U.S. Attorney: six charged in $1M health care fraud scheme

Five Massachusetts residents and one New York resident have been charged in connection with a scheme to defraud various health insurance companies by submitting fabricated claims seeking reimbursement for over $1 million worth of bogus medical expenses, purportedly incurred during international travel.

Brendon Ashe, 40, of Dorchester; Aqiyla Atherton, 36, of Roxbury; Darline Cobbler, 40, of Randolph; Henry Ezeonyido, 36, of Brockton; Ariel Lambert, 34, of Brooklyn, NY; and Chinenye Nwodim, 36, of Brockton, were charged in a complaint unsealed yesterday with one count each of health care fraud. All six defendants were released on conditions following initial appearances in federal court in Boston.

According to the charging document, the defendants allegedly submitted health insurance claims, or had claims submitted on their behalf, for expensive medical treatment that they purportedly received and paid for out-of-pocket while traveling overseas. The claims submitted to four different insurance companies related to alleged traumatic injuries such as stabbings, hit and run car accidents, as well as gunshot wounds that the defendants purportedly suffered and that required their hospitalization abroad. The complaint alleges that the defendants were in the United States at the time they claimed to be hospitalized in foreign countries. It is further alleged that some of the defendants received unrelated medical services in the United States at the same time they were purportedly hospitalized overseas.

In support of these claims submitted to the insurance companies, the defendants allegedly provided fabricated records - including fake bank records purporting to show payment to the treating facilities, bogus medical records purporting to show the medical care provided, and falsified police reports describing the circumstances of shootings or stabbings. In some instances, the details of the claims submitted by or on behalf of the defendants and supporting documentation - including the dates of service, country where the alleged traumatic injuries occurred, and nature and circumstances of the alleged injuries -are nearly identical to one another. As a result of these fraudulent claims, various health insurance companies were billed over $1 million for services that were never rendered.

"These defendants allegedly fabricated over $1 million in insurance claims for injuries that never happened in a brazen abuse of our healthcare system. This kind of deceit is not only illegal, it victimizes every law-abiding person by diverting resources from those truly in need and driving up costs for everyone," said Acting United States Attorney Joshua S. Levy. "Health care fraud is a serious crime that erodes public trust and undermines the integrity of our healthcare system. Prosecuting health care fraud, in whatever permutation it takes, has always been and remains a top priority."

"Yesterday, the FBI charged six people whose guiding compass appears to have been greed. We believe they feigned injuries they never suffered and submitted bogus claims for medical treatment rendered in overseas hospitals they never set foot in, while most claimed to be victims of violent crimes that never actually took place," said Jodi Cohen, Special Agent in Charge of the Federal Bureau of Investigation, Boston Division. "Unscrupulous schemes like the one we allege here drives up health care costs for all of us which is why the FBI, and our partners won't hesitate to bring to justice anyone who perpetrates blatant and egregious fraud."

"These individuals allegedly lied and said they sustained injuries or illness and had to pay substantial healthcare costs while abroad for their medical needs. We allege that they then fraudulently requested their health insurance carriers to reimburse them for these fictitious costs, including by using the U.S. Mail. Postal inspectors will not let these schemes go unchecked and are committed to protecting the integrity of the U.S. Mail," said Ketty Larco-Ward, Inspector in Charge of the United States Postal Inspection Service, Boston Division.

"Insurance Fraud Bureau of Massachusetts is committed to combating this illegal activity through vigilant investigation and collaboration with our partners. Insurance fraud harms everyone and undermines trust in the insurance system and increase costs of insurance," said Anthony M. DiPaolo, Executive Director of the Massachusetts Insurance Fraud Bureau.

The charge of health care fraud carries a sentence of up to 10 years in prison, up to three years of supervised release, and a fine of up to $250,000, or twice the gross gain or loss from the offense. 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.

Acting U.S. Attorney Levy, FBI SAC Cohen, USPIS INC Larco-Ward and IFB Executive Director DiPaolo made the announcement today. Assistant U.S. Attorneys Leslie Wright and Patrick Callahan of the Criminal Division's Health Care Fraud Unit are prosecuting the case.

The details contained in the complaint are allegations. The defendants are presumed to be innocent unless and until proven guilty beyond a reasonable doubt in a court of law.

* * *

Original text here: https://www.justice.gov/usao-ma/pr/six-individuals-charged-1-million-health-care-fraud-scheme