State Initiates False Claims Act Lawsuit against Norwalk Family Practitioner over Medicaid Fraud Allegations
released on July 13, 2017
found in newsletter: June & July 2017
The state has initiated a False Claims Act lawsuit alleging that a Norwalk-based family practitioner engaged in a pervasive and illegal scheme to defraud Connecticut’s Medicaid program by submitting false claims for services never provided, Attorney General George Jepsen and state Department of Social Services (DSS) Commissioner Roderick L. Bremby said today.
The state alleges that, from November 2013 until at least October 2016, Dr. Ramil Mansourov and his company, Ramil Mansourov, LLC, billed Connecticut’s Medicaid program – the Connecticut Medical Assistance Program (CMAP) – for millions in services that were never provided to his Medicaid patients and further defrauded the program by falsifying his income information in order to obtain Medicaid benefits for himself and his children.
“The audacity of the alleged fraudulent conduct in this case is astounding,” said Attorney General Jepsen. “In one case, this provider billed Medicaid for at least 500 visits to a particular patient that never happened, receiving $80,000 in taxpayer dollars for services never rendered, and at the same time, sought to receive Medicaid benefits himself. This sort of egregious fraud will not be tolerated, and we will hold accountable those who seek to engage in this sort of conduct.”
Commissioner Bremby said, “Enforcement under the False Claims Act is joining criminal charges against this provider, who is accused of especially flagrant violations against the Medicaid program. While this scenario does not represent providers as a whole, it indicates the critical importance of state and federal anti-fraud investigations to uproot and take appropriate action against outliers. I join Attorney General Jepsen in thanking our state and federal partners and their dedicated staff for outstanding work with DSS staff in this and other cases where taxpayers’ interests must be protected.”
Today’s state False Claims Act enforcement action is made in coordination with federal criminal charges filed by the U.S. Attorney for the District of Connecticut. Dr. Mansourov has been charged by federal criminal complaint with federal money laundering charges related to the allegations of healthcare fraud and is currently being sought by law enforcement. The criminal charges are only allegations and not evidence of guilt; a defendant is presumed innocent unless and until proven guilty beyond a reasonable doubt.
The Office of the Attorney General commenced an investigation after a referral from the state Department of Public Health (DPH) in the spring of 2016. The investigation was conducted with the assistance of the DSS Office of Quality Assurance and in coordination with the Office of the Connecticut U. S. Attorney and the U.S. Drug Enforcement Administration. DSS is the administering state agency for Connecticut’s Medicaid program.
Dr. Mansourov, a resident of Darien, is a licensed physician who operated a walk-in medical practice in Norwalk known as the Family Health Urgent Care Center, Inc. Through his billing company, Ramil Mansourov, LLC, Dr. Mansourov submitted claims to CMAP for services purportedly provided to Medicaid patients by both himself and other providers at the Family Health Urgent Care Center. All but a small fraction of these claims were for services purportedly provided by Dr. Mansourov.
The state alleges that Dr. Mansourov fabricated thousands of claims for services he purported to have provided but, in fact, never rendered. He claimed to have provided services not only at the Family Health Urgent Care Center, but also at patient residences and long-term care facilities in the state. During the relevant time period, the DSS reimbursed the defendants a total of at least $5.2 million for CMAP claims.
On many of the dates when services were purportedly rendered, the state alleges that Dr. Mansourov was actually working at various urgent care centers in Kentucky or was vacationing in Florida or out of the country. On other dates of service, the Medicaid recipients were in-patients admitted at acute care hospitals and, therefore, could not have been seen by Dr. Mansourov at his office, their residences or in long-term care facilities, the state alleges. In some instances, Dr. Mansourov billed Medicaid for hundreds of visits with particular Medicaid beneficiaries that simply did not happen, the state alleges, and the doctor provided falsified medical records to DSS auditors and investigators in an attempt to conceal the fraudulent activity.
The state has also alleged that Dr. Mansourov knowingly misrepresented his income – at a time when he was receiving millions in fraudulent CMAP reimbursements – on application forms to enroll himself and his two minor children as Medicaid beneficiaries, resulting in further false claims for reimbursement for their care through the CMAP.
The Attorney General and Commissioner Bremby thanked the DPH Facility Licensing & Investigation Section, U.S. Attorney Deirdre Daly and her staff and the DEA’s New Haven District Office Tactical Diversion Squad for their continued coordination on this matter.
Today’s action is part of a larger effort by the State of Connecticut’s Interagency Fraud Task Force, which was created in July 2013 to wage a coordinated and proactive effort to investigate and prosecute healthcare fraud directed at state healthcare and human service programs. The task force includes a number of Connecticut agencies and works with federal counterparts in the U.S. Attorney’s Office and the U.S. Health and Human Services, Office of Inspector General – Office of Investigations. For more information, please visit www.fightfraud.ct.gov.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Antitrust and Government Program Fraud Department at 860-808-5040 or by email at email@example.com; the Medicaid Fraud Control Unit in the Office of the Chief State’s Attorney at 860-258-5986 or by email at firstname.lastname@example.org; or the Department of Social Services fraud reporting hotline at 1-800-842-2155, online at www.ct.gov/dss/reportingfraud, or by email to email@example.com.
Forensic Fraud Examiner Kevin Jeffko, Legal Investigators Peter Harrington and Thomas Martin, Paralegal Holly MacDonald and Assistant Attorneys General Richard Porter and Michael Cole, chief of the Antitrust and Government Program Fraud Department, are assisting the Attorney General with this matter.
Please click here to view a copy of the state’s False Claims complaint.
Original Press Release