Facing Change: From Home to Prison Cell

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Calculator and stethoscope on paperwork

Abdirashid Ahmed, 41, and Garat Osman, 35, have been sentenced for committing health care fraud. The two Lewiston men were interpreters who conspired with local mental health counseling services to fraudulently obtain funds from MaineCare.

Between November 2015 and May 2018, Ahmed worked with Nancy Ludwig, a counselor and owner of a mental health and substance abuse counseling agency – Facing Change – to steal from Maine’s Medicaid program. (Evidently, before carrying out their illegal scheme, they must not have considered the change they would face moving from their homes to a prison cell.)

Together, the two men submitted claims for services that were never performed. (It was a typical healthcare scam. Fraudsters tend to think that claim reviewers don’t pay attention.)

Months after beginning their scheme, Ludwig began paying Ahmed to bring MaineCare beneficiaries to her agency. Ahmed, Ludwig, and other Facing Change employees created and submitted false claims to MaineCare for counseling and interpreting services. (Here’s an interpretation – their actions were illegal.)

The claims included statements of fictitious visits and exaggerated levels of service. After a MaineCare regulatory change, Ludwig and Ahmed altered their client’s diagnoses to schizophrenia so they would remain eligible for service reimbursement. (A more realistic diagnosis is that Ludwig and Ahmed are thieves and liars. A wrongful diagnosis of schizophrenia could really cause some problems for someone who doesn’t have it.)

Ludwig and some of her employees attempted to deceive the MaineCare Program Integrity Unit auditors by creating more false records during the fall of 2016. Osman began participating in this scheme during December 2016 when he formed his interpreter company. (That was the front for receiving the fraudulent funds from then until May 2019.)

Agents with the U.S. Department of Health and Human Services, Office of Inspector General, Maine Attorney General’s Office, and the FBI obtained a search warrant for Facing Change and Ahmed’s interpreting business. The warrant revealed that the scheme totaled in $1,863,264.83 of fraudulently collected funds from MaineCare.

After pleading guilty to their charges in May 2019, Ahmed was sentenced to two years in prison with three years of supervised release to follow. He will also pay $1,863,264.83 in restitution to MaineCare. Osman was sentenced to three years of probation and must pay $544,097.78 in restitution to MaineCare. (It appears the judge interpreted the law correctly and these two men got what they deserved.)

Today’s Fraud of the Day comes from a Department of Justice press release, “Lewiston Men Sentenced for Million-Dollar Health Care Fraud,” dated July 16, 2021.

ORTLAND, Maine— Two Lewiston men were sentenced today in U.S District Court in Portland for health care fraud, Acting U.S. Attorney Donald E. Clark announced.

U.S. District Judge Jon D. Levy sentenced Abdirashid Ahmed, 41, to two years in prison and three years of supervised release, and Garat Osman, 35, to three years of probation. Judge Levy also ordered Ahmed to pay $1,863,264.83 and Osman to pay $544,097.78 in restitution to MaineCare. Both men pleaded guilty in May 2019.

 

 

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.