In short
- Two individuals face additional charges for obstructing the investigation, and one is charged with making false statements.
- If convicted, defendants face up to 10 years in prison and $250,000 fines.
What happened
Six individuals and one company in Maine were arrested after a federal grand jury indicted them for health care fraud conspiracy. The indictment alleges they submitted false Electronic Visit Verifications and billed MaineCare for services not performed, with claims totaling more than $600,000 for a single client.
Two defendants are also charged with obstructing the health care fraud investigation, and one with making false statements. The case was investigated by the FBI, HHS-OIG, Homeland Security Investigations, and IRS-CI, with assistance from Maine’s Medicaid Fraud Control Unit, as part of the Homeland Security Task Force initiative.
The indictment further alleges that since 2020, Community and Noora Abd have submitted numerous claims to MaineCare for personal care services purportedly provided to a single Community client, identified in the indictment as Client 1, totaling more than $600,000.
In numbers
- $600,000 False MaineCare claims for one client
- 10 years Maximum prison sentence for health care fraud conspiracy
- $250,000 Maximum fine per count
What compliance teams should check
- Review all claims submitted to MaineCare by Community Home Health Care LLC since 2020 for possible false Electronic Visit Verifications.
- Screen for staff or entities linked to Noora Abd, Faysal Kalayaf Manahe, and Mohammed Alkhalaf for potential involvement in similar fraud typologies.
- Monitor for obstruction or false statement charges related to health care fraud investigations, as highlighted in this indictment.
Why it matters
This case highlights the risks of internal collusion and document falsification in health care billing, with over $600,000 in fraudulent claims submitted to a public program. Compliance officers must be vigilant for false Electronic Visit Verifications and ensure robust controls to detect and prevent similar schemes. The involvement of multiple agencies and the Homeland Security Task Force underscores the seriousness of such fraud and the potential for significant penalties, including lengthy prison sentences and substantial fines.
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