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.
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
