Sunday, January 3, 2016

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, the co-owners of a home health company in Dallas and two nurse employees were charged in an indictment for their alleged participation in a health care fraud case involving alleged fraudulent claims for home health 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. 

Patience Okoroji and Usani Ewah are alleged to co-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 with one 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 innocent unless and until proven guilty beyond a reasonable doubt in a court of law. 

The indictment alleges that from approximately January 2007 to September 2015, the defendants conspired to defraud Medicare by causing the submission and concealment of false and fraudulent claims for home health services in the amount of $13,434,550.  

According to the allegations, Okoroji and Ewah would in some cases pay recruiters, including Nwanguma, to recruit beneficiaries for home health services, regardless of whether the beneficiaries needed home health care.  The government contends that Okoroji, Ewah and Ogwuegbu allegedly prepared or caused to be prepared fraudulent Medicare documents that made it appear that the beneficiaries qualified for home health services.  These documents were used by doctors to certify Medicare beneficiaries 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.
Office: 213-233-2261


DISCLAIMER: Green & Associates' articles and blog postings are prepared as a service to the public and are not intended to grant rights or impose obligations. Nothing in this website should be construed as legal advice. Green & Associates' articles and blog postings may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents and contact their attorney for legal advice. The primary purpose of this website is not the commercial advertisement or promotion of a commercial product or service and this website is not an advertisement or solicitation. Anyone viewing this web site in a state where the web site fails to comply with all laws and ethical rules of that state, should disregard this web site.

The information provided on this website is for informational purposes only. It is not intended to create, and does not create, a lawyer-client relationship with Green & Associates, Attorneys at Law. Sending an e-mail to Tracy Green does not contractually obligate them to represent you as your lawyer, or create any type of client relationship. No attorney-client relationship will be formed absent a written engagement or retainer letter agreement signed by both Green & Associates and client and which specifies the scope of the engagement.

Please note that e-mail transmission is not secure unless it is encrypted. E-mail messages sent to Ms. Green should not include confidential or sensitive information.