Federal Grand Jury Charges Grand Prairie Husband and Wife for Medicare Fraud

DALLAS — On December 6, 2017, a husband and wife were indicted on charges that they submitted false and fraudulent claims for home health services and defrauded Medicare of more than $3.4 million, announced U.S. Attorney Erin Nealy Cox of the Northern District of Texas.

Edwin Oparaochaekwe, 53, and Chiazom Oparaochaekwe, 47, both of Grand Prairie, Texas, are charged collectively with 10 counts of health care fraud.  Today, both defendants were arrested and made their initial appearance before a U.S. Magistrate Judge.

The indictment alleges that from December 2011 through May 2017, Prime World Home Health (Prime World) was an approved home health agency located originally in Irving, Texas and most recently in Mansfield, Texas.  Edwin Oparaochaekwe was part-owner of Prime World and worked as a recruiter. Chiazom Oparaochaekwe was a registered nurse and also part-owner of Prime World.

As part of the scheme, the defendants marketed Prime World’s services directly to Medicare beneficiaries, instead of obtaining referrals from physicians who had legitimate physician-patient relationships with patients. To obtain the required physician homebound certifications and plans of care (CMS-485s), the defendants sought and obtained signatures on CMS-485s from physicians who had no prior relationship with the patients, and who, in many cases, never saw or treated them. The defendants sought home health certifications for patients regardless of the patient’s eligibility for home health care.

Prime World employees were directed to submit claims for patients that did not have legitimately signed CMS-485s.  For some of the unsigned CMS-485s, Chiazom Oparaochaekwe forged the signatures by photocopying physician signatures and affixing them on the unsigned document.  Chiazom Oparaochaekwe then placed a copy of the forged document in the patient’s medical record.

An indictment is an accusation by a federal grand jury, and a defendant is entitled to the presumption of innocence unless proven guilty.  If convicted, each of the 10 counts of health care fraud carries a maximum statutory penalty of 10 years in federal prison and a $250,000 fine.  Restitution could also be ordered.  In addition, the indictment includes a forfeiture notification that would require the defendants, upon conviction, to forfeit any property derived from proceeds of the offenses alleged.

The case was investigated by the Department of Health and Human Services-Office of Inspector General, the Federal Bureau of Investigation, and the Texas Medicaid Fraud Control Unit.  Assistant U.S. Attorney Kate Rumsey and Special Assistant U.S. Attorney Jason Meyer are handling the prosecution. 

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