Two Guyanese indicted in large-scale Medicaid fraud

Oct 03, 2019 News

NEW YORK (https://ag.ny.gov) – Attorney General Letitia James on September 17 announced the indictment and arrest of the owner of Purple Heart Transportation (“Purple Heart”), Sean Ally, 44, as well as the indictment and arrest of a driver of the company, Lissette Joza, 31, for stealing over $1 million from the New York Medicaid programme for billing fake transportation services that were never provided.

The Ozone Park, Queens transportation company was said to be headquartered here.

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 some months earlier. Shamiza Ally, the third indicted defendant, remains at large abroad.
“Medicaid fraud hits those who can least afford it the hardest,” said Attorney General 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.”
Prosecutors from the Attorney General’s Medicaid Fraud Control Unit (MFCU) outlined in court a scheme whereby the defendants, together, using a number of different techniques, billed Medicaid for transportation services that never occurred.
Medicaid reimburses transportation providers for transporting Medicaid patients to and from covered medical services.
Between late September 2017 and early May 2019, Purple Heart submitted claims to and collected from Medicaid over $29 million for allegedly providing transportation services to Medicaid patients in and around New York City.
However, prosecutors found and allege that over $19 million of that amount was for unmatched services — services for which there no corresponding bill for medical treatment for the patients who purportedly received the transportation services.
During their investigation, prosecutors uncovered a number of different techniques allegedly used by the defendants to submit 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.
As a result, according to claims data analyzed by prosecutors and outlined today 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 crowded 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. Additionally, portions 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 in an indictment unsealed in Supreme Court, Queens County with the crime of Grand Larceny in the First Degree. Each 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 additionally 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.
The charges filed in this case are accusations. The defendants are presumed innocent until proven guilty in a court of law. Grand Larceny in the First Degree and Money Laundering in the First Degree are both class “B” felonies for which the maximum state prison sentence is twenty-five years.
Offering a False Instrument for Filing in the First Degree is a class “E” felony carrying maximum prison term of 4 years. Sean Ally and Lissette Joza were arraigned this morning before the Honorable Barry Kron, Justice of the Supreme Court, Queens County.
Defendants were remanded and their cases were adjourned until tomorrow in Part K-5 Queens Supreme Court.
In conjunction with the criminal case, 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 the criminal defendants.
The asset forfeiture action and civil recovery action seeks to recover over $57 million in damages from the defendants for defrauding the State Medicaid programme.
The Attorney General thanks the New York State Department of Health, the Office of the Medicaid Inspector General, Medical Answering Services, and the New York City Taxi & Limousine Commission for their assistance and cooperation during the investigation. Additionally, the Attorney General expresses her thanks for the assistance and cooperation provided by the New York City Police Department as well as the Departments of Homeland Security and Immigration and Customs Enforcement in the apprehension of defendants Sean Alley and Lissette Joza Friday night at JFK airport.
MFCU’s investigation was conducted by Investigators Anthony Caban, Dan McCarron, Aleksandr Lipkin, and Bikens Pierre with the assistance of Supervising Investigator Ronald Lynch and Deputy Chief Investigator Kenneth Morgan.
The audit investigation was conducted by Senior Auditor Investigator Kizzy-Ann Waldropt and Auditor-Investigator Klodjan Gjegji and Kizzy-Ann Waldropt with the assistance of NYC Regional Deputy Chief Auditor Jonathan Romano and NYC Regional Chief Auditor Thomasina Smith. Also assisting in the investigation were Legal Assistants Chrisalys DeJesus and Kelvin Caraballo, and Data Scientist Si Lok Chao.
The criminal case is being prosecuted by NYC Deputy Regional Director Erin Kelsh along with Special Assistant Attorneys General Jonathan Reiner and David Arias with assistance from NYC Regional Director Christopher M. Shaw and Chief of Criminal Investigations-Downstate Thomas O’Hanlon.
The civil action was litigated by Senior Counsel Konrad Payne with the assistance of Civil Enforcement Chief Alee N. Scott and Special Assistant Attorney General Diana Elkind. MFCU is led by Director Amy Held and Assistant Deputy Attorney General Paul J. Mahoney. The Division of Criminal Justice is led by Chief Deputy Attorney General for Criminal Justice José Maldonado.