3 charged in Guam for $30M health care fraud

Alicia A.G. Limtiaco, United States Attorney for the Districts of Guam and the Northern Mariana Islands, announced today that the federal grand jury has indicted Clifford P. “Cliff” Shoemake, Kimberly C. “Casey” Conner, and Nicholas A. “Nick” Shoemake, on one (count of Conspiracy to Commit Health Care Fraud, 10 substantive counts of Health Care Fraud, one count of Conspiracy to Launder Monetary Instruments and Engage in Monetary Transactions, 10 substantive counts of Engaging in Monetary Transactions with Proceeds of Specified Unlawful Activity, and 21 substantive counts of Laundering of Monetary Instruments.

Cliff Shoemake and Casey Conner were part owners in Smart Energy Design, Inc., d/b/a Guam Medical Transport or GMT. Cliff Shoemake served as GMT’s president, and Conner served as its vice president. Nick Shoemake is the son of Cliff Shoemake, and served as executive assistant of GMT.

GMT was a corporation engaged in the business of providing non-emergency ambulance transportation services in Guam. Most of GMT’s business was providing routine, scheduled ambulance transportation services to and from kidney dialysis clinics for beneficiaries of federal health care benefit programs including Medicare and TriCare.

The indictment alleges that beginning in or about March 2010 and continuing through on or about March 21, 2014, the defendants caused Medicare and TriCare to make payments to GMT based on the submission of false and fraudulent claims for ambulance transportation services. During this time period, GMT submitted claims to Medicare and TriCare totaling approximately $32,735,378.03, which resulted in payments approximating $10,884,964.49.

Medicare covers ambulance transportation services only when provided to a beneficiary whose medical condition at the time of transport is such that ambulance transportation is medically necessary and reasonable. In the absence of an emergency condition, ambulance services are only covered where (a) the patient being transported could not be transported by any other means without endangering the individual’s health; or (b) the patient was before, during, and after transportation, bed-confined.

The indictment further alleges it was also part of the conspiracy that the defendants would enrich themselves by transferring and disbursing, and causing the transfer and disbursement of monies fraudulently obtained from federal health care benefit programs from GMT to themselves and others. The defendants used the proceeds of their fraudulent scheme for their own personal use in several ways, including personal travel expenses associated with vacations to Hawaii, Europe, Australia, and Alaska, payments for their personal income taxes, a down payment and closing costs associated with the purchase of a personal residence, personal utility expenses, monthly rental payments on a personal residence, monthly automobile loan payments, and credit card bills for numerous miscellaneous personal expenses. The defendants are scheduled to appear in court for an initial appearance and arraignment on Jan. 26, 2016.

This investigation was conducted by the Federal Bureau of Investigation, the United States Department of Health and Human Services Office of Inspector General, and the Internal Revenue Service, Criminal Investigations. The prosecution is being handled jointly by the United States Attorney’s Office for the District of Guam and the United States Department of Justice, Criminal Division, Fraud Section.

Members of the public are reminded that an Indictment is only a charge and is not evidence of guilt. Defendants are presumed innocent and are entitled to a fair trial at which time the government must prove guilt beyond a reasonable doubt. (PR)