Fraud and Abuse: To what end?

I had an 'a-ha' moment about fraud and abuse in healthcare when a colleague of mine asked me if I saw an email that went out last Thursday. It was one of the few I had not opened yet.  He said he had to stop himself from forwarding it again to me...another Nigerian convicted of Medicare fraud.  I told him it's in the public record and I know he is not implying guilt by common nationality so no need to worry.  I said this to myself as well as a matter of fact:: nothing to do with me personally whatsoever.  The quick exchange reminded me of a friend of mine who was a mid level in a Wall Street firm. He had the misfortune of having the name 'Ike'--a common Igbo name ubiquitous in the ridiculous 419 emails most of us received in the United States. Many potential clients stopped short of asking him if he's related to some Nigerian '419' letter writer, named Ike. His managers were constantly explaining away his innocence. But many would not deal with him when it came to their money as a result of this non-guilt by association. He lost clients.  The few bad apples cast a shadow over everyone else.  Therein lies the true consequence of short-sightedness.

Think about it, as removed as I am from all these people in Texas (it seems that's where they concentrate), I am asked about what I know about these Nigerians (nothing), whether I can tell where they are from (they are mostly Igbos), and what it is about them that makes fraud in healthcare such an attractive option (my guess: quick money, a belief that everyone is stupid, and a belief that you will not be caught).  I have no answer for them.  Remember my post about what my dad told us about what it means to be an Igbo?  This is the disconnect. The vast majority of Nigerians in healthcare are law abiding citizens. If I had to guess, they are squeaky clean in their approach to their occupations.  For many, it took a lot for them to achieve their success so it is not something Nigerians (indeed immigrants in general) take for granted. After all, what awaits them in their home countries is nothing short of despair and hardship.

There are many other nationalities prominently featured in healthcare fraud and abuse.  The list below includes someone who appears to be Ghanaian, but who really knows.  There are the Russians, Armenians, all sorts of people.  However, Nigerians are over-represented in Medicare and Medicaid abuse. From distributors of durable medical equipment to home health and physical therapy providers.  Why? Why is the slower, legal way of doing things so unattractive to so many?  Anyone can make a decent living doing things the right way.  But how do we gauge a decent living?

Maybe, you have to drive a Honda versus a Mercedes, and maybe it takes you 15 years to build the house in your village rather than 6 months, but if you give up the Mercedes and its maintenance costs you might be able to build it in a couple of years.  So you have to give up all the meaningless titles in your town for your good name, and your name only.  Maybe you don't get to buy the most expensive lace, but really, who is checking to see what you're wearing?  Who cares?  And here's one I have heard to my amazement: you won't get to buy every woman in your large Nigerian church her own ankara material and matching headpiece, but really, no other woman has done that and they're all still welcome to attend that church.

Here's what I know:  I know that there would be no Medicare or Medicaid if everyone aimed to defraud it from the beginning. Nothing would have remained of the system after 1970 for recent immigrants to defraud today.  So I continue to remain puzzled by this short list of recently convicted Nigerians who made it their occupation to defraud an already struggling system.

1.

03/07/2011: Former DME Business Owner Sentenced To Prison for 70 Months in Medicare Scam

HOUSTON—The owner of a false “storefront” durable medical equipment business will serve 70 months in federal prison after admitting that he set up a scheme to defraud Medicare of $1.6 million and stole doctors' identification data, prosecutors announced Feb. 25 (United States v. Kaluanya, S.D. Tex., No. 4:09-cr-00589, sentenced 2/23/11).

 2.

02/22/2011: Home Health Agency Owner Sentenced To 46 Months for Defrauding Medicare

HOUSTON—A Texas woman who owned a home health care agency will serve 46 months in federal prison for paying patients for Medicare information used to falsely bill the program $1.8 million, prosecutors announced Feb. 15 (United States v. Onyegbu, N.D. Tex., No. 3:10-cr-254-N, sentenced 2/14/11).

3.

Owner of Physical Therapy Clinics Pleads Guilty to Defrauding Medicare

PHILADELPHIA—The owner of two physical therapy clinics in New Jersey pleaded guilty to charges stemming from fraudulent Medicare billings for which he allegedly received $3.8 million, U.S. Attorney Christopher J. Christie said in a March 5 news release (United States v. Ikeh, D.N.J., No. 06-574, guilty plea 3/5/07).  Chidi Ikeh, who owned and operated Vital Health Care Services in Ewing, N.J., and U.S. Vital Health Care Services in Cherry Hill, N.J., pleaded guilty to one count of health care fraud and one count of wire fraud in connection with Medicare billings submitted from February 2002 until August 2005.

4.

RALEIGH, N.C.—Two individuals given prison terms for their roles in a Medicare fraud scheme involving motorized wheelchairs must be resentenced, the U.S. Appeals Court for the Fourth Circuit ruled Jan. 21 in an unpublished decision (United States v. Osuji, 4th Cir., No. 08-5207, unpublished 1/21/11; United States v. Varnado, 4th Cir., No. 08-5209, unpublished 1/21/11).

5.

This case had a whole slew of Nigerians in addition to others involved in the scheme. 

Texas Doctor Sentenced to 41 Months In Prison for Wheelchair Fraud Scheme

HOUSTON—A Houston area doctor Jan. 4 was sentenced to 41 months in prison for his role in a multi-million dollar scheme that fraudulently billed Medicare and Medicaid for power wheelchairs, orthotic devices, and other durable medical equipment, prosecutors announced Jan. 5 (United States v. Grant,S.D. Tex., No. 4:09-cr-00424, sentenced 1/4/11). Separately on Jan. 4, Atlas sentenced co-defendant Obisike Nwankwo, a delivery driver for Onward, to 21 months in prison and ordered him to pay $29,052 in restitution. The jury had convicted Nwankwo of one count of conspiracy to commit health care fraud. Atlas is scheduled to sentence co-defendants Vinitski, delivery driver Clinton Lee, patient recruiters Michael Kalu Obasi and Ju-Jing Quin, and DME employee Basil Obasi Lau on Jan. 12.

6.

Just a few days ago, another Nigerian testified before Congress on how easy it is to defraud Medicare. Here’s the newspaper article: 

The Hill Swindling Medicare 'easy,' fraudster tells House panel

Bilking Medicare out of millions of dollars is "incredibly easy," a convicted felon told a House oversight subpanel Wednesday afternoon.
Aghaegbuna "Ike" Odelugo, who faces sentencing this spring for Medicare fraud, told lawmakers it didn’t take “more than a month” to develop a scheme that swindled Medicare out of nearly $10 million over a three-year period.
Odelugo, a Nigerian native who gamed Medicare’s durable medical equipment (DME) system, said he only needed basic data-entry skills and a few fraudulent marketers.



7. And today, as I was about to post, another conviction. 


PHOENIX—A Las Vegas woman pleaded guilty March 7 in federal court to an unspecified number of counts of health care fraud in connection with her acting as a straw owner of a Los Angeles-area medical supply company that submitted more than $3.5 million in false Medicare claims, the Department of Justice announced March 8 (United States v. Ibrahim, C.D. Cal., No. 2:09-cr-01008-GHK, guilty plea 3/7/11).

Here's an earlier CNN article on this particular group.  Husband, wife, etc.