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, said Prosecutor Theodore J. Romankow.
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 2nd Degree Health Care Claims Fraud and Conspiracy. It is preliminarily estimated that Dr. Hessein and his brother Ashraf Sami, 56, netted up to roughly $5 million through their scheme, said Romankow.
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, said Romankow. 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," said Romankow.
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, said Romankow.
"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, said Romankow.
With the proceeds of this fraud, Dr. Hessein and Ashraf 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, N.J., as well as numerous bank accounts were seized by the authorities.
Sami is being held on $200,000 bail and Hessein on $300,000. Both are being lodged at the Union County Jail.