HOUSTON – A Houston federal jury has returned guilty verdicts against four defendants on all counts as charged in a $6 million fraudulent Medicare billing scheme, announced U.S. Attorney Kenneth Magidson. Giam Nguyen, D.O., 46, of Houston, Benjamin Martinez, M.D., 35, of Dallas, Donovan Simmons, M.D., 43 of Austin, and Anna Bagoumian, 43 of Glendale, California, were convicted late yesterday following an eight-day trial and approximately 13 hours of deliberation.
The scheme involved fraudulent billing for diagnostic testing done at three different clinics from September 2008 to May 2010. Patients were paid to come to the clinics and the clinics then billed for tests that were either not performed or not medically necessary.
Zavan Pogosyan, 38, of Glendale, California, managed three clinics in Houston located at 2110 Jefferson Street, 6892 Southwest Freeway and 2112 Pease. He hired Nguyen, who was the only doctor working at the clinics, according to testimony. Pogosyan hired Martinez and Simmons to travel to Houston once a month to review patient files at the clinic located on Pease Street.
Patients were brought to the clinics by recruiters/marketers like Frank Montgomery, 66, of Houston, who were paid by the clinics for each patient they delivered. Seryan Mirzakhanyan, 40, Edvard Shakhbazyan, 32, both of Glendale, California, paid the marketers for the patients as did Pogosyan and Bagoumian.
Mirzakhanyan and Montgomery testified about receiving the cash payments. The court also heard that Bagoumian participated in shredding all of the patient and business records of the Jefferson clinic.
Some of the Medicare beneficiaries also testified as to being paid approximately $100 to go to the clinics. They had primary care physicians, but they reported that they were not referred to the clinics by their physicians nor did they receive any of the test results.
A law enforcement agent told the jury he reviewed patient files seized during the searches of the Pease and Southwest Freeway clinics and reported that 730 of the 1229 patients reported their chief complaint as back pain. Nevertheless, those patients were given ultrasounds of their kidneys, abdomens, thyroids, carotid arteries as well as allergy tests and anorectal tests. His testimony also revealed that not one of the files contained a plan of treatment or any indication that the test results were discussed with the patient.
Further, an expert witness told the jury that the anorectal manometry and EMG of the anal or urethral sphincter test results in the patient files were physiologically impossible and therefore could not have been done. He also said there was no medical justification in any of the files to do either of the tests.
The court also heard that Simmons had admitted being paid $40,000 for reviewing 20-30 patient files in less than four hours. Bagoumian received checks totaling $183,000 and cashed every one of them, according to testimony.
Mirzakhanyan, Pogosyan, Shakhbazyan and Montgomery pleaded guilty prior to trial and await sentencing.
Simmons and Bagoumian were found guilty of conspiracy to defraud Medicare, while all four were convicted of health care fraud. Nguyen, Martinez and Simmons were also found guilty of money laundering. Each of these convictions carry a maximum 10-year prison sentence. The jury convicted Bagoumian of conspiracy to pay and receive kickbacks for which she faces another five years in prison.
U.S. District Judge Lynn N. Hughes presided over the trial and has set sentencing for Oct. 3, 2016.
Multiple agencies conducted the investigation to include The Texas Attorney General’s Office – Medicaid Fraud Control Unit, IRS – Criminal Investigation, FBI, Department of Health and Human Services – Office of Inspector General. Assistant U.S. Attorney (AUSA) Al Balboni and Special AUSA Rodolfo Ramirez prosecuting the case.