UNION — On Wednesday, law enforcement agencies arrested a Union County doctor and charged him with submitting nearly $52 million in fraudulent Medicare and private insurance health care claims, Union County Prosecutor Theodore J. Romankow said.
During early morning raids, Dr. Amgad Hessein, 54, of Advanced Pain Management Specialists formerly headquartered in Union Township and currently located in Belleville, and his brother were arrested. Hessein was charged with second degree health care claims fraud and conspiracy. According to preliminary estimates, prosecutors believe that Dr. Hessein and his brother Ashraf Sami, 56, netted up to roughly $5 million through their scheme, Romankow said.
The case began in April 2009 in Union Township when Sami, an office manager at Advanced Pain Management Specialists, reported a theft by an employee to the local police department, Romankow 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 Union County Prosecutor’s Office Insurance Fraud Unit and the New York Regional office of the United States Department of Health and Human Services, Office of the Inspector General joined the investigation.
During the course of the investigation it was discovered that Advanced Pain Management Specialists billed the Medicare program nearly $52 million between January 2006 and July 2009, Romankow 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,” said Romankow. “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 Dr. Hessein submitted claims for every day of the year in 2006 and 2007 and on multiple occasions his billable hours exceeded 24-hours on many days, Romankow said.
With the proceeds of this alleged fraud, Dr. Hessein and Sami purchased oceanfront real estate in New Jersey, commercial properties and several luxury vehicles. Those properties and vehicles, including a $1.59 million home in Belmar, as well as numerous bank accounts were seized by the authorities.
Prosecutor’s Office Detective David Nechamkin and Special Agent Gene Fayer of the U.S. Department of Health and Human Services investigated the case. Union County Assistant Prosecutor Michael Sheets will prosecute the case. The Union Township Police Department, the Union County Police Department, the Monmouth County Prosecutor’s Office and the New Jersey Division of Consumer Affairs Enforcement Bureau assisted with the arrests and search warrant execution.
Sami is being held on $200,000 bail and Hessein on $300,000. Both are being lodged at the Union County Jail.
These criminal charges are mere accusations. The defendants are presumed innocent until proven guilty in a court of law.
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