In Deeper Than He Thought

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Sometimes, people have good intentions when starting out with an endeavor to help others. Perhaps this was the case for today’s fraudster, who ran a string of Houston home healthcare clinics that provided community-based support to developmentally disabled people. Although the man jumped in with both feet to serve those less fortunate, somewhere along the way he realized he was in deeper than he thought and became involved in a $17 million Medicare billing fraud scam that helped pay bills related to his business.

The man, who ran five clinics in the Houston area, and his daughter paid recruiters by cash, check, Western Union and Moneygram to bring in hundreds of “patients-for-hire.” (He authorized kickbacks for the “patients” and he also incentivized his staff to keep the devious scheme afloat by paying them on a per-patient basis.) For more than seven years, the father and daughter duo submitted claims to Medicare and Medicaid for hundreds of patients who did not need nor receive the services documented.

Court documents show that the owner and his daughter paid physicians to create fake documentation indicating that the patients had ailments qualifying them to receive home health services. In all, the five clinics submitted bogus claims for $17.2 million. (The company was reimbursed for nearly $16.2 million.)

While in court, the home healthcare owner’s lawyer explained that the clinic owner didn’t live an ostentatious lifestyle, he just simply got caught up in paying the bills. Ironically, the owner told the judge that he was not there to “pass the buck” and he had not intended to defraud the government. (Let’s be clear, he paid his bills with the government’s money. He passed the government’s bucks along, not his own. It’s all in the semantics.) His lawyer jumped back in with the explanation that the excess money became intoxicating, he lost perspective and failed to exercise sound judgement. (So, he was drunk with fraud I suppose. Well, he definitely has a really bad hangover that doesn’t show signs of going away any time soon.)

The 61-year-old clinic owner was sentenced to 40 years in federal prison for his brazen Medicare billing scheme. His 48-year-old admitting nurse received five years in prison and three years of supervised release for his part in the scam. His daughter has pleaded guilty to conspiracy to commit healthcare fraud and is scheduled to be sentenced.

Fraud has a way of clouding the perceptions of the perpetrator. At this point, he may wish he had drowned in debt instead of masterminding this healthcare fraud scheme. His scheme also swept away his co-conspirators in a flood of bad decisions. (They all ended up jumping into the deep waters of fraud and realized too late that they were in over their heads.)

Today’s “Fraud of the Day” is based on an article entitled, Houston clinic owner sentenced in $17 million Medicare fraud schemepublished by The Houston Chronicle on August 17, 2017.

The owner of a string of Houston home health care clinics was sentenced to 40 years in federal prison Thursday for a brazen scheme involving more than $17 million in fraudulent Medicaid and Medicare billing.

“I’m not here to pass the buck,” Godwin Oriakhi, who ran the five clinics, told U.S. District Judge Sim Lake before sentencing. “I never set out in any way to defraud the government.”

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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.