Thursday, February 6, 2014

Hospital administrator and businessmen sentenced to prison for submitting fraudulent cost reports to Medicare

MONROE, La. (AP) — A former Madison Parish Hospital administrator and two of its vendors have been sentenced for health care fraud.
U.S. Attorney Stephanie A. Finley said Tuesday that U.S. District Judge Robert G. James sentenced Charles W. Alford, 71, of Newellton, to 37 months in prison and ordered him to pay $1.3 million in restitution.
James also sentenced Barney W.I. Hughes IV, 45, of Keller, Texas, to a year in prison and ordered him to pay $566,874 restitution and Henry R. Ham, 65, of West Monroe, to 14 months in prison and $817,000 in restitution.
According to evidence presented at Monday's guilty plea, Alford was hospital administrator for Madison Parish Hospital in Tallulah; Hughes served as owner of Tech Solutions of Keller, Texas; and Ham, was owner of Insurance World in Monroe.
Both Hughes and Ham paid Alford a combined total of more than $1.3 million in kickbacks for his approval and continuation of their business agreements.
Madison Parish Hospital leased equipment and personnel from Tech Solutions to operate the hospital's nuclear medicine and ultrasound departments.
At no time did Alford or Hughes disclose to the hospital's board or Medicare that they had an exclusive agreement. From October 2006 to June 2012, the hospital paid Hughes' company $2,029,504, and Hughes paid Alford $566,874 of that total. They submitted fraudulent cost reports to Medicare at least six times from December 2006 to 2011.
Madison Parish Hospital purchased a majority of its health insurance and life insurance products from Ham. Alford and Ham negotiated and set the insurance policy rates and Alford approved Ham's billings as well as the hospital's payments to Ham.
From 2007 through April 2012, the hospital paid Ham $4,979,487, and Ham paid Alford $817,000 of that total. They submitted fraudulent cost reports to Medicare at least five times from December 2007 to 2011.

Husband, wife and business associate charged with health care fraud

William Owuama, 55, Marla Owuama, 46, and Florida Holiday Island, 64, all of Houston, have been charged in an eight-count indictment alleging conspiracy to commit health care fraud, health care fraud and conspiracy to violate the federal anti-kickback statute, announced United States Attorney Kenneth Magidson.

The sealed indictment, returned Jan. 22, was unsealed this afternoon as all three defendants made their initial appearance before U.S. Magistrate Judge Frances Stacy at 2 p.m. At the hearing, Judge Stacy permitted Marla Owuama and Island be released upon posting bond. Upon surrendering his passport, William Owuama is also expected to be released upon posting bond.

The indictment alleges William Owuama was the owner of Wilmar Healthcare Systems, his wife Marla was a registered nurse and Island transported patients to and from the clinic. According to allegations, they not only paid patients for visiting the clinic in violation of the anti-kickback statute, but billed Medicare and Medicaid for vestibular testing that was never performed. The indictment also alleges the clinic billed Medicare and Medicaid under the provider number of a local doctor while that doctor was incarcerated on unrelated charges. From January 2006 through October 2009, Medicare and Medicaid paid Wilmar more than $4 million based on the alleged fraudulent claims.

If convicted, all three defendants face up to five years in federal prison and a $250,000 fine for conspiring to commit healthcare fraud and violating the anti-kickback statute. The Owuamas also face up to 10 years in prison and a $250,000 fine for the substantive healthcare fraud charges.

The investigation leading to the charges in this case was conducted by the U.S. Department of Health and Human Services – Office of Inspector General and the Texas Attorney General’s Office Medicaid Fraud Control Unit. Special Assistant United States Attorney (SAUSA) Adrienne Frazior and AUSAs Andrew Leuchtmann and John Pearson are prosecuting the case.

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