Point Pleasant Woman Pleads Guilty To Participating In $1 Million Medicare Fraud Scheme

TRENTON, N.J. – A Point Pleasant woman today admitted in U.S. federal court that she took part in a $1 million Medicare fraud scheme involving the Good Samaritans of America, U.S. Attorney Paul J. Fishman said.

Sheila Kahl, 44, pleaded guilty to one count of conspiracy to commit health care fraud and one count of conspiring to wrongfully access individually identifiable health information and illegally reimburse health care professionals, he said.

“Instead of helping seniors navigate federal benefit programs, The Good Samaritans of
America was merely a front for an elaborate Medicare scheme that subjected elderly victims to
unnecessary genetic testing, all in an effort to score commission payments from clinical labs,”
Fishman said. “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.”

The scheme involved stealing private medical information and using "callous scare tactics" aimed at convincing elderly and Medicare beneficiaries to submit to unnecessary DNA testing, said Special Agent in Charge Scott J. Lampert, of the federal Department of Health and Human Services Office of the Inspector General.

“Today’s plea resulted from joint law enforcement action to detect and block a planned multi-state expansion of this deplorable scam against the program and its enrollees," he said.

Kahl and Seth Rehfuss, 42, Somerset, used the Good Samaritans of America to gain access to low-income senior housing complexes. They claimed that the organization was a "trusted nonprofit' that helped seniors navigate federal benefits programs, Fishman said.

"In reality, The Good Samaritans of America was a front to present information about genetic testing," he said.

Rehfuss and others even advertised free ice cream to ensure attendance at the
presentations.

Rehfuss used fear-based tactics during the presentations, even telling seniors that they would be vulnerable to heart attacks, stroke, cancer and suicide if they did not have the genetic testing. Rehfuss also claimed that the genetic testing allowed for “personalized medicine.”

Rehfuss and others involved in the scheme took DNA swabs where the presentations took place or visited seniors' apartments on a different day.

"Regardless of the timing or location of the swabbing, the DNA swab was collected without the involvement of any healthcare providerand without any determination by a healthcare provider that such testing was medically necessary or appropriate, " Fishman said.

Rehfuss used Craigslist ads to recruit healthcare providers for the scheme. They then entered into contracts and the healthcare providers received requisition forms that often included a patient’s personal information, Medicare information, medication lists and diagnosis codes.

"The healthcare providers were paid thousands of dollars per month by Kahl and Rehfuss
to sign their names to requisition forms authorizing testing for patients they never examined and
were in no way involved in the patients’ care or treatment," he said.

Medicare paid more than $1 million to two clinical laboratories. Rehfuss obtained over a hundred thousand dollars and distributed commissions to Kahl of tens of thousands of dollars.

The two and others were working to expand the scheme to other states, including Georgia, Delaware,Virginia, Maryland, Pennsylvania, South Carolina, Michigan, Mississippi, Florida, Tennessee and Arizona.

The healthcare fraud conspiracy charge carries a maximum potential penalty of 10 years
in prison and a $250,000 fine, or twice the gross gain or loss from the offense. The conspiracy to
wrongfully access individually identifiable health information and to pay kickbacks charge
carries a maximum penalty of five years in prison and a $250,000 fine, or twice the gross gain or
loss from the offense.

Rehfuss was originally charged for his role in the scheme on Dec. 2, 2015. The pending
charges against Rehfuss are merely allegations, and he is considered innocent unless and until
proven guilty.
Image: Patch file photo.