Maybe He Thought There Was Still Hope

Most folks think it is pretty hard to get a doctor to make a house call these days. Apparently a Dearborn, Michigan, doctor is an exception to that rule. According to charges filed by the Justice Department against Dr. Hicham Elhorr, Dr. Elhorr was even willing to make house calls on people who were already dead.

Dr. Elhorr, 45, is a family practice doctor in Dearborn. He owns a company called House Call Physicians, and as part of his practice he makes (made) house calls on homebound patients.

According to a September 20, 2012, Department of Justice press release, Dr. Elhorr was a “leader” in a $40,000,000 scheme to fraudulently bill Medicare. A criminal complaint against Dr. Elhorr, filed in the U.S. District Court in Detroit, Michigan, was unsealed that same day.

Dr. Elhorr was arrested in mid-September, and charged with defrauding Medicare. According to the filings, Dr. Elhorr billed Medicare for home visits that either were not medically necessary, or that he never even made. According to the charges, Dr. Elhorr even submitted charges for house calls that he supposedly made while he was out of the country, or when the patient was in the hospital and not at home, or even after the person already had died.

Dr. Elhorr’s billings to Medicare were astonishing. Since January 2008, his company, House Calls Physicians billed Medicare for $9.2 million in house calls. Apparently Dr. Elhorr had help in making such a large number of house calls, but not from doctors. Dr. Elhorr is accused of billing for visits by unlicensed doctors.

House Call Physicians also referred patients to home health care, which resulted in another $30.8 million in payments from Medicare. According to the allegations, Dr. Elhorr took kickbacks from the home health companies to make the referrals. The allegations say that some of the home health care referrals were not medically necessary.

The Government executed search warrants and searched three locations. The Government also seized three bank accounts that it said were related to the scheme.

The U.S. Department of Justice, the FBI and the U.S. Department of Health & Human Services’ Office of Inspector General have all been involved in the investigation.

The articles and the press release do not say how the Justice Department learned about the fraud. I am a lawyer who represents whistleblowers who know about just this type of fraud by a medical provider against Medicare, and so it immediately occurred to me that this whole matter could have begun as a False Claims Act case filed by a whistleblower. Often allegations just like the ones in this case begin as a qui tam lawsuit filed by a whistleblower (known as a “relator”) under the False Claims Act. We do not know the answer to that question for sure yet, because thus far only a criminal case has been unsealed. The civil case that is filed by the whistleblower typically remains under seal while the criminal case proceeds first.