FBI: Bensalem Resident Involved in $9M Health Care Fraud Scheme

A Bensalem resident is one of five nurses charged in a health care fraud conspiracy that resulted in more than $9 million in fraudulent Medicare charges, according to the Philadelphia Division of the Federal Bureau of Investigation.

According to an indictment unsealed today, Alexsandr Koptyakov, 39, of Bensalem worked at Home Care Hospice Inc. (HCH), a hospice care provider in Philadelphia, which allegedly authorized and supervised the admission of ineligible patients for services. 

Philadelphia resident Patricia McGill, 64, served as the director of professional services for HCH. McGill and Goltman, along with Natalya Shvets, 42, of Southhampton, Giorgi Oqroshidze, 36, of Philadelphia and Yevgeniya Goltman, 42, of Newtown, have been charged with one count of conspiracy to commit health care fraud and numerous counts of health care fraud.

Between January 2005 and December 2008, the indictment said approximately $9.3 million in fraudulent claims authorized by McGill were submitted to Medicare. Shvets, Oqroshidze, Goltman, and Koptyakov created fraudulent nursing notes for approximately 150 patients indicating hospice services were provided when in reality they were not, according to the indictment.

McGill allegedly authorized nursing staff, including her co-defendants, to fabricate and falsify documents for patients who were ineligible or to reflect a higher, more costly level of care than was actually provided to the patients.

All five defendants were arrested this morning.

HCH, a for-profit business on Grant Avenue in Philadelphia, was co-owned by Matthew Kolodesh, who is charged separately. HCH provided hospice services for patients at nursing homes, hospitals, and private residences.

In February 2007, HCH was notified that it was subject to a claims review audit, according to the indictment. In anticipation of this audit, McGill assisted the hospice director in reviewing patient charts, sanctioning false documentation by the nursing staff and authorizing the alteration of charts, the indictment said.

In September 2007, HCH was notified that it had exceeded its cap for Medicare reimbursement and would have to repay $2.63 million to the government program.

At that point, the hospice director and McGill allegedly directed staff to review patient files and discharge hospice patients, resulting in a mass discharge of patients. In October 2007, 79 hospice patients were discharged and a total of 128 were discharged by January 2008. Some of those patients had been ineligible for hospice or inappropriately maintained on hospice service in excess of six months, according to the indictment.

Some of the patients discharged were shifted to another hospice business owned by Kolodesh. In the spring of 2008, approximately 20 percent of the discharged patients were placed back on hospice service at HCH with McGill’s knowledge, according to the indictment.

If convicted of all charges, McGill faces a potential advisory sentencing guideline range of 108 to 135 months in prison, a fine of up to $150,000 and a $1,400 special assessment.

Shvets, Goltman, and Koptykov each face a potential advisory sentencing guideline range of 27 to 33 months in prison, a fine of up to $60,000 and an $800 special assessment. Oqroshidze faces a potential advisory sentencing guideline range of 21 to 27 months in prison, a fine of up to $50,000 and a $700 special assessment.

The case was investigated by the Federal Bureau of Investigation and the Department of Health and Human Services-Office of Inspector General. It is being prosecuted by Assistant United States Attorney Suzanne B. Ercole and Trial Attorney Margaret Vierbuchen of the Organized Crime and Gang Section in the Justice Department’s Criminal Division.