Maine

May 26, 2010

Winslow Woman Sentenced for Bank Fraud, Embezzlement and Health Care Fraud Offense (U.S. Attorney for the District of Maine)

Bangor, Maine - United States Attorney Paula D. Silsby announced on May 26, 2010, that Karen B.Dumont, 65, of Winslow, Maine, was sentenced to a term of 18 months/years of imprisonment in U.S. District Court in Bangor, Maine, for bank fraud, embezzlement and unlawfully obtaining employment with a health care provider after her exclusion from participation in Medicare and state health care programs as a result of a previous health care fraud conviction. Ms. Dumont was also sentenced to 60 months of supervised release and ordered to pay a fine of $7,000. Ms. Dumont pleaded guilty to these charges on February 22, 2010.

According to court records, Karen Dumont, a bookkeeper and medical billing specialist formerly employed by a Waterville physician, engaged in a scheme to steal and embezzle for her own personal gain by diverting, forging, and depositing insurance claim reimbursement checks addressed to and made payable to the medical practice for medical services it provided to patients. Court records also show that, unbeknownst to the medical practice, Ms. Dumont had previously been excluded from participating in federally-funded health care programs because of a previous conviction for healthcare fraud.

The investigation leading to today’s sentencing was conducted by the by the Office of the

Inspector General (OIG) for the U.S. Department of Health and Human Services and the Office of the Maine Attorney General. HHS-OIG Special Agent in Charge Susan Waddell stated: “We will continue to work closely with the Healthcare Crimes Unit of the Maine Attorney General’s Office and the Division of Program Integrity to identify individuals who work in violation of their federal exclusion, and those businesses who employ such excluded individuals. Medical facilities have a duty to check the HHS excluded provider data base to protect the patients they serve, and protect themselves from potential liability.”

United States Attorney Silsby praised the investigation conducted by the Office of the

Inspector General (OIG) for the U.S. Department of Health and Human Services and the Office of the Maine Attorney General.

April 16, 2010

Rockland Woman Sentenced on Federal Health Care Fraud and Drug Charges (U.S. Attorney for the District of Maine)

Portland, Maine - United States Attorney Paula D. Silsby announced that Rochelle Kenney, 51, of Rockland, was sentenced on April 16, 2010, in U.S. District Court in Bangor, Maine, to 60 months imprisonment, 3 years supervised release, a special assessment of $200, and ordered to pay restitution of $160.91 to MaineCare. As an additional condition of supervised release that she is to serve upon her release from prison, Chief U.S. District Judge John A. Woodcock, Jr., ordered that Kenney provide written notice to her treating physicians and pharmacists that she has a history of drug abuse and prescription medication diversion. Kenney pled guilty on June 9, 2009, to health care fraud and distribution of methadone.

Court records reveal that between December 2003 and July 2006, Kenney was a methadone patient at methadone clinics and obtained prescription medications from Knox County area pharmacies during that time. Methadone clinics are health care benefit programs and submit claims and receive payment from MaineCare, Maine’s Medicaid program which is funded in part with federal money. MaineCare is also a health care benefit program which paid for her methadone treatment and prescription medications.

Kenney was a methadone clinic patient who committed fraud in order to obtain “take home doses” of methadone and prescription medications between January 2004 and April 2005. She sold, gave away, traded or otherwise distributed the methadone and prescription medications to others, including to her brother, John Kenney, in April 2005. John Kenney used the methadone he received from his sister, Rochelle, and died within hours of having taken it. In a prior sentencing hearing, the Court found that drugs had not killed John Kenney.

The Government had argued that the defendant was a “state-subsidized drug dealer” whose illegal conduct impacted countless others in the community. Knox County Sheriff Donna Dennison addressed the Court and stressed the problems associated with prescription medication diversion being experienced by Knox County and Maine generally. She asked that the Court impose a sentence that would send a strong deterrent message to those who would divert their pharmaceuticals.

In imposing sentence, the Court upwardly departed 27 months from the otherwise applicable sentencing guideline range. The Court found that the defendant’s conduct violated a public trust and was, in effect, “killing the community” of Rockland. The Court also found that the defendant had never truly accepted responsibility for diverting drugs to her brother and countless others.

United States Attorney Silsby praised the investigation conducted by the Knox County Sheriff’s Office, the Maine Drug Enforcement Agency, and the Chief Medical Examiner’s Office, as well as the assistance provided by the U.S. Drug Enforcement Administration.

January 8, 2010

Ambulance Services, Inc. & Northern Maine Medical Center Settle Federal Health Care Billing Issues (U.S. Attorney for the Eastern District of Maine)

Portland, Maine: On Jan. 8, 2010, United States Attorney Paula D. Silsby today announced a civil settlement with Ambulance Services, Inc. (“ASI”) and Northern Maine Medical Center (“NMMC”), located in Fort Kent.

The settlement involved improper billings to the Medicare and Medicaid programs for ambulance services provided by ASI. As part of the settlement, ASI and NMMC have paid $1,032,000 in full satisfaction of any outstanding claims.

The government alleged between 2003 and 2005, ASI and NMMC made a series of false representations in the reimbursement claims they submitted to the Medicare and Medicaid programs for ambulance services provided by ASI. Specifically, the government alleged that ASI and NMMC repeatedly billed Medicare and Medicaid for expensive "Advanced Life Support" ambulance services when the actual ambulance services rendered were for less expensive "Basic Life Support." The alleged improper bills were initially submitted by ASI. In 2005, NMMC assumed responsibility for managing ASI billing, and the government alleged that NMMC knew or should have known the billing was improper and failed to rectify the problem.

The investigation began when, in 2006, government officials performed a statistical review of the ASI and NMMC reimbursement claims to Medicare and Medicaid. When informed of those finding, ASI and NMMC fully cooperated and performed a self-audit, which confirmed the amount of the overpayment.

The settlement ends an investigation that was conducted by the Office of Inspector General, U.S. Department of Health & Human Services, and the U.S. Attorney's Office.

U.S. Attorney Silsby praised the investigation conducted by all of those involved.

December 22, 2009

Auburn Man and Portland Woman Indicted on Federal Health Care Fraud and Benefit Fraud Charges (U.S. Attorney for the Eastern District of Maine)

Portland, Maine: United States Attorney Paula D. Silsby announced today that Ahmed Yusuf Guled, 74, of Auburn, Maine, and Dahabo Abdulle Osman, 58, of Portland, Maine, were indicted by a federal grand jury in a twenty-three count indictment.

According to U.S. Attorney Silsby, the indictment alleges that from 2006 to 2009, Guled and Osman conspired with each other to commit health care fraud offenses with respect to personal care services that were reimbursed by MaineCare under the Adults with Disability and Elderly Waiver Program. Under this program, MaineCare members who are eligible to be admitted into a nursing home because they are unable to care for themselves may choose to receive the services of a personal care assistant in their home. The indictment alleges that Ahmed Guled made false statements to nurse assessors in order to qualify for personal care services that were not necessary. According to the indictment, Dahabo Osman was then paid to serve as Guled's personal care assistant based upon false and fictitious time sheets. U.S. Attorney Silsby stated that MaineCare paid out more $61,000 based upon false claims caused by Guled and Osman.

U.S. Attorney Silsby also stated that Ahmed Guled and Dahabo Osman were charged with making false statements with respect to their applications or their continued eligibility to receive federal benefits. These federal benefits include Supplemental Security Income payments issued by the Social Security Administration, public housing or Section 8 subsidized housing funded by the U.S. Department of Housing and Urban Development, MaineCare and Temporary Assistance to Needy Families (TANF) funded, at least in part, by the U.S. Department of Health and Human Services, and food stamps, now know as Supplemental Nutrition Assistant Program (SNAP) benefits, funded by the U.S. Department of Agriculture. The indictment alleges that Guled failed to disclose or falsely reported the number of bank accounts he owned and the balances in those accounts while Dahabo Osman failed to disclose that she received wages as a personal care assistant. For example, according to the indictment, in August 2007 Ahmed Guled failed to disclose to the Maine Department of Health and Human Services during a review of his MaineCare, SNAP and TANF benefits that he owned three bank accounts with combined balances than exceeded $25,000. U.S. Attorney Silsby stated that both Guled and Osman were charged with theft of U.S. government property, namely, SSI, MaineCare, SNAP, and TANF benefits.

Guled was indicted on a total of sixteen counts, three which have a maximum term of imprisonment of ten years each. The remaining thirteen counts have a maximum term of imprisonment of five years each. Osman was charged in twelve counts, three of which have a ten year maximum term of imprisonment and nine of which have a five year maximum term of imprisonment. The maximum fine for each count in the indictment is $250,000.

This matter was investigated by special agents or investigators from the following law enforcement agencies: the respective Inspector General's Offices of the U.S. Department of Health & Human Services, Housing and Urban Development, Agriculture, and Social Security Administration, as well as the FBI, the U.S. Bureau of Immigration and Customs Enforcement, the Internal Revenue Service, Criminal Investigation, the U.S. Postal Inspection Service, the U.S. Attorney's Office, the Healthcare Crimes Unit of the Maine Attorney General's Office, and the Fraud Investigation and Recovery Unit and Program Integrity Unit of the Maine Department of Health & Human Services.