On February 13, 2012, U.S. District Judge Stephen V. Wilson sentenced Evans Oniha, the co-owner of two Los Angeles-area health care companies, to 96 months in prison following a federal jury trial in the Central District of California in which the jury found Mr. Oniha guilty of one count of conspiracy to commit health care fraud, four counts of health care fraud and one count of false statements relating to health care matters. Mr. Oniha's jury trial was in July 2011. Judge Wilson also ordered Mr. Oniha to pay $7 million in restitution and to serve three years of supervised release following his prison term.
This case arose out of an investigation into power wheelchairs being billed to Medicare by Mr. Oniha's company. This was an illegal marketing case since the companies used marketers that did not comply with STARK or Anti-Kickback laws. Mr. Oniha and his co-defendant are both originally from Nigeria.
According to court documents, in 2002, Mr. Oniha and his co-defendant Camillus Ehigie founded and began operating Prosperity Home Health Services Inc., a home health agency, and Caravan Medical Supplies Inc., a durable medical equipment (DME) company. According to testimony presented at trial, from October 2002 to February 2011, Mr. Oniha, Mr. Ehigie and others payed “marketers” for Medicare beneficiary information, fraudulent prescriptions and other documents for DME and home health services.
Testimony at trial showed that the marketers were individuals who acquired patient Medicare numbers and doctors’ prescriptions and sold them to Mr. Oniha. Mr. Oniha used these documents to submit and cause the submission of claims to Medicare for DME and home health services that were not medically necessary and that often were not provided to Medicare beneficiaries. In many cases, the services were provided to beneficiaries but under the laws, if there is illegal marketing the claim becomes a false claim especially where there is no medical necessity.
Prosperity submitted approximately $8 million in claims to Medicare for home health services. The DME company Caravan submitted approximately $5.8 million in claims to Medicare.
The co-defendant Mr. Ehigie pleaded guilty during trial -- two days before the jury came back with guilty verdicts on Mr. Oniha. Mr. Ehigiie plead guilty to 11 counts of health care fraud, one count of conspiracy to commit health care fraud, one count of making false statements in a federal health care investigation, and one count of obstructing a criminal health care investigation. Mr. Ehigie is scheduled to be sentenced on July 9, 2012.
Attorney Commentary: I received a call this week from a reporter who is doing a piece on health care fraud and commented how there is more fraud than ever. I replied to him that many of these cases are old and are being prosecuted before the statute of limitations run. This case, for example, goes back to 2002 and the investigation was pending for several years before charges were filed.
I mention in the article that the individuals here were from Nigeria. One of the issues in many health care fraud cases are that the individuals are originally from other countries who open health care businesses here and have no idea of the rules and regulations that govern the industry. There is almost universally no consultation with attorneys in setting up the businesses or implementing marketing plans.
In some cases, the patients received the services or DME and the defendants naively believe that just because the services or products were provided it means that there cannot be a viable health care fraud case. They do not understand that if there is illegal marketing that alone will be enough to sustain a conviction. They also fail to appreciate that when they pay marketers, those marketers will have often done illegal tactics themselves in order to secure patients (pay patients, coach patients on what to say, etc.) It is often difficult representing these unsophisticated defendants because they cannot understand how this can be a "fraud" case.
It would be very helpful for the government to require any one receiving a Medicare or Medi-Cal / Medicaid provider number to undergo a required training in the laws and regulations. When a Medicare application is submitted a signature is required stating that the person is familiar with the laws and regulations and agrees to follow them, but that would be difficult since the laws are complex and changing and even lawyers struggle to stay up with the laws.
Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 15-minute consultation.
The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and in health care fraud related matters in Los Angeles, California and throughout the state and country. Their website is: http://www.greenassoc.com/
I mention in the article that the individuals here were from Nigeria. One of the issues in many health care fraud cases are that the individuals are originally from other countries who open health care businesses here and have no idea of the rules and regulations that govern the industry. There is almost universally no consultation with attorneys in setting up the businesses or implementing marketing plans.
In some cases, the patients received the services or DME and the defendants naively believe that just because the services or products were provided it means that there cannot be a viable health care fraud case. They do not understand that if there is illegal marketing that alone will be enough to sustain a conviction. They also fail to appreciate that when they pay marketers, those marketers will have often done illegal tactics themselves in order to secure patients (pay patients, coach patients on what to say, etc.) It is often difficult representing these unsophisticated defendants because they cannot understand how this can be a "fraud" case.
It would be very helpful for the government to require any one receiving a Medicare or Medi-Cal / Medicaid provider number to undergo a required training in the laws and regulations. When a Medicare application is submitted a signature is required stating that the person is familiar with the laws and regulations and agrees to follow them, but that would be difficult since the laws are complex and changing and even lawyers struggle to stay up with the laws.
Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 15-minute consultation.
The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and in health care fraud related matters in Los Angeles, California and throughout the state and country. Their website is: http://www.greenassoc.com/
