April 27, 10

NEWS / Owner of Home Health Care Agency in Orange Arrested for Allegedly Defrauding Medicaid of Nearly $5 M

TRENTON - Attorney General Paula T. Dow, Criminal Justice Director Stephen J. Taylor and Medicaid Inspector General Mark Anderson announced the arrest today of the owner of a home health care agency in Orange on charges he submitted a false application to become a Medicaid provider and fraudulently billed Medicaid for services that were never rendered or that were authorized with forged physician signatures. It is alleged that his company, Be Kind Health Care Services Inc., fraudulently billed Medicaid nearly $5 million.

According to Acting Insurance Fraud Prosecutor Riza Dagli, Olasehmdeme “Isaac” Arowosaye, 53, of West Orange, was arrested as the result of a cooperative investigation by the Medicaid Fraud Control Unit of the Office of the Insurance Fraud Prosecutor and the New Jersey Office of the Medicaid Inspector General. He was charged with second-degree health care claims fraud, third-degree Medicaid fraud and third-degree tampering with public records or information.

Detectives and investigators of the Division of Criminal Justice and the Office of the Medicaid Inspector General arrested Arowosaye today near his home. They also executed a search warrant and seized records at the offices of Be Kind Health Care Services at 289 Reynolds Terrace in Orange. Arowosaye was lodged in the Essex County Jail in lieu of $150,000 bail.

“We charge that this defendant, through his home health care company, repeatedly submitted fraudulent claims to Medicaid, including bills for patients who were deceased or in the hospital at the time he claimed to have provided them services in their homes,” said Attorney General Dow. “We have zero tolerance for Medicaid fraud, which costs New Jersey’s Medicaid program, and the state and federal taxpayers who fund it, millions of dollars every year.”

“This office simply will not tolerate somebody seeking to game the system as Mr. Arowosaye tried to do. Today is a good example of how working with our state partners will improve the integrity of the Medicaid Program and protect precious state dollars,” said Medicaid Inspector General Anderson.

Be Kind Health Care Services is owned by Arowosaye and his wife, a registered nurse. The company employs personal care assistants to provide services such as bathing, medical care and assistance with everyday activities to incapacitated patients in their homes.

Be Kind Health Care Services billed Medicaid a total of $4,970,359 for services purportedly rendered between July 2005 and July 2008. However, the investigation revealed that Arowosaye, who is CEO of the company, and Be Kind Health Care Services allegedly billed Medicaid for services that were never rendered, as well as services that were not medically necessary and were authorized by Medicaid based on forged documents.

“Every dollar lost to fraud is one less dollar available to provide much-needed health care services and medicines to residents who otherwise could not afford them,” said Acting Insurance Fraud Prosecutor Dagli. “We will continue to work cooperatively with the Office of the Medicaid Inspector General to aggressively investigate and prosecute Medicaid fraud.”

The investigation began when the Office of the Medicaid Inspector General conducted an audit of Medicaid claims submitted by Be Kind Health Care Services and discovered numerous discrepancies. The Office of the Medicaid Inspector General commenced a full investigation and also referred the matter to the Division of Criminal Justice.

It is alleged that Be Kind Health Care Services billed Medicaid for at least a dozen patients who, in fact, were dead when the services were purportedly rendered. The company also allegedly billed Medicaid for about 30 patients who were in hospitals at the time the company claimed to have provided services. While patients are hospitalized, hospital nurses provide all of their care.

It is also alleged that Be Kind Health Care Services allegedly forged the signatures of a number of doctors on Medicaid forms to make it appear that the doctors authorized services provided by Be Kind Health Care Services. As a result, the company allegedly obtained payment for services which had not actually been authorized by a physician as required by the Medicaid program.

In addition, it is alleged that Be Kind Health Care Services became a Medicaid provider as a result of an application submitted by Arowosaye in 2005 in which he used a false identity and gave other false information. It is alleged that all of the nearly $5 million in payments that Be Kind Health Care Services received from Medicaid were obtained by fraud, because Arowosaye gave a false answer to a material question on the application that, if answered truthfully, would have prevented the company from being approved as a Medicaid provider.

The state will seek full restitution from the company and Arowosaye. The Division of Criminal Justice is filing an asset forfeiture case today seeking to seize assets of Arowosaye.

The investigation was conducted and coordinated for OIFP’s Medicaid Fraud Control Unit by Sgt. Warren Monroe, Deputy Attorney Debra Conrad, and Deputy Attorney General Erik Daab, who is Deputy Chief Counsel of the Medicaid Fraud Control Unit. Deputy Attorney General Carol Stanton Meier, Detective Sgt. Scott Naismyth and Analyst Bethany Schussler are handling the asset forfeiture action for the Division of Criminal Justice.

Second-degree crimes carry a maximum sentence of 10 years in state prison and a criminal fine of $150,000. Third-degree Medicaid fraud carries a maximum sentence of three years in state prison and a criminal fine of $10,000. Third-degree crimes carry a maximum sentence of five years in prison and a $75,000 fine.

The charges are merely accusations and the defendant is presumed innocent until proven guilty. Because the charges are indictable offenses, the allegations must be presented to a state grand jury for potential indictment.

http://www.nj.gov/oag/newsreleases10/pr20100426a.html

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