New Fraud Busts Put Money Back Where it Belongs – Caring for the Sick

Last Thursday, yet another individual pleaded guilty for his involvement in a $374 million dollar Medicare fraud scheme that was linked to a single physician. Cyprian Akamnonu, the owner of a home health agency pleaded guilty to being part was part of a larger ring of health care providers in north Texas. According to the government, records show that Akamnonu has operated Ultimate Care Home Health Services, Inc. since 2006, the entire time, recruiting people as Medicare beneficiaries for unneeded services. He now faces up to 10 years in prison and must forfeit 21 properties, four vehicles and personal and business funds.

Akamnonu wasn’t the only one linked in the conspiracy to commit Medicare fraud. Back in April, Dr. Jaques Roy, an office manager who has been named the largest healthcare fraudster in the United States, was charged with defrauding the government of over $374 million in Medicare and Medicaid payments. According to reports, the government was tipped off when it realized Dr. Roy was linked to over 11,000 patients, more than any other physician in the country. As part of their fraudulent scheme, recruiters would be paid $50 to find homeless people in shelters and use their names to submit Medicare claims.

Arrests on individuals such as Akamnonu and Roy certainly isn’t rare. The government is finding more and more cases such as this. A couple of weeks ago, the government announced charges against 91 individuals for their alleged participation in Medicare and Medicaid fraud schemes involving approximately $429.2 million in false billing for providing home health services, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment (DME) and ambulance services. Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius made the announcement.

These individuals allegedly participated in schemes to submit claims to Medicare for medically unnecessary treatments, or in some cases, for treatments that were never even provided. As in the Akamnonu case, the government alleged that “patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could submit fraudulent billing to Medicare for services that were medically unnecessary or never provided.” 

“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,” said Attorney General Holder. “Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program – they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans.”

“Today’s arrests put criminals on notice that we are cracking down hard on people who want to steal from Medicare,” said HHS Secretary Sebelius. “The health care law gives us new tools to better fight fraud and make Medicare stronger. In addition to the arrests made today, HHS used new authority from the health care law to stop future payments to many of the health care providers suspected of fraud, saving Medicare resources and taxpayer dollars from being lost to fraud in the first place.”

The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 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. Just these two sets of indictments alone, both made within the same year, represent well over $800 million in monies lost due to fraud.

FBI Associate Deputy Director Perkins stated, “Health care fraud leads to higher health care costs and makes quality care more difficult to obtain, and working together to stop fraud, … will ensure that Americans’ hard-earned dollars are used to care for the sick – not to line the pockets of criminals.” And there is absolutely no doubt that this new push by the government to find these cases is putting that money back where it belongs.