The responsibility of the Office of the Inspector General (OIG) is the following:
- Oversee the economy, efficiency, and effectiveness of the administration of SSA programs.
- Prevent and detect fraud, waste, and abuse in SSA programs and operations.
- Inform SSA and Congress about agency problems and deficiencies and recommend corrective action*
At TyphoonDATA, we use the exclusion database provided by the United States Department of Health and Human Services (HHS) to search for those who may have had disciplinary actions in the past and are no longer eligible for SSA programs.
Let’s take a look at two people on the exclusion list.
Charles Esechie worked at Baptist Home Care Providers (Baptist) in the Houston area for a man named Godwin Oriakhi. While there, Esechie knew Oriakhi was operating an illegal kickback scheme. In fact, he also knew a few of the patients there were homeless and were referred to Baptist by recruiters.
Not only did he know, but eventually Esechie became part of the schemes when he defrauded Medicare by submitting fraudulent claims. Sometimes, he’d claim to be working Baptist when in reality he was working at a hospital. To cover for this, Esechie copied patient information from set templates given to him by Oriakhi and by others working at Baptist.
By the time Esechie and Oriakhi were caught, they had defrauded approximately $4,792,199 in false claims.
Many similar cases exist and it is up to departments like the OIG to discover, report, and exclude these individuals who are working the system to their advantage.
Evelyn Mokwuah of Pearland, Texas was caught in a similar scheme. She worked at Beechwood Home Health and Criseven Health Management Corporation where evidence at trial showed she defrauded Medicare of millions in fraudulent claims. Like Esechie, Evelyn was involved with recruiters who went out to find Medicare beneficiaries, claimed falsified information on patients, and billed for patients who did not qualify for services.
All total, Mokwuah was convicted of $20 million in the scheme.
As seen above, one or two individuals alone could cost Medicare millions. These are just two examples among the many that occur each year not including those who have not been discovered.
Both Charles Esechie and Evelyn Mokwuah are on the federal OIG exclusion list and because TyphoonDATA checks these lists as well as other databases such as System for Award Mangement (SAM), these individuals will get flagged and marked.