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Lewiston Men Sentenced for Million-Dollar Health Care Fraud

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 PORTLAND, Maine— Two Lewiston men were sentenced today in U.S District Court in Portland for health care fraud, Acting U.S. Attorney Donald E. Clark announced.

U.S. District Judge Jon D. Levy sentenced Abdirashid Ahmed, 41, to two years in prison and three years of supervised release, and Garat Osman, 35, to three years of probation. Judge Levy also ordered Ahmed to pay $1,863,264.83 and Osman to pay $544,097.78 in restitution to MaineCare. Both men pleaded guilty in May 2019.

According to court records, Ahmed and Osman were interpreters who conspired with several Lewiston/Auburn mental health counseling services to defraud MaineCare. One of the counselors was Nancy Ludwig, who was the owner of Facing Change, a mental health and substance abuse counseling agency in Lewiston. From about November 2015 until May 2018, Ludwig and Ahmed led a conspiracy to commit health care fraud by submitting claims to MaineCare for services that were not rendered as billed.

Beginning in February 2015, Ludwig agreed to pay Ahmed a kickback in return for Ahmed bringing MaineCare beneficiaries to Facing Change. Ludwig, Ahmed and other employees at Facing Change then caused false and fraudulent claims to be submitted to MaineCare for both counseling and interpreter services. The false claims included claims for visits that never occurred and claims that inflated the level of service provided. In 2016, in response to a MaineCare regulatory change, Ludwig and Ahmed conspired to change the diagnosis of many of Ahmed’s clients to schizophrenia so they could remain eligible to receive MaineCare reimbursement for the services at Facing Change.

In the fall of 2016, auditors with the MaineCare Program Integrity Unit audited Facing Change. Ludwig and many of her employees conspired to manufacture false and fraudulent records in an attempt to deceive the auditor. Osman joined the fraud scheme in December 2016 and established an interpreter company that received all the fraudulent payments from that time until early May 2019. In May 2019, agents with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), the FBI and the Maine Attorney General’s Office executed search warrants at Facing Change and Ahmed’s business. Investigators eventually determined that MaineCare was defrauded of $1,863,264.83 in this fraud scheme.

“Healthcare fraud depletes funds intended to provide care for our most vulnerable citizens,” said Phillip M. Coyne, Special Agent in Charge for HHS-OIG. “Today’s sentencing is a strong reminder that we will spare no resources to bring to justice those that undermine the integrity of our federal health care system and those served by it. I appreciate the continued partnership with the Maine U.S Attorney’s Office to protect public funds.”

“Federal and state investigators did tremendous work in uncovering this fraud scheme,” said Acting U.S. Attorney Clark. “The U.S. Attorney’s Office was proud to be part of the team that brought these defendants to justice. We will always aggressively pursue those who attempt to defraud the public in this fashion.”

People who suspect health care fraud are encouraged to report it by calling 1-800-HHS-TIPS.

This prosecution was the result of a three-year collaborative investigation by HHS-OIG, the FBI and the Maine Attorney General’s HealthCare Crimes Unit. The investigation started because of the auditing work done by the MaineCare Program Integrity Unit.



Source: http://criminal-justice-online.blogspot.com/2021/07/lewiston-men-sentenced-for-million.html


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