A California man with a long history of healthcare fraud was sentenced to 10 years behind bars and ordered to pay millions in restitution as well as forfeit his interest in two residential properties and one business property in Los Angeles. His wife, who will be sentenced later this month.
Imran Shams pleaded guilty to conspiracy to commit healthcare fraud and concealment of his exclusion from Medicare.
But the charges are just the tip of the iceberg.
Serial Healthcare Fraudster
According to court documents, Shams was convicted of Medicare and Medicaid fraud in separate 1990 and 2001 cases in New York and California. Each time he was excluded from participating in Medicare and all federal healthcare programs.
To be reinstated, Shams had to submit a written application. He never did, yet he continued to operate healthcare clinics in New York that billed federal healthcare programs. In November 2017, Shams pleaded guilty to conspiracy to pay and receive healthcare kickbacks and other charges in the Eastern District of New York related to his operation of these clinics.
But his illegal activity didn’t stop there.
By 2018, Shams and his wife, Lourdes Navarro owned, operated and managed a California-based clinical testing laboratory that billed Medicare and other federal healthcare programs.
Navarro too had been convicted in May 2000 of felony grand theft related to billing fraud involving the Medicare and Medi-Cal programs.
Banned From Billing
As a result of their convictions, both were banned from billing federal healthcare programs.
To get around the ban, the couple fraudulently concealed their roles with the lab and identified someone else as the sole owner and managing officer.
Between August 2018 and April 2022, when the grand jury returned the indictment in this case and Shams was arrested and ordered detained without bond, the lab had fraudulently billed Medicare approximately $234 million of which Medicare paid approximately $31.7 million based on the fraudulent claims.
COVID-19 Fraud
According to court documents, during the COVID-19 pandemic, Navarro and Shams used the lab to obtain nasal swab specimens from residents and staff at nursing homes, assisted living facilities, rehabilitation facilities, and students and staff at primary and secondary schools, for the purported purpose of conducting screening tests to identify and isolate individuals infected with COVID-19.
Obtaining those samples allowed the lab to perform more extensive respiratory pathogen panel (RPP) tests on some of the specimens, even though only COVID-19 testing had been ordered and even though there was no medical justification for conducting the more extensive tests.
The testing had been procured through the payment of illegal kickbacks and bribes to a marketer.
“On July 24, 2018, defendants Shams and Navarro met with Marketer A in Las Vegas, Nevada, and provided a contract pursuant to which Marketer A would be paid illegal kickbacks and bribes in the form of a percentage of the reimbursements received by (the lab), including from federal healthcare programs, in exchange for Marketer A arranging for specimens and doctors’ orders to be provided so (the lab) could perform laboratory tests and submit false and fraudulent claims for payment to Medicare,” the indictment reads.
The indictment says the couple laundered money through various shell companies and used the ill-gotten gains to purchase real estate, luxury items and personal goods and services.
In October 2023, Navarro pleaded guilty to conspiracy to commit healthcare fraud and wire fraud. She faces a maximum penalty of 20 years in prison.
COVID Task Force Not Letting Up
As we first wrote about in July 2020, COVID-related healthcare fraud began within months of the start of the pandemic. In May 2021, the Department of Justice launched a task force to combat fraud related to a number of COVID-19 relief programs including healthcare fraud.
Since then, hundreds of people have been arrested and charged with fraud relating to the COVID pandemic. According to an August 2023 press release, nationwide enforcement action to combat COVID-19 fraud, led to 718 enforcement actions – including federal criminal charges against 371 defendants – for offenses related to over $836 million in alleged COVID-19 fraud.
The Health Law Offices of Anthony C. Vitale represents healthcare professionals in state and federal court who are charged with fraudulent billing, illegal kickbacks, Medicare and Medicaid fraud, and false claims, among others. For more information, contact us at 305-358-4500 or email info@vitalehealthlaw.com
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