Detroit-area residents Carlos Grana and Dwight Armstrong have pled guilty to Medicare fraud, according to the Departments of Justice and Health and Human Services.
Grana and Armstrong each pled guilty to one count of conspiracy to commit healthcare fraud before U.S. District Court Judge Lawrence P. Zatkoff. Each faces a maximum penalty of 10 years in prison and a $250,000 fine.
Court documents show that Grana managed the day-to-day operations of Careplus LLC, a medical clinic in Livonia, Mich. He admitted that he paid patient recruiters for Medicare beneficiary referrals. Recruiters found and transported Medicare beneficiaries to Careplus and Grana paid them $100 to $150 per patient referral, and instructed the recruiters to pay the patients $50 from that amount.
In exchange for the payments, investigators said, Grana and others expected the Medicare beneficiaries to undergo a medical examination and medically unnecessary tests.
Between February 2008 and October 2009, Grana and others submitted approximately $2.2 million in fraudulent claims to the Medicare program. Medicare paid approximately $2 million of those claims.
Armstrong was one of the patient recruiters for Careplus. He said he instructed his recruits, based on directions from the owners and operators of Careplus, to claim they had certain symptoms to trigger medically unnecessary tests.
According to investigators, Armstrong's recruits generated approximately 12 percent of the amount fraudulently billed by Careplus to the Medicare program, or approximately $342,000 in claims. Medicare paid approximately $250,000 on those claims.