Dallas-Based Home Health Company Owners and Nurses Charged for Roles in Alleged Medicare Fraud for Home Health Over 8 Year Period
On December 22, 2015, theco-owners of a home health company in Dallas and two nurse employees werecharged in an indictment for their alleged participation ina health care fraud case involving alleged fraudulent claims for homehealth services.
The government alleges that the billing at issue was $13.4 million to Medicare and Medicaid. It is also alleged that there were some payments to recruiters and that some of the services were performed were medically unnecessary.
PatienceOkoroji and Usani Ewah are alleged toco-own Timely Home Health Services Inc. (Timely).Kingsley Nwanguma LVN and Joy Ogwuegbu RN are alleged to have worked for Timely. Each of these four individuals of Texas were each charged withone count of conspiracy to commit health care fraud and each were charged with three or more counts of health care fraud.An Indictment is not evidence and all persons charged are presumed innocentunless and until proven guilty beyond a reasonable doubt in a court of law.Theindictment alleges that from approximately January 2007 to September 2015, thedefendants conspired to defraud Medicare by causing the submission andconcealment of false and fraudulent claimsfor home health servicesin the amount of$13,434,550.
According to theallegations, Okoroji and Ewah would in some cases pay recruiters, includingNwanguma, to recruit beneficiaries for home health services, regardless ofwhether the beneficiaries needed home health care. The government contends that Okoroji, Ewah andOgwuegbu allegedly prepared or caused to be prepared fraudulent Medicaredocuments that made it appear that the beneficiaries qualified for home healthservices. These documents were used by doctors to certify Medicarebeneficiaries for home health care. Attorney Commentary – Ethnic Community Issue:This is the latest case involving immigrants (naturalized citizens) involved in home health care fraud with hundreds of investigations in Dallas alone since 2012. Other cities such as Los Angeles, New York, Miami, and Detroit involve a high percentage of ethnic communities.
A combination of easy Medicare enrollment by people not experienced in healthcare, lax audits, limited pre-enrollment investigations, lack of knowledge of the rules and regulations, and good faith payment resulted in criminal cases involving numerous ethnic communities. There is a fundamental tension in various ethnic communities when they are charged with offenses since the law abiding members of the community believe that mentioning the ethnic background creates an ethnic slur. However, as an attorney defending physicians, I know that if the individual is born outside the United States, there is another bar to jump in defending the case.
More education needs to be done in the ethnic communities regarding billing of insurance and government programs and U.S. laws on fraud. So many times we encounter individuals who did not know the laws on referral fees, the rules on medical necessity, and have no idea that it is a crime (not just a civil business dispute) to bill where there has been a kickback or knowingly providing medically unnecessary service even when there is a physician order. Education is critical and Medicare and Medicaid needs to provide more training and information at enrollment.
Posted by Tracy Green, Esq.