Health Care Fraud: Nurse Convicted, Aided And Abetted Her Employer’s Illegal Scheme.

Health Care Fraud: Nurse Convicted, Aided And Abetted Her Employer’s Illegal Scheme.

Legal Eagle Eye Newsletter for the Nursing Profession

August 2018

The nurse argued in her defense that she was not directly involved in billing and did not personally submit any false documentation to Medicare. However, it was proven that she personally committed a number of acts with the specific intent to aid and abet her employer in the commission of health care fraud. Her conviction is upheld. UNITED STATES COURT OF APPEALS FIFTH CIRCUIT July 10, 2018

A nurse was convicted of aiding and abetting health care fraud committed by her employer, a home health agency. A Federal statute makes it a criminal offense knowingly and willfully to execute or attempt to execute a scheme to defraud any health care benefit program or to obtain money or property from a health care benefit program by false or fraudulent pretenses, representations or promises. A criminal conviction for aiding or abetting the commission of a criminal offense requires proof that the accused was associated with the criminal venture, participated in it and sought to make the venture succeed.

In her defense the nurse argued that she simply worked as a home health nurse, saw her patients as needed, performed the appropriate nursing services and was paid a salary for her work. She claimed the evidence showed no specific intent to advance her employer’s scheme.

The Government's case argued first and foremost, the nurse signed medical records pertaining to her patients which she knew her employer would submit to Medicare that falsely represented that certain Medicare beneficiaries qualified for home health. The nurse was proven to have misrepresented the care that she herself provided to her patients on forms required by Medicare that she did not herself submit to Medicare but knew that her employer would submit.

Careful review of her documentation showed that sometimes she was ostensibly working with more than one patient at the same time. She told some of her patients to sign blank timesheets for the services she supposedly provided to them. In other cases the nurse simply went ahead and forged her patients’ signatures on the timesheets herself. Kickbacks were paid to the nurse’s patients on behalf of her employer. The nurse was fully aware that such payments are expressly prohibited by Medicare regulations.

From the evidence the US Court of Appeals for the Fifth Circuit (Texas) was convinced the nurse herself acted with intent to defraud the US government. Her sentence of thirty-three months imprisonment was upheld along with a requirement that she and her employer repay the government $4.7 million as restitution. US v. Anyanwu, __ Fed. Appx. __, 2018 WL 3385502 (5th Cir., July 10, 2018).