Health Care Fraud: Detroit Area Doctor Convicted

Health Care Fraud

This past Monday, a Detroit area doctor was given a prison sentence for health care fraud. Hussein “Sam” Awada, 46, of Royal Oak, Michigan received 7 years after being convicted in federal court.

The Federal Bureau of Investigation or FBI believes that heath care fraud is a rising threat. Let’s take a look at what health care fraud is and how this Warren, Michigan doctor committed it.

According to Cornell University, health care fraud is defined as,

“Health care fraud is a type of white-collar crime that involves the filing of dishonest health care claims in order to turn a profit.”

There are many different possible ways to commit health care fraud. Here are few examples:

  • Billing for services that were never done.
  • Billing for multiple claims for same service.
  • Adjusting medical records.
  • Employing unlicensed staff.

In the same article by Cornell University, it was reported that about 10 cents of every dollar spent on health care goes to paying for fraudulent claims.

Who is in Charge of Investigating Health Care Fraud?

The responsibility of investigating health care fraud falls to the Federal Bureau of Investigation, the office of the Inspector General, and the U.S. Postal Service. The FBI “uses coordinated initiatives, task forces and strike teams, and undercover operations to target fraud.”

Hussein “Sam” Awada’s Health Care Fraud

Hussein Awada will be facing 7 years in prison, forfeit various assets, and will have to pay $2.3 million in restitution to Blue Cross and Medicare, according to Macomb Daily. Macomb Daily also reported that “Federal agents said Awada ran a 16-month “pill mill” with another doctor to write prescriptions for 80,000 Oxycodone and Roxicodone, along with other controlled medications to be sold on the street.”

According to the Detroit News U.S. Attorney Barbara L. McQuade said the following in a statement.

“More people die from overdoses of prescription drugs in America than from overdoses of all other drugs combined. We hope that prosecuting the doctors who are putting these drugs on the streets will deter others from contributing to this epidemic.”

It was reported that “marketers” would bring the names of patients who Awada would prescribe the medications to. The marketers would then buy the pills off of the patients and sell them to street dealers.

With that patient information, Awada would submit bills to Medicare and Blue Cross for services that were either never done or weren’t medically justified.

The Detroit News reported that Awada allegedly claimed that he had put away around $20 million dollars.

Awada originally faced up to 30 years in prison. However, in a plea deal, Awada plead guilty and agreed to cooperate with investigators. Macomb Daily reported that his cooperation did not result in any further indictments.

In addition, the Macomb Daily reported that Awada also forfeited his interest in Midwest Family Medicine building, Midwest Family Practice, and Cafe Jole, $660,000 in cash, three vehicles, dozens of items from the business like computers, flat screen TVs, and X-ray machines.

Take Away

The government takes health care fraud very seriously, and anyone facing these types of charges should too. If you have been charged with health care fraud, your first step is to hire a criminal defense attorney experienced in federal courts and health care fraud.

Please call my office to learn more.

248-348-7400 or 586-530-1000