Guyanese charged with Medicaid fraud in New York
New York Attorney General Letitia James on September 17 announced the indictment and arrest of the owner of Purple Heart Transportation (“Purple Heart”), Guyanese Sean Ally, 44, as well as the indictment and arrest of a driver of the company, Lissette Joza, 31, for stealing over US$1 million from the New York Medicaid programme for billing fake transportation services that were never provided.
A release from James’ s office said that Ally and Joza were arrested upon their arrival at JFK airport from Guyana. Both defendants as well as a third indicted defendant, Shamiza Ally, fled the United States months earlier. Shamiza Ally, the third indicted defendant, remains at large overseas.
“Medicaid fraud hits those who can least afford it the hardest,” said James. “My office will not allow those who are driven by greed to corrupt a system that is designed to support the health and wellbeing of our most vulnerable. We will continue to hold accountable health care providers who forsake their responsibility to their patients and our society, and chose to instead line their pockets”, she added according to the release.
Prosecutors from the Attorney General’s Medicaid Fraud Control Unit (MFCU) set out in court a scheme whereby the defendants, using a number of different techniques, billed Medicaid for transportation services that never occurred. Medicaid repays transportation providers for transporting Medicaid patients to and from covered medical services. Between late September 2017 and early May 2019, the release said that Purple Heart submitted claims to and collected from Medicaid over US$29 million for allegedly providing transportation services to Medicaid patients in and around New York City. However, prosecutors allege that over US$19 million of that amount was for unmatched services — services for which there no corresponding bill for medical treatment for the patients who supposedly received the transportation services.
During their investigation, the release said that prosecutors uncovered a number of different techniques allegedly used by the defendants to tender claims to Medicaid for fake trips.
“For example, prosecutors assert that the defendants allegedly paid numerous Medicaid patients a weekly kickback to use their Medicaid identification numbers so that they could then bill for non-existent transportation services in the name of these patients. New York State law strictly prohibits all medical providers, including transportation companies, from paying or offering to pay cash kickbacks to anyone in return for the referral of medical services ultimately paid for by Medicaid”, the release said.
As a result, according to claims data evaluated by prosecutors and presented in court, Purple Heart billed Medicaid for fake transportation services supposedly provided to dozens of patients daily by numerous drivers, who Purple Heart claimed repeatedly drove upwards of a thousand miles a day in and around New York City’s highways and city streets. Large sums of that money were then purportedly funneled through bank accounts to the individual defendants and to defendants Heart Holdings, Inc. and SA & SB Enterprises, LLC, both of which are shell companies controlled by several of the defendants, the release said. Additionally, sums of the money were then allegedly used by several defendants to make multiple real estate purchases, while further sums were transferred out of the United States.
Sean Ally and Shamiza Ally, along with Purple Heart, were charged via an indictment unsealed in Supreme Court, Queens County with the crime of Grand Larceny in the First Degree. Each defendant was also charged along with Lissette Joza and the two suspected shell companies, Heart Holdings, Inc. and SA & SB Enterprises, LLC, with one count of Money Laundering in the First Degree. Sean Ally, Shamiza Ally, and Purple Heart were further charged with a second count of Money Laundering in the First Degree. Finally, Sean Ally was charged with two counts of Offering a False Instrument for Filing in the First Degree.
Along with the criminal case, the release said that the Attorney General also obtained court orders to restrain the assets of the criminal defendants Sean Ally, Lissette Joza, Shamiza Ally, Purple Heart, SA & SB Enterprises, LLC, and Heart Holdings Corp., and filed a civil asset forfeiture and New York State False Claims Act action against them. The asset forfeiture action and civil recovery action seeks to recover over US$57 million in damages from the defendants for defrauding the State Medicaid program.
