PHOTOS: Nigeria-Born & Kenya-Born US Doctors Charged As Part Of Medicare Fraud; For Largest Crackdown In US History Involving Stealing Of US$712 Million

Dr. Noble U. Ezukanma and Dr. Ransome N. Etindi (both based in Texas, US)

In the largest crackdown on healthcare fraud in U.S. history, federal officials charged more than 200 people, including doctors, nurses and medical professionals on Thursday for their roles in Medicare scams that cost taxpayers US$712 million. Among the 243 people charged, 46 licensed medical professionals were accused of crimes ranging from money laundering to identity theft and conspiracy to commit healthcare fraud through Medicare, the federal health insurance program for people ages 65 and older.

“The defendants charged include doctors, patient recruiters, home healthcare providers, pharmacy owners, and others,” U.S. Attorney General Loretta E. Lynch said in a statement. “They billed for equipment that wasn’t provided, for care that wasn’t needed, and for services that weren’t rendered.”

IBTimes report continues:
The accused individuals work in a variety of specialties within the health care industry including pharmacy, occupational therapy, psychotherapy, home healthcare and medical equipment. About 44 of them were accused of committing fraud through Medicare’s prescription drug benefit program known as Part D. Lynch and Department of Health and Human Services (HHS) Secretary Sylvia Burwell announced the sweep of charges on Thursday along with FBI Director James B. Comey.

The crimes were committed in cities across the country from Tampa, Fla. to Detroit, Mich. and Los Angeles, Calif. Administrators at a mental health treatment facility in Miami, Fla. allegedly received about US$32 million from Medicare for intensive treatments that were not delivered between 2006 and 2012. In Dallas, six owners of a company that sent physicians on house calls were accused of requesting US$43 million for a single doctor's services and billing for 90-minute appointments when a typical visit actually only lasted 15 or 20 minutes. A group of co-conspirators in New Orleans are said to have mailed glucose monitors to Medicare patients across the country who didn’t’ need them, and collected more than US$22 million from the program.  

The charges were lodged by the Medicare Fraud Strike Force, a joint Department of Justice and HHS enforcement group formed in 2007 to weed out cases of healthcare fraud across the country. So far, the group has charged 2,300 people with falsely billing Medicare for over US$7 billion. The Affordable Care Act dedicated US$350 million in new funds to the fight fraud, and expanded the work of the team from two cities to nine locations.

The U.S. Department of Justice and the Department of Health and Human Services announced the largest law enforcement effort to date to combat Medicare fraud on Thursday. U.S. Attorney General Loretta Lynch speaks at a press conference about charges filed against 243 people for fraudulent charges totaling more than US$712 million. Reuters/Yuri Gripas

Meanwhile the Dallas Morning News reports two doctors and a nurse are among seven North Texans charged in connection with the nation’s largest home health care fraud bust, federal authorities said Thursday.

The Medicare Fraud Strike Force led the nationwide effort that resulted in federal charges against 243 people, including 46 doctors, nurses and other licensed medical professionals, the U.S. attorney’s office said.

The various schemes netted the suspects US$712 million in billings for nonexistent treatments, officials said.

“This action represents the largest criminal health care fraud takedown in the history of the Department of Justice,” said U.S. Attorney General Loretta Lynch.

Five North Texans were arrested on Tuesday as part of an alleged $40 million swindle. They include Dr. Noble U. Ezukanma, 56, a Fort Worth doctor; Myrna S. Parcon, a.k.a. “Merna Parcon,” 62, of Dallas; Lita S. Dejesus, 70, of Allen; Oliva A. Padilla, 57, of Garland; and Ben P. Gaines, 55, of Plano. All are charged with conspiracy to commit health care fraud, officials said.

All made their first appearance in court and have been released on bond, authorities said. A sixth person, Dr. Ransome N. Etindi, 56, of Waxahachie, is expected to surrender to authorities on Friday in Dallas.

Home health care serves an important role in caring for seniors and the disabled who are discharged from hospitals. Many recuperate at home and need care delivered there by physicians, nurses or therapists. Each visit to the patient is billed as an episode of care.

But the case announced on Thursday is the latest in a succession of home health care fraud crackdowns.

At least 800 home health care agencies in North Texas are accused of participating in such schemes. A Rockwall physician, Jacques Roy, was charged in 2012 with running what prosecutors called the largest home health fraud ever orchestrated by a single doctor. Roy has since lost his license and is awaiting trial.

Federal officials put in place a moratorium last year to stop any new Dallas and Houston home health care agencies from receiving Medicare payments.

According to authorities, Ezukanma, Parcon, and Dejesus owned and operated US Physician Home Visits, also known as Healthcare Liaison Professionals, Inc. on Viceroy Drive in Dallas. Ezukanma and Etindi authorized Medicare billings for the company, the indictment said.

Gaines formed A Good Homehealth, which Parcon secretly owned, in the same office, officials said.

And Parcon and Padilla formed Essence Home Health, also known as Primary Angel Inc. on Midway Road in Addison, the indictment said.

All three companies operated as one and shared employees, authorities said.

Ezukanma, a native of Nigeria, received his Texas medical license in 1999 and specializes in internal medicine and pulmonary critical care, records show.

Etindi’s medical license was suspended in 2011 after the medical board said he had sex with a patient, records show. The board required that for 10 years he have a chaperone present when he examines a female patient.

Etindi, a native of Kenya, received his Texas medical license in 2001.

Conspiracy

The conspiracy to defraud Medicare began in January 2009 and lasted until June 2013, the indictment said.

The three companies “reversed the home health process,” the indictment said. They requested home health care services for people whether they were homebound or not instead of a physician ordering such services after examining them.

Ezukanma authorized the services without knowing anything about the patients in some cases, the indictment said.

‘An alarming rate’

US Physician Home Visits billed “at an alarming rate,” submitting claims for doctor visits lasting at least 90 minutes when most actually took 15 to 20 minutes, the indictment said.

The company billed Medicare for patient examinations that Ezukanma and Etindi couldn’t possibly have provided, according to the indictment.

On Oct. 16, 2012, for example, Ezukanma submitted bills for 205 hours he supposedly worked that day, the indictment said.

As part of the investigation, federal agents seized $344,900 from Ezukanma’s home in Fort Worth, which is valued at more than half a million dollars.

Patient information

In a separate case, Mariamma Viju, 50, of Garland, was charged with one count of conspiracy to commit health care fraud, five counts of health care fraud, and one count of wrongful disclosure of individually identifiable health information.

Viju is a registered nurse and co-owner of Dallas Home Health, Inc. She also was arrested on Tuesday and later released on bond.

Viju received her Texas nursing license in 2001, records show.

The indictment said Viju and others stole patient information from Dallas-area hospitals to find patients for Dallas Home Health.

Viju stole the information from Baylor University Medical Center at Dallas, where she worked as a nurse until she was fired, the U.S. attorney’s office said.

Her company billed for home health services for people who were not eligible for such care, authorities said.

Viju, who was director of nursing for her company, “falsified and exaggerated the nature of patients’ health conditions” to generate profits for Dallas Home Health, according to authorities.

She also is accused of paying kickbacks to the patients.

Her husband, Viju Mathew, 50, of Garland, a former registration specialist at Parkland Memorial Hospital, pleaded guilty in November to one count of fraud and related activity in connection with a similar scheme, officials said.

He stole confidential patient information while working at Parkland in order to drum up business for his home health care business, authorities said. He is scheduled to be sentenced in August.

Acting U.S. Attorney John Parker of the Northern District of Texas said in a statement Thursday that his office will continue to target those “who cheat not only Medicare and Medicaid but all taxpayers and vulnerable patients.”
“When these schemes are uncovered, and they will be, this office will not hesitate to bring indictments … against those who defraud these essential health care programs,” Parker said.