Maryland Woman Arrested on Federal Charges Alleging She Defrauded D.C. Medicaid Program

            WASHINGTON – A Maryland woman who was employed as a personal care aide was arrested today on federal charges stemming from a scheme in which she allegedly submitted nearly $400,000 in false claims to the District of Columbia’s Medicaid program.

            The announcement was made by U.S. Attorney Jessie K. Liu, Special Agent in Charge Matthew J. DeSarno, of the FBI Washington Field Office’s Criminal Division, District of Columbia Inspector General Daniel W. Lucas, and Special Agent in Charge Maureen R. Dixon, of the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), for the region that includes Washington, D.C.

            Hope Omone Falowo, 42, of Bowie, Md., was arrested on a criminal complaint charging her with health care fraud and making health care false statements. She made her first appearance in the U.S. District Court for the District of Columbia. She was released on personal recognizance pending a hearing set for July 19, 2018.

            According to the complaint, Falowo was employed as a personal care aide from approximately January 2013 through March 2017. Under the Medicaid program, personal care aides perform services intended to assist Medicaid beneficiaries in carrying out the activities of daily living. These can include helping beneficiaries get in and out of bed, bathe, dress, eat out, take medication, and engage in toileting. To receive personal care services under Medicaid, a beneficiary must obtain a prescription from a doctor.

            Last year, Falowo’s billing practices drew the attention of the District of Columbia Department of Health Care Finance, and that led to an investigation. According to the complaint, the investigation determined that Falowo submitted approximately $399,165 in false claims between 2013 and 2017. The complaint alleges that these claims fall into three categories: claims purporting that she provided services in excess of 24 hours in a given day; claims purporting that she provided services when she was in fact on international travel; and claims purporting that she provided services to Medicaid beneficiaries to whom she provided no care at all. 

             The charges in criminal complaints are merely allegations, and every defendant is presumed innocent unless and until proven guilty beyond a reasonable doubt. The statutory maximum penalty for a charge of health care fraud is 10 years of incarceration.  The statutory maximum for health care false statements is five years of incarceration. The maximum statutory sentence is prescribed by Congress and is provided here for informational purposes. If convicted of any offense, a defendant’s sentence will be determined by the court based on the advisory Sentencing Guidelines and other statutory factors.

            The investigation into this matter was conducted by the FBI’s Washington Field Office, the District of Columbia Medicaid Fraud Control Unit, and the Office of Inspector General for the U.S. Department of Health and Human Services.

            The case is being prosecuted by Trial Attorney Amy Markopoulos of the Justice Department’s Criminal Division, with assistance from Paralegal Specialist Robert Fishman.

            The arrest this morning was among the results of the nation’s largest ever health care fraud enforcement action. Attorney General Jeff Sessions and Department of Health and Human Services (HHS) Secretary Alex M. Azar III, announced results of the nationwide effort earlier today. All told, the enforcement action involves 601 charged defendants across 58 federal districts, including 165 doctors, nurses and other licensed medical professionals, for their alleged participation in health care fraud schemes involving more than $2 billion in false billings.  Of those charged, 162 defendants, including 76 doctors, were charged for their roles in prescribing and distributing opioids and other dangerous narcotics.