缅因州六人涉医保诈骗被起诉：一家护理公司被指虚报逾60万美元、服务根本没上门
美国缅因州 Cumberland 县 South Portland 市一家居家护理公司的六名人员被联邦大陪审团起诉并于 10 月 27 日被捕。美国司法部缅因区联邦检察官办公室（USAO）宣布，六人被控合谋实施医疗保健诈骗，公司本身也被列为被告；其中两人另被控妨碍医疗保健诈骗调查，一人另被控作虚假陈述。
被起诉的六人是 Noora Abd（37 岁）、Faysal Kalayaf Manahe（51 岁）、Adel Al Rashid（47 岁）、Sura Almohammed（47 岁）、Ether Alyaseen（46 岁）与 Mohammed Alkhalaf（41 岁），被告公司为 Community Home Health Care LLC。起诉书称，这家持证个人护理机构总部位于 South Portland，由 Noora Abd 所有并经营，其余被告受雇担任个人支持专员等职务；机构通过她向缅因州医疗补助计划 MaineCare 申报并获得护理服务费用。
起诉书指控，被告提交虚假的电子探访验证（EVV）记录，谎称已为客户提供个人护理服务、实际上服务并未进行；自 2020 年以来，仅就一名客户，公司与 Noora Abd 就提交了大量申报、总额超过 60 万美元。Noora Abd 与 Faysal Kalayaf Manahe 另被控妨碍调查，Mohammed Alkhalaf 另被控作虚假陈述。
联邦检察官 Andrew B. Benson 表示，医疗保健诈骗损害所有人的利益，保护联邦资助医疗计划的完整性至关重要。联邦调查局（FBI）波士顿分局、卫生与公共服务部监察长办公室（HHS-OIG）、国土安全调查局（HSI）与国税局刑事调查局（IRS-CI）参与调查，缅因州医疗补助诈骗控制部门提供协助；此案属国土安全特别工作组（HSTF）行动的一部分。
按司法部公布的量刑上限，医疗保健诈骗共谋罪成立最高可判 10 年监禁、25 万美元罚金或按诈骗总损失两倍计罚，外加最长 3 年监督释放；妨碍调查与虚假陈述罪名成立各最高可判 5 年。起诉书仅为指控，全部被告在法庭以排除合理怀疑证明有罪之前均推定无罪。
Six Charged in Maine Health Care Fraud Case: Company Accused of Billing More Than $600,000 for Care Never Provided
Six people tied to a home care company in South Portland, Cumberland County, Maine, were arrested on October 27 after being indicted by a federal grand jury. The U.S. Attorney's Office for the District of Maine announced that the six are charged with health care fraud conspiracy and that the company itself is also charged; two of them additionally face charges of obstructing a health care fraud investigation, and another is charged with making false statements.
The defendants are Noora Abd, 37, Faysal Kalayaf Manahe, 51, Adel Al Rashid, 47, Sura Almohammed, 47, Ether Alyaseen, 46, and Mohammed Alkhalaf, 41, along with Community Home Health Care LLC. According to the indictment, Community is a licensed personal care agency headquartered in South Portland, owned and operated by Noora Abd, with the other defendants employed as personal support specialists and in other capacities. Through Abd, the company billed and was paid by MaineCare, Maine's Medicaid program, for personal care services.
The indictment alleges the defendants submitted false Electronic Visit Verifications claiming to have performed personal care services for clients when the services had not been performed, and that since 2020, Community and Abd submitted numerous claims for services purportedly provided to a single client totaling more than $600,000.
U.S. Attorney Andrew B. Benson said health care fraud costs everyone and that protecting the integrity of federally funded health care programs is paramount. The case was investigated by the FBI's Boston Division, the U.S. Department of Health and Human Services Office of Inspector General, Homeland Security Investigations and IRS Criminal Investigation, with assistance from Maine's Medicaid Fraud Control Unit, as part of the Homeland Security Task Force initiative.
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, and up to three years of supervised release; obstruction and false statement convictions each carry up to five years. 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：位于 Portland 的 Edward T. Gignoux 联邦法院大楼，缅因区联邦法院所在地。照片：美国总务管理局（GSA）、公共领域，经 Wikimedia Commons。 / The Edward T. Gignoux U.S. Courthouse in Portland, Maine. Photo: U.S. General Services Administration, public domain, via Wikimedia Commons.
