Health care fraud has become one of the hottest areas of federal law enforcement in recent months as the Obama administration embarks on sweeping reforms to the nation’s health system.
Now in a headline grabbing case in Texas, the FBI has announced the arrest of Dr. Emmanuel Nwora, 48, of Houston, who is accused of health care fraud and conspiracy to commit health care fraud, United States Attorney Kenneth Magidson has announced.
The indictment also charged Charles Harris, 52. It alleges that for three years from 2007 to 2010, the two men falsely billed Medicare and Medicaid using vestibular diagnostic codes. The indictment claimed they billed Medicare and Medicaid about $850,000 and were paid $390,000.
Vestibular problems are balance problems linked to the inner ear. Patients often report chronic dizziness.
Nwora ran a family practice clinic in Houston called Houston Optimum Care Medical Association, while Harris operated Cevine Health Care and Rehabilitation Center in Houston.
Courthouse News reported Nwora faces up to 130 years in federal prison, 10 years on each count, and a $250,000 fine, if he’s convicted.
Health care fraud is a white collar crime that takes many forms. Practitioner schemes can include obtaining subsidized or fully-covered prescription pills that are not required and selling them on the black market for a profit or billing by doctors for treatment that was never carried out.
In July the Obama administration announced a joint initiative with insurance providers to crack down on health care fraud.
“This partnership brings together the resources and best practices of government and private sectors, giving us an unprecedented ability to detect and stamp out health care fraud,” Kathleen Sebelius, the health and human services secretary, told the New York Times.
When agents detect evidence of fraud they can provide insurers with the names of doctors, hospitals and suppliers suspected of misconduct.
However, when agents are under pressure to prioritize a law enforcement area from above, there is inevitably pressure for results and the potential for miscarriages of justice. With these federal offenses carrying such heavy penalties, it’s important to ensure agents aren’t overly zealous in the way they carry out their work.
Both Clint Broden & Mick Mickelsen have represented several health care professionals charged in federal court with health care fraud. Clint Broden recently won an appeal in a health care fraud case before the United States Court of Appeals for the Fifth Circuit.
