$1 million Medicare fraud scheme targeted seniors housing residents, government says
A New Jersey woman faces up to 15 years in prison and $500,000 in fines after pleading guilty Thursday to her role in a $1 million Medicare fraud scheme through which residents of affordable seniors housing complexes were convinced to submit to unnecessary genetic testing.
Sheila Kahl admitted in federal court that she wrongfully accessed protected health information and paid kickbacks to healthcare professionals while working for The Good Samaritans of America, a purported nonprofit organization that presented its mission as helping older adults navigate federal benefits programs but, according to the U.S. Attorney's Office for the District of New Jersey, actually was a front used to present information about genetic testing.
From July 2014 to December 2015, according to information from the U.S. Attorney's Office, Kahl, Seth Rehfuss and others held presentations in the community rooms of New Jersey low-income seniors housing complexes, where Rehfuss suggested to residents that they would be vulnerable to heart attacks, stroke, cancer and suicide if they did not undergo genetic testing. As part of the scheme, investigators said, Rehfuss and others often took DNA swabs of the residents, and Rehfuss then used Craigslist to recruit healthcare providers who would authorize the testing after the fact.
Kahl and Rehfuss paid the healthcare providers thousands of dollars every month to sign their names to requisition forms that often contained the seniors' personal and medical information, even though they never examined and were not involved in the seniors' care or treatment, according to case documents and court statements. To keep the scheme going, investigators said, Kahl used fraudulent email accounts to access the individually identifiable health information of the older adults, specifically the results of the DNA analysis.
The actions of Kahl, Rehfuss and others resulted in the Medicare program paying more than $1 million to two clinical laboratories, according to the U.S. Attorney's Office. Rehfuss reportedly obtained more than $100,000 and paid Kahl tens of thousands of dollars in commissions.
The scheme was active in New Jersey, but Rehfuss and others were planning to expand it to Arizona, Delaware, Georgia, Florida, Maryland, Michigan, Mississippi, Pennsylvania, South Carolina, Tennessee and Virginia, according to investigators.
Rehfuss originally was charged for his role in the scheme in December 2015.
Thursday, Kahl pleaded guilty to one count of conspiring to commit healthcare fraud, which carries a maximum potential penalty of 10 years in prison and a $250,000 fine, or twice the gross gain or loss from the offense. She also pleaded guilty to one count of conspiring to wrongfully access individually identifiable health information and pay illegal remunerations to healthcare professionals, which carries a maximum penalty of five years in prison and a $250,000 fine, or twice the gross gain or loss from the offense.
She is scheduled to be sentenced March 14.