Submitting claims for reimbursement for providing healthcare services after being excluded from participating in Medicare and Medicaid healthcare benefit programs is fraud and violates the False Claims Act
Compliance Perspective – OIG Exclusion
Policies/Procedures: The Compliance and Ethics Officer with the Administrator will review policies and procedures involving background and OIG exclusion checks of employees and vendors.
Training: The Compliance and Ethics Officer will ensure that appropriate staff are trained to properly conduct and investigate as needed background and OIG exclusion checks.
Audit: The Compliance and Ethics Officer should periodically review background and OIG exclusion checks conducted by appropriate staff.
The Texas attorney general’s Medicaid Fraud Control Unit worked together with federal prosecutors to convict two home health owners and two employees for operating a $3.7 million fraudulent Medicare and Medicaid scheme.
The jury in a six-day trial convicted Celestine “Tony” Okwilagwe, Tutu Kudiaratu Etti, Loveth Isidaehomen, and Paul Emordi of one count each for conspiracy to commit healthcare fraud. Okwilagwe and Etti were also found guilty on two counts of false statements in connection with a healthcare benefit program.
The owners of Elder Care based in Garland Texas, Okwilagwe and Emordi, were illegally operating as a Medicare and Medicaid provider after previously being excluded from participating in federal healthcare benefit programs. The pair signed false documents to conceal their identity as exclude downers. All four of the defendants were accused of submitting false and fraudulent bills to Medicare for unnecessary services.
Sentencing for the four has not been scheduled.
