Author: Steven Chao

Anatomy of an OIG Record Part II

From the oig.hhs.gov website.

“OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect;  felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances.”

Sometimes an individual who has been in trouble will move to another state and attempt to resume or practice their medical profession. Such was the case with Laura Lynn Bell, who also went by the name Sukanlaya Hughes.

Laura Bell was a nurse in Arizona when her license was suspended in 2015 for domestic violence arrest among other things. From there she went on to defraud Veteran Affairs of almost $800,000. Without a license, and with charges against her, Laura attempted to steal an identity, forging documents and papers in the name of Alicia Houston. This was a skill she was already adept with since she stole identities of nurse practitioners and former patients to bill for medical services while working for VA.

A quick glance on nursys shows Laura Bell was able to practice nursing in six different states with a seventh as an applicant for a nurse practitioner in North Dakota before she was caught and her licenses revoked.

People like Laura Bell must be carefully scrutinized because they do what they can to slip under the radar and emerge somewhere else where they can continue to harm the people they look after. This makes it essential to check against databases such as the Federal OIG because these databases allow checks by SSN. Undoubtedly there will be those who find a way to change their social security numbers, but the extra precaution might unearth clues to things behind the scenes.

Sources

https://www.azfamily.com/archives/arizona-nurse-indicted-after-scamming-thousands-of-dollars-from-insurance-companies/article_fdc4eec5-1678-572d-8441-2dcbc0f691fc.html

https://www.bizjournals.com/phoenix/news/2019/01/02/chandler-nurse-practitioner-indicted-over-alleged.html

https://www.nursys.com/

Anatomy of an OIG Record

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.


 *    https://oig.ssa.gov/about-oig