In what authorities claimed was a $12 million Medicare fraud scheme, a doctor and two nurses were found guilty of charges they bilked the federal program over the course of eight years. The charges stemmed from what prosecutors claimed was a system in which the defendants had billed Medicare for home health services that were either unnecessary or never provided.
Each of the defendants was convicted on three counts of health care fraud and while the focus was on the health care aspect, because of the nature of these charges, it also falls under the purview of home health care fraud.
The three defendants were found guilty of all three charges each faced. According to a news blog by NBCDFW, Channel 5 out of Dallas-Fort Worth, Texas, entitled, North Texas Doctor, 2 Nurses Convicted of Health Care Fraud:
“A federal jury in Dallas on Friday convicted 70-year-old Dr. Kelly Robinett and 47-year-old Kingsley Nwanguma of conspiracy to commit health care fraud. Both were also convicted of three counts of health care fraud.
Officials say 42-year-old Joy Ogwuegbu was convicted of four counts of health care fraud.
Prosecutors say the scheme ran from 2007 through 2015. Robinett, Nwanguma and others defrauded Medicare through false claims through a home health agency and a physician house call company. Evidence showed medically unnecessary home health services were ordered and often not provided.”
The federal government has been cracking down in Medicare and Medicaid fraud in recent years, closing the books on dozens of fraudsters, ranging from individuals to complex and sophisticated organizations within the health care and home health care sectors. Often, charges of fraud tend to stem from billing related fraud, such as were the charges in this case.
A client would be referred by a doctor for specific care, especially at home. Then a home care provider or visiting nurse would log in the hours as services being provided, even though they might not have actually been necessary (according to the regulations set forth through CMS, the Center for Medicare and Medicaid Service) or provided.
The defendants in this case claimed that what they had provided were legitimate services, but the jury didn’t agree with them. There was no immediate word on the next court date for sentencing or if any of the defendants planned to appeal the verdict.
Home health care fraud has cost taxpayers billions of dollars and the federal government continues to crack down and prosecute offenders who seek to take advantage of a system aimed at helping the most vulnerable remain where they’re most comfortable: at home.