Point Pleasant woman pleads guilty in Medicare fraud investigation
A Point Pleasant woman risks up to 10 years in prison for the more grievous of two federal charges tied to what federal prosecutors describe as a million-dollar Mediare scam in the Garden State that was poised to go national.
Before a judge in Trenton, Sheila Kahl, 44, pleaded guilty to one count of conspiring to commit health care fraud, and one count of conspiring to wrongfully access individually identifiable health information and pay illegal remunerations to health care professionals. She has a March 14, 2017 sentencing date.
The investigation focuses on DNA tests administered to seniors, unnecessarily, under the guise of a bogus non-profit organization labeled The Good Samaritans of America, according to New Jersey U.S. Attorney Paul J. Fishman.
The goal, Fishman said, was to get commission payments from clinical labs through more than $1,000,000 paid out by Medicare.
"In addition to wrongfully accessing the victims' private medical information for personal gain, Kahl helped pay healthcare professionals thousands of dollars in kickbacks to fraudulently authorize the tests," Fishman said in prepared remarks.
Investigators, examining the case from July 2014 thorugh December 2015, contended that the defendants planned to expand into Georgia, Delaware, Virginia, Maryland, Pennsylvania, South Carolina, Michigan, Mississippi, Florida, Tennessee and Arizona.
At the center of the probe is Seth Rehfuss, 42, of Somerset, charged in December 2015. He, Kahl and others allegedly gained access to low-income senior housing complexes under the Good Samaritans banner, claiming to be an organization to help elderly people engage in federal benefit programs.
Investigators cited advertisements that Rehfuss and others allegedly authorized, offering free ice cream to attendees of their clinics.
Rehfuss, authorities said, used fear as a prime motivator, suggesting to seniors that genetic tests would leave them less vulnerable to heart attacks, stroke, cancer and suicide, and offering the tests as a route to "personalized medicine."
The defendants took DNA swabs at presentations, or arranged for re-visits, with no participation by actual health care providers, and without determinations by licensed professionals that the tests had medical value, authorities said.
To obtain a cover of authorization, Rehfuss allegedly recruited health care providers through Craigslist, contracted them with The Good Samaritans of America, and sent them requisition forms that oten included personal patient data, Medicare records, medication regimens and diagnosis codes, investigators said.
Refuss and Kahl allegedly paid the health care professionals thousand of dollars each month for their signatures on forms authorizing tests for patients they never examined, and used fake e-mail accounts to access DNA results and health information of individual seniors.
Medicare issued payments to the labs. Rehfuss allegedly received more than $100,000, and paid Kahl tens of thousands of dollars in commissions.
The possible sentence for the healthcare fraud conspriacy charge is up to 10 years, plus a fine as high as $250,000. The wrongful-access charge carries a maximum five-year sentence as well as a $250,000 fine.
Charges are accusations. Defendants are presumed innocent unless, and until, found guilty in a court of law.