Less than an hour north of Boston is Lowell, Massachusetts. Even though its population is just over 100,000 people, the city is actually the fifth most populous in the state. Lowell is also the home of 42 year-old, Winnie Waruru. Last week, the nurse pleaded guilty in a Boston federal court to charges related to a $100 million home health care fraud scheme.
As reported by the District of Massachusetts branch of the United States Department of Justice yesterday, Waruru pleaded guilty to several charges. They include one count of conspiracy to commit health care fraud; one count of health care fraud – aiding and abetting; one count of conspiracy to pay and receive kickbacks; two counts of making false statements; and one count of making a false statement in a health care matter.
Waruru was arrested and charged along with a co-defendant.
Her co-defendant, Faith Newton pleaded not guilty and is pending trial. In the indictment, Waruru and Newton are accused of engaging in a conspiracy between January 2013 and January 2017. During that time, Newton was part owner and operator of Arbor Homecare Services LLC. Waruru was a Licensed Practical Nurse employed as a home health nurse at Arbor.
According to the DoJ report, Waruru and Newton are alleged to have engaged in a conspiracy to use Arbor to defraud MassHealth and Medicare of at least $100 million. Their plot involved committing health care fraud and paying kickbacks to induce referrals. Newton then allegedly laundered her illegally obtained earnings.
The duo submitted claims for services that were never provided.
As the DoJ details, Waruru and Newton billed MassHealth and Medicare for home health services that were either never provided or were not medically necessary. As well, they billed for home health services that were not authorized. “Arbor, through Newton and others, developed employment relationships as way to pay kickbacks for patient referrals, regardless of medical necessity requirements,” details the DoJ.
In addition, the duo allegedly entered sham employment relationships with patients’ family members. The deal was for Waruru and Newton to purport to provide home health aide services that were not medically necessary and routinely bill for fictitious visits that did not occur. Newton either directly or through Arbor, targeted particularly vulnerable patients. These patients were either low-income, on disability or suffering from depression and/or addiction.
Waruru and Arbor billed MassHealth for Waruru’s skilled nursing visits.
Many of these visits never occurred, were not medically necessary or were not approved by a physician. Waruru was personally responsible for causing Arbor to bill MassHealth for over $1.2 million in skilled nursing visits. The majority of them were fraudulent. “Waruru also passed cash payments allegedly from Newton to two Arbor patients to retain those patients,” the DoJ reports.
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