缅因州6人被捕涉医疗诈骗：被控为未提供的个人护理服务向MaineCare虚假申报,单名客户申报逾60万美元
美国司法部缅因区检察官办公室宣布,缅因州6名居民在联邦大陪审团起诉后被捕,被控合谋实施医疗诈骗,涉案机构Community Home Health Care LLC通过虚假电子探访验证,自2020年以来仅为一名客户就向缅因州医疗补助计划MaineCare申报了逾60万美元的个人护理服务费用。
据起诉书,被控的6人为Noora Abd(又名Um Mohammed,37岁)、Faysal Kalayaf Manahe(又名Abu Aziz,51岁)、Adel Al Rashid(又名Abu Ayman,47岁)、Sura Almohammed(又名Um Ayman,47岁)、Ether Alyaseen(46岁)和Mohammed Alkhalaf(又名Abu Stayf,41岁),涉案公司Community Home Health Care LLC一并被起诉。Noora Abd与Faysal Kalayaf Manahe另被控妨碍医疗诈骗调查,Mohammed Alkhalaf另被控作虚假陈述。
起诉书称,Community Home Health Care LLC是一家总部位于South Portland、持有执照的个人护理机构,由Noora Abd拥有和经营,其余被告曾在该机构担任个人护理支持专员等职务。被告提交虚假的电子探访验证(Electronic Visit Verifications),声称已为机构客户提供了个人护理服务,而这些服务实际从未提供。自2020年以来,Community与Noora Abd仅为起诉书中代号为Client 1的一名客户,就向MaineCare提交了多笔个人护理服务申报,总额逾60万美元,并已获支付。
缅因区联邦检察官Andrew B. Benson表示,医疗诈骗以各种形式损害所有人的利益,此次逮捕应表明,凡按起诉书所述从医疗系统中窃取资金牟利者,都将被关停并绳之以法。联邦调查局FBI波士顿分局负责人Ted E. Docks表示,6名被告被指以未提供的服务骗取MaineCare数十万美元,其中两人还被指试图妨碍调查。
如合谋医疗诈骗罪名成立,被告最高面临10年监禁、25万美元罚款或相当于欺诈申报总损失两倍的罚款,以及最高3年监督释放;妨碍医疗诈骗调查最高面临5年监禁,作虚假陈述最高面临5年监禁。此案由联邦调查局FBI、卫生与公众服务部监察长办公室HHS-OIG、国土安全调查局HSI和国税局刑事调查局IRS-CI调查,缅因州医疗补助诈骗控制部门提供协助。起诉书仅为指控,所有被告在法庭被证明有罪之前均推定无罪。
Six Maine Residents Arrested in Health Care Fraud Conspiracy: Over $600,000 in MaineCare Claims for One Client Alleged
Six Maine residents were arrested after a federal grand jury indicted them for health care fraud conspiracy, the U.S. Attorney's Office for the District of Maine announced. Community Home Health Care LLC, a licensed personal care agency headquartered in South Portland, allegedly submitted false Electronic Visit Verifications to MaineCare and, since 2020, billed more than $600,000 for personal care services for a single client, identified in the indictment as Client 1.
As alleged in the indictment, Noora Abd, also known as Um Mohammed, 37, Faysal Kalayaf Manahe, also known as Abu Aziz, 51, Adel Al Rashid, also known as Abu Ayman, 47, Sura Almohammed, also known as Um Ayman, 47, Ether Alyaseen, 46, Mohammed Alkhalaf, also known as Abu Stayf, 41, and Community Home Health Care LLC are charged with health care fraud conspiracy. Noora Abd and Faysal Kalayaf Manahe are also charged with obstructing a health care fraud investigation, and Mohammed Alkhalaf is charged with making false statements.
According to the indictment, Noora Abd owned and operated Community, and the other defendants were employed by Community as personal support specialists and in other capacities. Community, through Noora Abd, billed and was paid by MaineCare for personal care services. The indictment alleges the defendants submitted false Electronic Visit Verifications claiming to have performed personal care services for clients when those services had not been performed.
U.S. Attorney Andrew B. Benson said health care fraud in all its forms costs everyone, and that the arrests should make clear that those who steal from the health care system for financial gain will be shut down and brought to justice. Ted E. Docks, Special Agent in Charge of the FBI's Boston Division, said the six allegedly netted hundreds of thousands of dollars in fraudulent claims for services not provided, and that two are accused of trying to obstruct the investigation.
If convicted of health care fraud conspiracy, the defendants face up to 10 years in prison, a fine of $250,000 or twice the total loss due to fraudulent claims, and up to three years of supervised release. Obstructing a health care fraud investigation and making false statements each carry up to five years in prison. The FBI, the U.S. Department of Health and Human Services Office of Inspector General, Homeland Security Investigations, and IRS Criminal Investigation investigated the case, with assistance from Maine's Medicaid Fraud Control Unit. An indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
来源：GSM·美国（原文链接）
图片来源：图：缅因州 Portland 老港区 Commercial Street 街景，本案涉案机构 Community Home Health Care LLC 位于邻近的 South Portland。照片：Dirk Ingo Franke，CC BY-SA，经 Wikimedia Commons。 / The Old Port district of Portland, Maine, near South Portland, where Community Home Health Care LLC is based. Photo: Dirk Ingo Franke, CC BY-SA, via Wikimedia Commons.
