One Giant Leap Toward Success: Avoid One Simple Misstep For “Fraud-kind”

If you’re a physician, it’s all too likely that you’re uncertain about the future, feel the pressure of an all too real governmentally imposed ceiling on your income, and have even less control than ever over your time.

It’s also likely that you seek a bigger and better future in which you have increased opportunities to earn money, escape from hospital domination, and gain increased control over your time.

There are many ways to accomplish those goals. But there’s one that’s not: Medicare fraud.

Take the case of the two Dallas area physicians and three nurses who were found, or had pleaded, guilty, for their roles in an $11.3 million Medicare fraud scheme involving false and fraudulent claims for home health services. They were sentenced last week on October 15, 2018. Now, they’re headed off to prison. Several of their co-conspirators are still awaiting sentencing.

The Players

Kelly Robinett, D.O. Robinett was a former part-owner and supervising physician at Boomer House Calls (“Boomer”) of Frisco, Texas. Robinett was sentenced to serve 42 months in prison.

Angel Claudio, M.D. Claudio was sentenced to serve six months in prison. 

Patience Okoroji was an LVN and a part-owner of Timely Home Health Services Inc. (“Timely”). Okoroji was sentenced to serve 120 months in prison.

Joy Ogwuegbu was the former Director of Nursing at Timely. Ogwuegbu was sentenced to serve 42 months in prison.

Kingsley Nwanguma was an LVN at Timely. Nwanguma was sentenced to serve 42 months in prison.

Two others, Usani Ewah, a part-owner of Timely and an RN, and Shawn Chamberlain, a part-owner of Boomer and a physician’s assistant, are awaiting sentencing.

The Scheme

Evidence at trial showed that:

1. The defendants engaged in a scheme to defraud Medicare by submitting and causing the submission of false and fraudulent claims to Medicare, through Timely, a home health agency, and Boomer, a physician house call company. 
2. Robinett certified Medicare beneficiaries—whom he had never seen and did not care to see—for medically unnecessary home health services that were often not provided. 
3. Ogwuegbu falsified nursing assessments and Nwanguma falsified nursing notes, to make it appear as if Medicare beneficiaries were qualified for and were provided skilled nursing services.   
4. Timely billed Medicare for over $11.3 million for home health services purportedly provided to Timely’s patients, some of which was attributable to certifications Robinett signed. 

It was also shown at trial that Robinett’s company, Boomer, billed Medicare over $1.6 million for medically unnecessary home health certifications and services and physician’s home visits. 

On the positive side for this sorry lot, those sentenced to prison won’t have to worry about who’s paying for their healthcare: You and I will be taking care of them. Through our taxes, I mean.

Hey, we all like money and many of us seek more freedom from interference, and yearn for more control over our time. There are contractual structures to obtain them. There are revisions to business models that increase the payoff on all three fronts. And, there are various forms of investment in facilities to break free of third-party control.

With so many legal ways, why resort to short term thinking that leads to a long term prison sentence?

Comment or contact me if you’d like to discuss this post.

Mark F. Weiss

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