Medicare Fraud Schemer Gets 40 Years for $17M in Fraudulent Billing

Medicare Fraud Schemer Gets 40 Years for $17M in Fraudulent Billing

The man behind a recently uncovered Medicare fraud scheme amounting to $17 million in fraudulent billing has been sentenced to decades in federal prison.

medicare logoGodwin Oriakhi was the owner of several home health care clinics in Houston, and worked with his daughter to run the clinics. The clinics were community-driven, according to court documents, and were meant to offer support for people with developmental disabilities, as well as home visits for people with certain medical needs.

Between 2009 and 2016, Oriakhi and his daughter allegedly submitted a large number of claims to both Medicare and Medicaid that were not actually medically necessary. In other cases, these claims were allegedly submitted even when a patient never received these services, unnecessary or not. Patients were brought in for these services through a number of marketers, who would then provide kickbacks.

According to investigators, the staff at these clinics were not salaried or even paid hourly. Instead, staff were paid on a per-patient basis. This clearly encouraged the Medicare fraud kickback scheme to keep going, prosecutors alleged, as new patients needed to be brought in and medical services needed to be rendered in order for staff to be paid—even, apparently, if these services were medically unnecessary.

Court documents note that the Oriakhi paid doctors to falsify documentation showing that patients had conditions qualifying them for home health services, even though they did not.

All in all, the clinics ended up submitting fraudulent claims amounting to $17.2 million over the course of these seven years involved in the Medicare fraud scheme. Out of that, they were reimbursed for almost all of it—nearly $16.2 million.

Oriakhi pleaded guilty to Medicare fraud this last March. His daughter, who ran the clinics alongside him, has also pled guilty, and is set to be sentenced in mid-November.

Oriakhi was sentenced to 40 years in federal prison, and wasn’t the only one involved in the fraudulent billing scheme to be sentenced. A nurse for one of the clinics was sentenced to five years in prison. A recruiter who admitted to helping bring in hundreds of patients in exchange for kickbacks is also facing sentencing.

Reporting Medicare Fraud

Whistleblower lawsuits are filed by employees or former employees who have found evidence of fraud or other illegal activities against the government. Many of these employees choose to come forward, acting as whistleblowers, because they feel that their employer’s actions are wrong—even if they are worried about retaliation.

When a person is considering becoming a whistleblower on behalf of the government, they may worry about being fired or otherwise retaliated against at work. However, there are regulations in place to protect whistleblowers. On top of these protections, whistleblowers are typically given a substantial reward for calling attention to the misconduct. Whistleblowers are usually given between 15 and 30 percent of the money recovered if the government wins at trial.

Many whistleblower lawsuits end up bringing in millions in settlement money, so a whistleblower monetary reward can be substantial.

If you believe you have witnessed some kind of fraud against the government by your current or former employer, you may be able to file a whistleblower lawsuit (also known as a qui tam lawsuit) against your employer on behalf of the government. Such lawsuits have been filed over Medicare Fraud, Medicaid fraud, health insurance billing fraud, physician/hospital kickbacks, and many other types of government financial fraud.

Contact the whistleblower attorneys at Bradley/Grombacher today for a free consultation regarding your claims.

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