医疗机构两名高管被起诉骗取华盛顿特区Medicaid数百万美元：虚报账单约1400万美元、几分钟通话按一小时计费
美国司法部哥伦比亚特区联邦检察官办公室11月5日宣布，一份在联邦地区法院解封的10项起诉状，指控华盛顿特区一家医疗机构的两名高管和一名社区支持工作者，涉嫌为从未提供的青少年心理健康服务向华盛顿特区医疗补助（Medicaid）虚报账单，或以严重虚高的费率开账，给该计划造成数百万美元损失。此案由联邦检察官 Jeanine Ferris Pirro 宣布，案件编号 26-CR-263。
Pirro 表示：「任何窃取纳税人资助计划资金的人都不安全。据指控，这些被告把 Medicaid 当作个人提款机，靠从未提供的服务虚报账单、造成数百万美元损失，并把钱花在豪华车辆和其他奢侈消费上。我们将继续揭露和起诉欺诈，直到这些骗局被瓦解、纳税人的钱得到保护。」
起诉状称，2022年1月至2025年2月期间，Quality Healthcare Services 向华盛顿特区 Medicaid 就心理健康康复服务（MHRS）开出约1,400万美元账单。该公司为来自低收入家庭的青少年提供心理健康康复服务。
被告 Mwasi Songambele 现年52岁，是坦桑尼亚公民、住在马里兰州 Laurel，身上有一份待执行的最终递解令；她是该公司的实际控制高管、负责日常运营，被控一项共谋医疗保健欺诈、四项医疗保健欺诈和一项共谋洗钱。其女 Maya Cheyo 现年31岁、住在弗吉尼亚州 Brambleton，是该公司运营总监兼人力资源总监，被控一项共谋医疗保健欺诈和两项医疗保健欺诈。第三名被告 Vanessa Kuh 现年29岁、住在马里兰州 Lanham，是该公司的社区支持工作者，被控罪名与 Cheyo 相同。
起诉状称，Songambele 指导员工如何记录 MHRS 并向 Medicaid 开账：她与 Cheyo、Kuh 及至少三名未具名同谋，被指虚增 MHRS 的服务时长，或记录根本没有发生的服务。Songambele 要求所有 MHRS 远程通话一律按4个单位（约一小时）计费，哪怕通话只有几分钟；为躲避华盛顿特区行为健康局的审查，管理层要求把服务时长随机填在53至67分钟之间，让通话时长看起来更真实。她还要求「务必用满」每名远程服务对象获批的全部600个单位——那是 Medicaid 为每名服务对象在180天内授权的总量——不论是否有医疗必要、也不论服务是否真的提供。
起诉状还寻求没收一批豪华车辆，包括2024款与2023款奔驰 G550、2022款奔驰2500货运厢式车、2020款奔驰 C300、2023款路虎卫士各一辆，以及位于马里兰州 Laurel 的 Tranquility Road 7000号段的一处房产和一块卡地亚 Panthere 中号手表。
此案由联邦调查局（FBI）华盛顿外勤办公室、哥伦比亚特区监察长办公室 Medicaid 欺诈控制组与卫生与公众服务部监察长办公室侦办，助理联邦检察官 Jason Facci 负责起诉。起诉状所载只是指控，三名被告在法庭证明有罪之前均推定无罪。
（来源：美国司法部哥伦比亚特区联邦检察官办公室）
Healthcare Provider Executives Indicted in Multi-Million-Dollar D.C. Medicaid Fraud: About $14 Million Billed, Minutes-Long Calls Charged as an Hour
The U.S. Attorney's Office for the District of Columbia announced on November 5 that a 10-count indictment unsealed in U.S. District Court charges two executives of a District-based healthcare provider and one of their community support workers in connection with a scheme to bill D.C. Medicaid for mental health services for juveniles that were never provided or were invoiced at grossly inflated rates, causing losses of millions of dollars to the D.C. Medicaid program. U.S. Attorney Jeanine Ferris Pirro announced the case, numbered 26-CR-263.
"No one stealing from taxpayer-funded programs is safe. As alleged, these defendants treated Medicaid as a personal piggy bank in a scheme that caused millions in losses, billing for services never provided while funding luxury vehicles and other extravagant purchases," said U.S. Attorney Pirro. "We will continue to uncover and prosecute fraud until these schemes are dismantled and taxpayer dollars are protected from abuse."
According to the indictment, from January 2022 through February 2025, Quality Healthcare Services billed D.C. Medicaid approximately $14 million for Mental Health Rehabilitation Services. The company, Quality Healthcare Services, LLC, provides mental health rehabilitative services to youth and adolescent beneficiaries from low-income families.
Mwasi Songambele, 52, is a citizen of Tanzania who resides in Laurel, Maryland, and has a pending final order of removal from the United States. She is the controlling executive of the company and runs its day-to-day operations, and is charged with one count of conspiracy to commit health care fraud, four counts of health care fraud, and one count of conspiracy to commit money laundering. Maya Cheyo, 31, of Brambleton, Virginia, is Songambele's daughter and the company's Chief Operating Officer and Human Resources Director; she is charged with one count of conspiracy to commit health care fraud and two counts of health care fraud. Vanessa Kuh, 29, of Lanham, Maryland, a community support worker at the company, is charged with the same counts as Cheyo.
According to the indictment, Songambele instructed employees on how to document and bill Medicaid for Mental Health Rehabilitative Services (MHRS). She, along with Cheyo, Kuh, and at least three other unnamed co-conspirators, allegedly inflated the amount of time spent conducting MHRS or documented MHRS encounters that never occurred. Songambele allegedly instructed the co-conspirators to bill four units, or about one hour, for all MHRS telehealth encounters even if the call only lasted a few minutes. To avoid scrutiny from the D.C. Department of Behavioral Health, management instructed them to pick a random time for the length of service, between 53 and 67 minutes, to make the length of the telehealth call appear more realistic. She additionally instructed them to "make sure to use" all 600 units for a telehealth consumer — the total amount authorized by Medicaid for a consumer during a 180-day period — without regard to medical necessity and without regard to whether the services had actually been performed.
The indictment also seeks the forfeiture of a fleet of luxury vehicles, including a 2024 Mercedes-Benz G550, a 2023 Mercedes-Benz G550, a 2022 Mercedes-Benz 2500 Cargo Van, a 2020 Mercedes-Benz C300, and a 2023 Land Rover Defender, as well as a house on the 7000 block of Tranquility Road in Laurel, Maryland, and a Panthere de Cartier watch, medium model.
The investigation was conducted by the FBI Washington Field Office, the D.C. Office of the Inspector General's Medicaid Fraud Control Unit, and the Department of Health and Human Services Office of Inspector General. The matter is being prosecuted by Assistant U.S. Attorney Jason Facci. An indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.
(Source: U.S. Attorney's Office for the District of Columbia)
来源：美国司法部哥伦比亚特区联邦检察官办公室
发布：GSM·美国（发布链接）
图片来源：图：位于华盛顿的美国司法部总部罗伯特·肯尼迪大楼。本案由哥伦比亚特区联邦检察官办公室宣布起诉。APK 摄，CC BY 4.0，经 Wikimedia Commons。 / Photo: The Robert F. Kennedy Department of Justice Building in Washington. The indictment was announced by the U.S. Attorney's Office for the District of Columbia. By APK, CC BY 4.0, via Wikimedia Commons.
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