By JOSEPH G. LARIOSA

(© 2011 Journal Group Link International)

C HICAGO (jGLi) – The Filipino immigrant accused of swindling $20 million in Medicare claims pleaded not guilty Thursday (July 7) before Northern District of Illinois Judge Charles R. Norgle, Sr. in Chicago.

Jacinto “John” Gabriel, Jr., 43, is due back in court for status hearing on Aug. 16.

A native of Dagupan City in the Philippines, Mr. Gabriel told this reporter, “I did not even know what happened during the arraignment,” which only took less-than ten minutes. He is represented by Leigh D. Roadman of Martin, Brown, Sullivan, Roadman & Hartnett, Ltd. of Chicago.

Saying that he was not able to naturalize “because I was so busy,” Gabriel will likely face deportation if he is convicted of two counts of wire fraud, two counts of healthcare fraud and 11 counts of money laundering in a 15-count indictment returned last June 29. He arrived in the U.S. in 1988.

Each count of wire fraud and money laundering carries a maximum penalty of 20 years in prison, while each count of healthcare fraud carries a maximum 10-year prison term.  Each wire fraud and healthcare fraud count carries a maximum fine of $250,000, or an alternate fine totaling twice the loss or twice the gain, whichever is greater. Each money-laundering count carries a maximum fine of $500,000.

The indictment is also seeking forfeiture of $20-million that the owner of two home healthcare outfits allegedly skimmed over five years in one of the state’s largest recipients of Medicare payments using fraudulent claims.

Gabriel owns Perpetual Home Health in suburban Oak Forest, Illinois, and Legacy Home Healthcare Services 4747 West Peterson Avenue, Suite 311, Chicago, Illinois.

FREE ON BOND

He has remained free on bond since he was arrested on preliminary charges in February.

According to the indictment, Gabriel allegedly schemed with others to submit millions of dollars in false claims for reimbursement of home healthcare services purportedly provided to Medicare beneficiaries, which alleged were never provided, were not medically necessary, or were inflated in price so that he and others could profit from the fraudulently-obtained funds.

Medicare is a federally-funded national healthcare-benefit program, which provides free or below-cost health care benefits to certain eligible individuals (“Medicare beneficiaries”), primarily individuals over the age of 65.

Medicare covers, among others, home healthcare, that is, healthcare services provided to Medicare beneficiaries suffering from illnesses or disabilities, which confined them to their homes.

Healthcare providers, including physicians and home-healthcare agencies, could apply for and obtain a Medicare provider number, enabling them to seek reimbursement for services provided to Medicare beneficiaries.

Gabriel and his co-schemers allegedly used the proceeds for various purposes, including using more than $5.5-million in cash to maintain lavish lifestyles, including gambling at casinos in Chicago area and in Las Vegas, Nevada, and to buy automobiles, jewelry and real estate in the United States and in the Philippines.

NO FORMAL MEDICAL TRAINING

To perpetuate themselves in their businesses, Gabriel and company not only paid his employees but also provided them with gifts and bribed physicians and gave kickbacks to others in exchange for patient referrals.

Gabriel, who had no formal medical training, medical degrees, nor licenses to practice as a healthcare professional, did not identify himself as an owner. But investigators led by Patrick J. Fitzgerald, United States Attorney for the Northern District of Illinois, learned Gabriel exercised ownership and control of the two home healthcare firms that had ceased operating and are no longer receiving Medicare payments.

Between May 2006 and January 2011, Perpetual submitted more than 14,000 Medicare claims seeking reimbursement for services allegedly provided to beneficiaries. As a result of those claims, Perpetual received more than $38-million in Medicare payments, making it one of the largest, if not the largest, recipients of Medicare payments for home health services in Illinois.

Between 2008 and January 2011, Legacy submitted allegedly more than 2,000 claims for Medicare reimbursement and received more than $5-million.

As part of the fraud scheme, Gabriel and his co-schemers allegedly obtained personal information of Medicare beneficiaries to bill Medicare without the beneficiaries’ knowledge or consent; created false patient files to support fraudulent Medicare claims and submitted false claims based on those records; used Medicare proceeds to pay himself, co-schemers, employees, and others who assisted him in carrying out the scheme; and concealed the fraud proceeds by directing Perpetual and Legacy to issue checks payable to fictitious entities, his friends and associates.# # #

Editor’s Note: To contact the author, please e-mail him at: (lariosa_jos@sbcglobal.net)