Twelve charged for healthcare fraud violations totaling $28 million

Twelve people were charged in federal court this week as part of a nationwide sweep targeting  healthcare fraud violations, law enforcement officials said.

Locally, the charges represent more than $28 million in money fraudulently obtained from Medicaid, Medicare or other insurance providers. The charges stem from three unrelated cases.

Details of cases filed this week:

United States v. Knight et. al.: Five people were named in an 18-count indictment for their roles in a $7 million home healthcare fraud conspiracy in which they provided forged documents and fraudulent forms to bill for services that were not provided.

Indicted are: Delores L. Knight, 69, of Cleveland Heights; Theresa L. Adams, 42, of Twinsburg; Isaac R. Knight, 28, of Macedonia; Sonja N. Ferrrell, 43, of Cleveland, and Juliet L. Bonner, 60, of Cleveland.

All five worked in some capacity for Just Like Familee II, Inc., and Just Like Familee III, Inc., which the defendants incorporated in 2005 and 2006, respectively, to provide home health services for elderly and disabled clients. The companies had locations at various times in Cleveland Heights, Twinsburg and Mentor, according to the indictment.

Together they defrauded Medicaid, Medicare and the Department of Veteran Affairs out of more than $7 million as a result of the conspiracy in which they prepared and submitted forged or false records in support of previously submitted and reimbursed billings for patients they did not actually provide face-to-face services, according to the indictment.

Prosecutors are seeking to forfeit all money that was illegally obtained, as well as a home at 1048 Morning Glory Drive in Macedonia owned by Delores L. Knight, and a home at 7915 Ridgetop Drive in Twinsburg owned by Theresa L. Adams.

United States v. Warsame et. al.: Five people were named in a 10-count indictment for their roles in a $3 million conspiracy involving a home health service company with offices in Cleveland to defraud government insurance programs by billing for services not provided.

Indicted are: Abdulazis Warsame, 50, of Cleveland; Yasin Warsame, 48, Amir Ahmed, 50, both of Columbus; George Epps, 42, of Cleveland, and Norma Lauer, 67, of Reynoldsburg.

All five worked for Lifeline Home Health Services, which was incorporated in 2006 and had an office at 12200 Fairhill Road in Cleveland.

The defendants conspired between 2009 to 2013 to defraud Medicaid by submitting false documentation to become an accredited home healthcare provider, forging documents to make it appear doctors had approved specific plans of care, fabricating and billing for home health visits that had not taken place. Ahmed also recruited patients by offering cash kickbacks in exchange for becoming patients of Lifeline, according to the indictment.

Collectively, Ahmed, Lauer and the Warsames received payment for more than $3 million in fraudulent claims, according to the indictment.

United States v. Ward: Queen Ward, 64, of Cleveland Heights, was charged with one count of healthcare fraud while her daughter, Sharon Ward, 45, of Richmond Heights, was charged with one count each of healthcare fraud and aggravated identity theft related to the fraudulent billing of more than $18.1 million.

Together, they owned and operated Heritage Home Healthcare Agency in Cleveland Heights, despite the fact that Sharon Ward was previously convicted of Medicaid fraud, which precluded her participation in all federal health care programs for five years. Sharon Ward continued to own Heritage Home Health while she was excluded, as well as continued to see patients as a nurse, conducted nursing visits and bill Medicaid for her and her employees’ services. Queen Ward continued to bill Medicaid for her daughter’s services, and continued to pay Sharon Ward, despite the fact that she had been told by the Ohio Medicaid Fraud Control Unit that Sharon Ward was an excluded provider and had never been reinstated as an accredited provider, according to court documents.

Queen Ward also created fraudulent background checks for prospective employees that had criminal records and therefore would have been disqualified, according to court documents.

Between 2006 and 2014, Heritage Home Health received more than $18.1 million from Medicaid and Sharon Ward received a salary of more than $2.2 million, all during Sharon Ward’s period of exclusion from federal health care programs, according to court documents.

“The conduct detailed in these cases is egregious,” said Steven M. Dettelbach, U.S. Attorney for the Northern District of Ohio. “These programs were designed to help the sick and infirm, and these defendants defrauded them out of millions of dollars for their own personal gain.”

“Health care fraud affects every American,” said Stephen D. Anthony, Special Agent in Charge of the FBI’s Cleveland office. “Waste, fraud and abuse take critical resources out of our health care system, contribute to the rising cost of health care and degrades the integrity of our health care system and legitimate patient care. This week’s efforts send a message to those defrauding our system that authorities will collaboratively address this significant crime problem.”

“Today’s announcement illustrates the OIG’s continued efforts in combating health care fraud,” said Lamont Pugh III, Special Agent in Charge, U.S. Department of Health & Human Services, Office of Inspector General – Chicago Region. “The OIG and our law enforcement partners are steadfast in our commitment to detecting and dismantling health care fraud schemes and holding perpetrators of these crimes accountable.”

“Ohio has one of the best Medicaid Fraud Control Units in the country, and we diligently work with our state, local, and federal partners to weed out those who bill Medicaid and Medicare for services they did not provide or services that are not medically necessarily,” said Attorney General Mike DeWine. “Heath care fraud diverts funds from people who legitimately need care, and through joint efforts like this one, we intend to continue to aggressively go after those who steal from taxpayers and take money that they are not entitled to receive.”

“Healthcare Fraud Task Force investigations are vital in identifying and holding accountable those who would steal from taxpayers, Medicare beneficiaries and veterans,” said Gavin McClaren, Cleveland Resident Agent in Charge, Department of Veterans Affairs, Office of Inspector General, Criminal Investigation Division.

“IRS-Criminal Investigation is dedicated to ensuring those that choose to launder their ill-gotten gains are held accountable for their crimes,” said Kathy Enstrom, Special Agent in Charge of IRS-Criminal Investigation Cincinnati Field Office. “Forfeiture of these assets should serve as a warning that law enforcement will not tolerate such flagrant abuse of our safety net programs.”

These are the just latest healthcare fraud cases filed by federal prosecutors following investigations by federal and state agencies. Others include indictments against Dr. Harold Persaud, who is awaiting trial on charges that he performed unnecessary catheterizations, tests, stent insertions and caused unnecessary coronary artery bypass surgeries as part of a scheme to overbill Medicare and other insurers by $7.2 million; seven people and a company for their roles in a multi-million dollar fraud conspiracy involving an experimental form of chiropractic manipulation performed in Shaker Heights; three people who operated Eman Transportation Services in Cleveland charged with defrauding Medicaid of approximately $245,000 by billing for rides of patients who did not use or need wheelchairs and for transporting Medicaid recipients to non-covered appointments and an Akron physician was sentenced to 10 years in prison for illegally prescribing hundreds of thousands of doses of painkillers and defrauding health insurance by submitting insurance claims for unperformed services, billing insurance providers for services after collecting a cash payment, and other fraudulent practices.

These cases are being prosecuted by Assistant U.S. Attorneys Michael L. Collyer, Mark Bennett, Adam Hollingsworth and Special Assistant U.S. Attorney Maritsa Flaherty, following investigations by the Federal Bureau of Investigation; U.S. Department of Health & Human Services, Office of Inspector General; Ohio Attorney General’s Medicaid Fraud Control Unit; the Department of Veterans Affairs, Office of Inspector General, Criminal Investigation Division; the Internal Revenue Service – Criminal Investigations.

If convicted, the defendants’ sentences will be determined by the court after review of factors unique to this case, including the defendant’s prior criminal record, if any, the defendant’s role in the offense and the characteristics of the violations.  In all cases, the sentence will not exceed the statutory maximum and, in most cases, it will be less than the maximum.

An indictment or information is only a charge and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.