Ghanaian doctor arrested in the USA for $23 million insurance fraud

Federal prosecutors say a prominent Tallahassee cardiovascular surgeon indicted on health-care fraud charges bilked the federal government and health insurance companies out of $23 million by submitting claims for surgeries he never performed.

Dr. Moses deGraft-Johnson, owner of the Heart and Vascular Institute of North Florida, was indicted Feb. 4 on 58 counts of health-care fraud and related charges, according to federal court documents. The indictment, issued by a federal grand jury in Tallahassee, was unsealed Thursday. 

On Friday, U.S. Magistrate Judge Charles Stampelos found that deGraft-Johnson was a flight risk and ordered him held at the Federal Detention Center in Tallahassee pending his trial, currently set for March 23. 

Assistant U.S. Attorney Andrew Grogan said that while the doctor claimed in a pretrial report to have only $200,000 in checking and savings accounts, he actually has more than a million dollars in cash assets, along with expensive pieces of jewelry and high-end vehicles. He cautioned that deGraft-Johnson, a world traveler with dual United States and Ghana citizenship, could slip out of an ankle monitor and leave the country.

“You can get enough money to hit the road,” Grogan said during a three-hour detention hearing in federal court. “That’s what we’re concerned about.”

According to the indictment, deGraft and an office assistant, Kimberly Austin, conspired to bill for vascular procedures that were never performed on patients. Austin was charged with a single count of attempt and conspiracy to commit mail fraud.

And while the indictment identified about $1.2 million in fraudulent claims, Grogan said deGraft-Johnson actually got $23 million and counting in proceeds from the scheme. If convicted, he could face 17 years or more in prison under sentencing guidelines.

His attorney, William Bubsey of Tallahassee, urged Stampelos to free him on bond and let him reside at his downtown Tallahassee condo with an ankle monitor. He noted the doctor has no criminal history or problems with drugs and alcohol and wouldn’t pose a danger to the community.

Bubsey said his client even saved the life of rapper 50 Cent when he was shot multiple times in 2000, before he became famous, and arrived at the doctor’s trauma unit in Queens.

He also tried to poke a hole in the government’s assertion about how much money deGraft-Johnson got from billing for the procedures: “That’s for a jury to decide,” he said.

Prosecutors suggested deGraft-Johnson led a lavish lifestyle with proceeds from the health-care fraud, including a high rise apartment in Manhattan, where his wife and children live, and residences in South Hampton, New York; Miami and outside Houston. He traveled abroad to Madrid, London, Ghana and China, sometimes billing for procedures on dates he was overseas.

Patients visiting the outpatient clinic often received diagnostic tests to determine whether they had heart disease, whether the procedure was medically necessary or not, according to the indictment.

Also, deGraft-Johnson — who was affiliated with Capital Regional Medical Center — and Austin billed benefit programs for much more expensive procedures of balloon angioplasty and atherectomy. He also was listed on Capital Health Plan’s provider directory, though he was later scrubbed from the website.

The indictment says he submitted fraudulent claims to CHP, Florida Blue, WellCare and Medicare. Grogan said his outpatient clinic also made cold calls to get patients treated at Capital Regional Medical Center. The calls often targeted older African-American patients; the institute scratched lawyers, doctors and people under 40 off its list.

“The defendants used deGraft-Johnson’s privileges at a local hospital to contact patients recently treated at said hospital and schedule them for medically unnecessary appointments … for purposes of subsequently billing health care benefit programs for interventional vascular procedures which were not performed,” the indictment says. 

Rachel Stiles, a spokeswoman for Capital Regional Medical Center, said deGraft-Johnson was never employed by the hospital and always acted as an independent contractor.

“Capital Regional Medical Center has had no affiliation with the Heart and Vascular Institute of North Florida,” she said in an emailed statement.

DeGraft-Johnson said in a published interview last year that he worked 120 hours a week and commuted every Monday morning from his apartment in New York City to Tallahassee, returning on Thursdays. He also said he aspired to run for president of Ghana one day, a dream his wife confirmed during testimony Friday. One of his family members served as vice president of the African nation in the early 1980s.

His wife, their young children and one of his brothers sat in the back row of the courtroom, sobbing throughout the hearing. His brother also gave tearful testimony about how deGraft-Johnson inspired him to go to medical school himself and helped him study while friends his age were partying.

“This is not in his character or this family’s character,” his brother said.

Source: tallahassee