S. Department of Health and Human
Services Office and Daniel Gilmore of the
FBI. Attorney General Milgram
Attorney General Milgram also
thanked the following private insurance carriers
for providing information in the investigation:
Horizon Blue Cross Blue Shield; AETNA; AmeriHealth/Keystone
East; Atlanticare; Qualcare; High Point; New
Jersey Manufacturers; Union Local 164 IBEW;
UFCW Local 152; Tricare; Procurs (Magnacare);
Beechstreet; BC/BS Federal Employee Health
Benefit Plan (FEHBP); AETNA (FEHBP); Government
Employees Hospital Association; Special Agents
Mutual Benefit Association; American Postal
Workers Union (FEHBP); Mail Handlers (FEHBP);
Oxford; CIGNA; Atlantic Mutual Insurance;
Allstate PIP; NJ CURE PIP; New Jersey Skylands;
and Liberty Mutual.
“When doctors commit
fraud it is particularly disturbing, because
the integrity of the health care claims process
depends on the trustworthiness of the licensed
professionals involved,” said Acting
Insurance Fraud Prosecutor Dagli. “The
Office of Insurance Fraud Prosecutor will
continue to vigorously investigate and prosecute
this type of criminal activity.”
Second-degree crimes carry
a maximum sentence of 10 years in state prison
and a $150,000 fine, while third-degree crimes
carry a maximum sentence of five years in
prison and a $15,000 fine. Third-degree Medicaid
fraud carries a sentence of up to three years
in prison and a $10,000 fine.
The
indictment
is merely an accusation and the defendants
are presumed innocent until proven guilty.
The indictment was handed
up to Superior Court Judge Maria Marinari
Sypek in Mercer County, who assigned the case
to Atlantic County, where the defendants will
be ordered to appear in court at a later date
to answer the charges.
The Medicaid Program is funded
by the state and federal governments. The
State of New Jersey administers the Medicaid
Program through the Division of Medical Assistance
and Health Services and through the Office
of Insurance Fraud Prosecutor’s Medicaid
Fraud Control Unit, which investigates both
criminal and civil Medicaid fraud and abuse
in that program.
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