Jury Convicts Houston Father and Daughter of Health Care Fraud
|U.S. Attorney’s Office April 08, 2011|
HOUSTON—The owners of a Houston area durable medical equipment company have been convicted by a jury of multiple counts of health care fraud arising from their roles in a scheme to defraud Medicaid through fraudulent billing for adult urinary incontinence supplies, United States Attorney José Angel Moreno and Texas Attorney General Greg Abbott announced today.
Bassey Essien, 60, and his daughter, Rose Essien, 31, of Houston, were found guilty on April 7, 2011, after an eight-day trial of multiple felony counts. Bassey Essien was convicted of all 19 counts alleged in the indictment against him—including conspiracy, health care fraud, and aggravated identity theft. Rose Essien was convicted of 15 of the 19 counts including 11 counts of health care fraud and five counts of aggravated identity theft. A third defendant, the Essien’s delivery driver, was acquitted on all counts.
Through the operation of Logic World Medical and Roben Medical, both durable medical equipment (DME) companies located in Houston, the Essiens unlawfully received Medicaid beneficiaries’ information, including names, addresses, and Medicaid numbers, which they then use to file false claims with the Medicaid program.
The evidence showed that the Essiens routinely billed Medicaid for adult urinary incontinence supplies they did not deliver to the Medicaid beneficiaries or for delivering supplies in amounts significantly less than the amounts billed to Medicaid. Additionally, the Essiens routinely billed Medicaid for adult urinary incontinence supplies provided to Medicaid beneficiaries who either did not need the supplies or whose physicians had not prescribed them. Adult incontinence supplies include adult diapers, underpads, wipes and pull-up briefs.
Through their DME company, the defendants continued to bill Medicaid for incontinence supplies even after their delivery staff and/or delivery contractors were told by the beneficiaries they did not need or want the supplies. They regularly billed Medicaid for the delivery of 300 diapers, the maximum allowed amount of incontinence supplies each month per beneficiary, and for extra-large size diaper briefs, which have the highest Medicaid reimbursement rate, without consideration to the actual size needed by the beneficiary. They even billed Medicaid for delivering a quantity of extra large adult size diapers far in excess of the amount they purchased from wholesale suppliers. The evidence showed the defendants only purchased six percent of the amount of extra large diapers they claimed to have delivered.
The scheme to defraud began in April 2004, under the company Logic World, with the last false claim having been filed in February 2010 under the name Roben Medical. The Essiens billed Medicaid for claims totaling approximately $2,341,293.64 and received payments for those claims totaling approximately $1,455,837.91.
Over government objection, the court has permitted Bassey and Rose Essien to remain on bond pending sentencing on July 8, 2011
Benjamin Essien, 34, Bassey Essien’s son, pleaded guilty to conspiracy to commit health care fraud, health care fraud, and aggravated theft in advance of trial.
All three defendants face a maximum of 10 years’ imprisonment and a $250,000 fine for the conspiracy conviction as well as each health care fraud conviction. Each count of aggravated identity theft carries a mandatory two-year consecutive term of imprisonment.
This case was the result of the investigative efforts of the Health and Human Services Office of the Inspector General, the Texas Attorney General’s Medicaid Fraud Unit in Houston, and the FBI. Special Assistant United States Attorney Justo A. Méndez and Assistant United States Attorney Al Balboni are prosecuting the case.