According to numerous reports published by the United States Department of Justice, Medicare continues to take immense hits from members of the medical community. The seemingly endless instances of health care fraud have bilked the national health insurance program of millions upon millions of dollars. Just yesterday, the DOJ reported that a Houston, Texas-based trio was found guilty for their roles in a $17 million Medicare fraud scheme.
The three-person team of fraudsters is made up of 64 year-old physician, John P. Ramirez and clinic owners and operators, 62 year-old Ann Nwoko Shepherd and 30 year-old, Yvette Nwoko. After a six-day trial, the trio was convicted of one count of conspiracy to commit health care fraud.
Individual charges were also handed down.
“Nwoko was convicted of three counts of health care fraud, Shepherd was convicted of six counts of health care fraud and Ramirez was convicted of three counts of false statements relating to health care matters,” explains the DOJ report, “Sentencing is scheduled for Dec. 12 before U.S. District Judge David Hittner of the Southern District of Texas, who presided over the trial.”
The report goes on to detail the evidence that was presented at the trial. Between approximately December 2011 to August 2015, Ramirez, Shepherd and Nwoko plotted to defraud Medicare out of payments for medical services. Shepherd was the owner and operator of Southwest Total Medical Inc., which operated as Amex Medical Clinic in Houston. Through the clinic, she sold medical orders and other documents that were signed by Ramirez to home-health agencies in the Houston area.
Ramirez provided fraudulent medical orders.
As part of the scheme, the doctor falsified information about the medical conditions and subsequent requirements of patients in the medical orders. They were sold by Shepherd to co-conspirators who worked at home-health agencies. The purchased fraudulent paperwork was then used to bill and receive payments from Medicare. The billed medical services were neither medically necessary nor provided to patients.
“Later in the conspiracy and scheme, Nwoko acted as the manager of Amex Medical Clinic where she too sold false and fraudulent paperwork used by co-conspirators to bill and receive payment from Medicare for similarly unnecessary medical services, the evidence showed,” reports the DOJ.
In addition, the report continues, Shepherd also caused Amex Medical Clinic to bill Medicare for both physician services that were actually provided by an unlicensed practitioner and medical services that were never provided at all. In total, the trio of Ramirez, Shepherd and Nwoko bilked Medicare out of $17 million.
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