A 43-year-old resident of Laurel, Md., and Fort Lauderdale, Fla., was arrested today on charges of leading a conspiracy to commit healthcare fraud by overbilling Medicaid in Washington, D.C., for mental health care services to some of the capital’s poorest people.
He and several associates were accused of collecting more than $10 million by billing for mental-health related services that were not medically necessary, not reimbursable, and did not occur.
The extensive scheme shows how a lack of oversight could make it possible for this group to collect millions of dollars, much of it by following slightly arcane rules and also using telehealth, which made it easy for them to seemingly supply a lot of services quickly. Beginning in 2020 and running through 2023, the plan apparently proceeded undetected.
The accused leader, Omolere Omomowo, appeared today U.S. District Court for the Southern District of Florida. A co-defendant, Zilah Bessem, 36, a resident of Frisco, Tex., who previously lived in Maryland, was charged in the same indictment and arrested Thursday evening at Dallas-Fort Worth International Airport. Four other defendants – Gregory Clark of Washington, D.C., Ernest Ikomi of Beltsville, Md., Diane Mochi of Adelphi, Md., and Seraphine Nwufor of Bowie, Md. – are expected to make their initial appearances in the U.S. District Court for the District of Columbia in the next week, according to a press release from the United States Attorney’s Office in the District of Columbia.
Another person was mentioned in the case as “Co-Conspirator 1,” but not named. Court experts said that means this person is either cooperating or charged but not unsealed yet.
The indictment was announced by U.S. Attorney Matthew M. Graves, FBI Special Agent in Charge David J. Scott of the Washington Field Office, and Daniel W. Lucas, Inspector General for the District of Columbia.
Assessments of patients
The indictment says that Omomowo was chief financial officer of a D.C. mental health provider, Prestige Healthcare Resources. Prestige received certification to start an Assertive Community Treatment program, which provides intensive, integrated services to the most at-risk adults, individuals with an “intractable, serious, and persistent mental illness.” For treatment of such people, ACT providers were authorized to submit bills for a greater number of hours and at a higher rate than standard rates given the seriousness of the mental-health and substance-abuse issues faced by program participants.
The indictment alleges that Omomowo directed a scheme under which most or all of the consumers on certain caseworkers’ caseloads were stepped up from standard mental health care to getting services as part of the ACT Program. The people involved are accused of submitting false assessments for services that were not medically necessary, and then billing Medicaid for services that were not necessary and also for services that were not delivered.
“Omomowo and his co-defendants then conspired to and did submit false and fraudulent encounter notes for standard mental health services to Medicaid that (1) grossly inflated the amount of time spent conducting the mental health services; (2) were based on activities not authorized to be reimbursed by Medicaid; and (3) for mental health service encounters that did not occur,” the press release says.
The indictment noted that a lot of this activity took place not in person, but by telehealth visit, under the relaxed telehealth practices of the early pandemic.
“According to the indictment, in April 2021, following an employment dispute with the CEO of Prestige, Omomowo resigned and started a new company, The Marcaulay Group, to continue the fraudulent billing scheme. At Omomowo’s direction, the co-defendant CSWs also left Prestige and joined The Marcaulay Group. The Marcaulay Group, however, was not certified with the Department of Behavioral Health, so Omomowo partnered with D.C.-based mental health service providers Affordable Home Healthcare LLC and later Goshen Healthcare Management Services LLC.”
Proceeds from the scheme, the court papers say, included $10,101,628 in a Wells Fargo account that was used for the purchase of two luxury condominiums and a Mercedes-Benz; $3,835,053 in a Bank of America account that was used for luxury condo payments and a payment to a luxury boat retailer; $3,264,401 in a JP Morgan Chase account used for payments on two Mercedes-Benzes.
The indictment charges all six defendants with conspiracy to commit health care fraud. It also charges Omomowo with an additional 10 counts of substantive health care fraud, and each of the five co-defendants with an additional two counts of health care fraud. In addition, Omomowo is charged with four counts of expenditure money laundering for making large purchases with the money. f convicted, each defendant faces a maximum statutory sentence of 20 years in prison for the conspiracy charge and lesser penalties for the other offenses.
The accused were ordered to forfeit two condos and several cars; a money penalty is possible if conviction follows, the court papers add.
