A federal jury found one physician and two nurses guilty today of health care fraud, and one physician and one nurse guilty of conspiracy to commit health care fraud, all for their roles in a home health fraud scheme.
U.S. Attorney Erin Nealy Cox of the Northern District of Texas, Acting Assistant Attorney General John P. Cronan of the Justice Department’s Criminal Division, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Region, Special Agent in Charge Eric Jackson of the FBI’s Dallas Field Office and Director of Law Enforcement David Maxwell of the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.
After a five-day trial, Kelly Robinett, M.D., 70, of Denton County, Texas; and Kingsley Nwanguma, 47, of Dallas County, Texas were each convicted of one count of conspiracy to commit health care fraud. In addition, Robinett and Nwanguma were each convicted of three counts of health care fraud, and Joy Ogwuegbu, 42, of Collin County, Texas was convicted of four counts of health care fraud. Sentencing before U.S. District Judge Reed O’Connor of the Northern District of Texas, who presided over the trial, has not yet been scheduled.
“Medical professionals Kelly Robinett, Kingsley Nwanguma, and Joy Ogwuegbu engaged in a multimillion-dollar scheme to defraud the taxpayer-funded Medicare program by certifying patients for medically unnecessary home health services and falsifying medical records to hide their crimes,” said Acting Assistant Attorney General Cronan. “The Criminal Division and our law enforcement partners are committed to protecting taxpayer dollars by vigorously pursuing medical professionals and anyone else who seeks to profit off our federal health programs through fraud and deceit.”
“The significance of this case highlights the responsibility healthcare workers, especially physicians and nurses, have to protect not only their patients, but prevent fraud against any federal health insurance program during the performance of their duties,” said Eric K. Jackson, FBI Dallas Special Agent-In-Charge. “Their decision to undertake this level of fraud against the government is something that the FBI will always make a priority to investigate and bring to justice those who would use their influential positions and their access for personal gains.”
“All patient care decisions must be based on legitimate assessments of medical need,” said CJ Porter, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “In this case, decisions revolved around a fraud scheme to enrich the defendants. The Office of Inspector General, with our enforcement partners, will continue to pursue prosecutions of this nature to protect federal health care program dollars.”
From 2007 through 2015, Robinett, Nwanguma, and others, engaged in a scheme to defraud Medicare by submitting and causing the submission of false and fraudulent claims to Medicare, through Timely Home Health Services Inc. (Timely), a home health agency, and Boomer House Calls, a physician house call company. The evidence presented at trial showed that Robinett, a doctor of osteopathic medicine, 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. The evidence further established that Ogwuegbu, a registered nurse, falsified nursing assessments and Nwanguma, a licensed vocational nurse, falsified nursing notes, to make it appear as if Medicare beneficiaries were qualified for and were provided skilled nursing services.
Evidence at trial demonstrated that 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. Robinett’s company Boomer House Calls billed Medicare approximately $1 million for medically unnecessary home health certifications and services and physician’s home visits.
Four other defendants, have been convicted in this matter and in a related case.
The Medicare Fraud Strike Force operations are part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. The Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the Medicare Fraud Strike Force has charged over 3,500 defendants who collectively have falsely billed the Medicare program for over $12.5 billion.
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