USA: Doctor Charged in $52 Million Medicare Fraud Case

A Union County doctor is being accused of submitting nearly $52 million in fraudulent Medicare and private insurance health care claims, the Union County Prosecutor's Office announced Thursday.

Dr. Amgad Hessein, 54, was arrested early Wednesday, Prosecutor Theodore J. Romankow said. Hessein's practice, Advanced Pain Management Specialists, formerly was headquartered in Union Township and currently is located in Belleville.

Hessein was charged with second-degree health care claims fraud and conspiracy.

Authorities estimated that Hessein and his brother, Ashraf Sami, 56, netted roughly $5 million through their scheme. Sami also was arrested Wednesday and is facing criminal charges.

The case began in April 2009 in when Sami, an office manager at Hessein's practice, reported a theft by an employee to the local police department, authorities said. During that investigation by Union Township Police Department Detective William Fuentes, "it became clear that Dr. Hessein and Advanced Pain Management Specialists were involved in a scheme of overbilling, upcoding and submitting fraudulent claims for treatments not rendered," Romankow said.

The prosecutor's office Insurance Fraud Unit and the New York Regional office of the U.S. Department of Health and Human Services' Office of the Inspector General joined the investigation. During the course of the probe it was discovered that Advanced Pain Management Specialists billed the federal Medicare program nearly $52 million between January 2006 and July 2009, authorities said.

"Bank records revealed that the doctor had billed for treatments for which he did not have the equipment to perform, would bill patients for higher level, more costly treatments than were actually performed, and would bill for visits when patients were not even in the office," Romankow said.

"Most brazenly, on many occasions the doctor billed for treatments that he allegedly performed in his office while he was actually out of the country."
The investigation revealed that Hessein submitted claims for every day of the year in 2006 and 2007, and on multiple occasions his billable hours exceeded 24 hours some days, authorities said.

With the proceeds of the fraud, Hessein and Sami purchased oceanfront real estate in New Jersey, commercial properties and several luxury vehicles, according to the prosecutor's office. Those properties and vehicles, including a $1.59 million home in Belmar, as well as numerous bank accounts were seized by authorities.

Sami is being held on $200,000 bail and Hessein on $300,000. Both are being lodged at the Union County Jail, authorities said.