For the past decade, a Kenyan nurse based in the United States embodied the image of a successful woman who moved west and struck gold.
With a fledgling company, a well-paying job and a number of properties on the side, the nurse was living the enviable American dream until the long arm of the law caught up with her.
On Tuesday, September 13, the US Government released a statement confirming that the nurse, who worked with an accomplice who is set to undergo trial, pleaded guilty before U.S. Senior District Court Judge George A. O'Toole Jr. to swindling as much as Ksh12 billion (USD100 million) in its healthcare sector.
The operation began in January 2013 while the Licensed Practical Nurse worked as a home health nurse at Arbor Homecare Services LLC.
"According to the indictment, from January 2013 to January 2017, the accomplice was part owner and operator of Arbor Homecare Services LLC. The medic was a Licensed Practical Nurse employed as a home health nurse at Arbor.
"The suspect and an accomplice engaged in a conspiracy to use Arbor to defraud MassHealth and Medicare of at least $100 million by committing health care fraud and paying kickbacks to induce referrals. The accomplice then allegedly laundered the ill-gotten gains," read the statement in part.
According to Massachusetts prosecutors, the scheme was centred around billing the state for either work not done or health visits that were unnecessary.
For instance, Arbor, the company linked to the two, failed to train staff, billed for home health services that were never provided or were not medically necessary and billed for home health services that were not authorised.
"Arbor developed employment relationships as a way to pay kickbacks for patient referrals, regardless of medical necessity requirements.
"They also allegedly entered sham employment relationships with patients' family members to provide home health aide services that were not medically necessary and routinely billed for fictitious visits that did not occur," added the statement.
Further, the nurse was accused of billing MassHealth, a Massachusetts Government health programme, skilled nursing visits, many of which she did not perform, were medically unnecessary, or were not approved by a physician.
The nurse herself is accused of leading to fraudulent billing of up to Ksh144 million (USD1.2 million)
Meanwhile, the two were living large driving a Maserati, Range Rover and snatching up properties that the US is now seeking to repossess. They also reportedly had money in 40 bank accounts.
One nurse pleaded guilty to 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.
According to US law, the charges of health care fraud, conspiracy to commit health care fraud, money laundering conspiracy and money laundering each attracts a sentence of up to 10 years in prison, three years of supervised release and a fine of up to $250,000 (Ksh30 million) or twice the amount of the money involved in the laundering.
The conspiracy to pay kickbacks and make a false statement in health care matters each provide for a sentence of up to five years in prison, three years of supervised release and a fine of up to $250,000 (Ksh30 million).
Sentences are imposed by a federal district court judge based upon the U.S. Sentencing Guidelines and statutes which govern the determination of a sentence in a criminal case.
The accomplice pleaded not guilty and is pending trial.
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