If someone you know is in denial about the magnitude of health care fraud in the United States, show them this.

The National Health Care Anti-Fraud Association estimates conservatively that health care fraud costs the nation about $68 billion annually — about 3 percent of the nation’s $2.26 trillion in health care spending. Other estimates range as high as 10 percent of annual health care expenditure, or $230 billion.

Take the cases of a Michigan doctor and his cohorts who have been recently sentenced to prison time for health care fraud worth over a quarter of a billion dollars.

Francisco Patino, M.D., 68, was sentenced to 16.5 years in prison for his role in the scheme that resulted:

●in over $250 million in false and fraudulent claims being submitted to Medicare, Medicaid, and other health insurance programs,

●exploited patients suffering from addiction by administering unnecessary injections;

●illegally distributed over 6.6 million doses of medically unnecessary opioids;

●engaged in money laundering.

Considerable evidence amassed during a years-long investigation, including testimonies from witnesses that Patino allegedly traded drugs for sex with a stripper, hid profits from the illegal scheme, kept $50,000 in cash under a mattress and allegations of domestic violence, including one claim he ripped out his ill, 80-pound ex-wife’s feeding tube.

“This defendant exploited vulnerable patients struggling with addiction by overprescribing highly dangerous opioid pills and exposing them to unnecessary and sometimes painful injections,” said Assistant Attorney General Kenneth A. Polite, Jr. of the Justice Department’s Criminal Division.

Patino was convicted at his 2021 trial in the Eastern District of Michigan and joins 21 other defendants who were previously sentenced for participating in the same scheme. 

According to court documents and evidence at trial:

●Patino owned multiple medical practices and clinical laboratories in Michigan.

●He played a critical role in developing and implementing a “shots-for-pills” protocol at several pain clinics, whereby patients were required to receive unnecessary back injections in exchange for prescriptions of dangerous and high doses of medically unnecessary and addictive opioids. 

● He excessively prescribed highly addictive opioids to his patients.

●In exchange for opioids, these patients would receive – or be billed as if they had received – facet joint or nerve block injections, both lucrative spinal injections.  Although these spinal injections were purportedly intended to treat chronic pain, Patino injected the patients without regard to medical necessity.

●Evidence also revealed that if patients refused to accept the injections, Patino would withhold their prescriptions for opioids.

●From January 2012 through July 2017, Patino billed Medicare for more of these injections than any other provider in the country.

●In 2016 and 2017, Patino prescribed more 30-milligram Oxycodone pills than any other provider in Michigan.

●Patino also developed an illegal kickback relationship with at least one diagnostic laboratory, from which he was paid in exchange for referring his patients’ samples to that lab.

●Patino was aware that his ownership structure and kickbacks violated the law and authored emails acknowledging that such ownership constituted a “violation of the Stark and Anti-Kickback laws,” and attempted to conceal and disguise the ownership structure and scheme in order to keep himself “out of Federal Prison & having all our assets seized.”

The evidence showed that Patino:

•laundered the proceeds of the scheme to falsely portray himself as a legitimate doctor through the publication of a diet book and plan described as the “next Atkins,”

• paid-for appearances on a nationally syndicated television show,

•paid for the sponsorship of boxers, cagefighters, and prominent Ultimate Fighting Championship World Champions and Hall of Famers.

Patino also spent funds he derived from these various schemes on luxury jewelry, cars, and international vacations.

Between the medically unnecessary spinal injections and kickback-induced laboratory testing, Patino was responsible for over $120 million worth of fraudulent bills submitted to insurers for payment.

Additionally, Patino pioneered the shots-for-pills protocol while working with CEO Mashiyat Rashid of the Tri-County Wellness Group of medical providers in Michigan and Ohio.

In 2018, Rashid pleaded guilty to conspiracy to commit health care fraud and wire fraud and money laundering and was sentenced to 15 years in prison on March 3, 2021.

Others convicted at trial or by guilty plea include 12 other physicians who were trained in Patino’s protocols, along with many non-physician defendants who participated in the conspiracy. 

The five other defendants most recently sentenced for their part in this scheme include:

• Yasser Mozeb, 40, of Hamtramck, Michigan, the office manager of the Tri-County clinics, was sentenced to five years in prison and ordered to pay over $46 million in restitution following his guilty plea to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and pay and receive illegal kickbacks and bribes.

• Kashif Rasool, 47, of Troy, Michigan, a physician, was sentenced to 32 months in prison and ordered to pay nearly $2 million in restitution following his guilty plea to one count of conspiracy to commit health care fraud.

• Tariq Siddiqi, 45, of Sterling Heights, Michigan, a physical therapist and home health owner, was  sentenced to 30 months in prison and ordered to pay over $880,000 in restitution following his guilty plea to one count of health care fraud conspiracy in connection with his payment of illegal kickbacks for the referral of patients from the clinics for medically unnecessary home health services.

• Tasadaq Ali Ahmad, 55, of Canton, Michigan, the owner of a home health agency, was sentenced to 58 months in prison and ordered to pay over $20 million in restitution following his guilty plea to one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and pay and receive kickbacks.

• Stephanie Borgula, 42, of Livonia, Michigan, a licensed physical therapist, was sentenced to 15 months in prison and ordered to pay over $825,000 in restitution following her guilty plea to one count of conspiracy to commit health care fraud.

Top 10 Health Fraud Schemes

1. Billing for services not rendered.
2. Billing for a non-covered service as a covered service.
3. Misrepresenting dates of service.
4. Misrepresenting locations of service.
5. Misrepresenting provider of service.
6. Waiving of deductibles and/or co-payments.
7. Incorrect reporting of diagnoses or procedures (includes unbundling).
8. Overutilization of services.
9. Corruption (kickbacks and bribery).
10. False or unnecessary issuance of prescription drugs.

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