A press release from the U.S. Attorney’s Office, Western District of North Carolina:
CHARLOTTE, N.C. – Steven Osbey, of Kernersville, N.C., has agreed to entry of a consent judgment against him in the amount of $4,711,159.00 in favor of the United States and State of North Carolina (the Governments), subject to a separate agreement regarding his participation in the Governments’ ability to pay process. The judgment represents repayment to the government for allegations that Reign & Inspirations, LLC (R&I), a clinic co-owned by Osbey and Aljihad Shabazz, charged Medicaid for physician home visits that never occurred.
More specifically, the Governments alleged Osbey and Shabazz conspired to carry out an extensive health care fraud scheme wherein they submitted or caused to be submitted claims to NC Medicaid for in-home physician visits with patients that simply never occurred—in all, billing more than 30,000 hours of these purported physician visits and sometimes billing as if the physician provided over 100 in-home visits in a single day, purportedly lasting an hour each (an obvious physical impossibility).
This investigation was conducted in parallel between the civil and criminal divisions of the U.S. Attorney’s Office. Shabazz pleaded guilty to criminal healthcare fraud conspiracy and money laundering charges and was sentenced to 52 months in prison followed by two years of supervised release.
The civil settlement obtained in this matter was the result of a coordinated effort between the Department of Justice and the FBI field offices in Charlotte, with assistance from the Medicaid Investigations Division of the North Carolina Attorney General’s Office, and the Office of Inspector General of the United States Department of Health and Human Services. AUSAs Caroline McLean and Seth Johnson were responsible for the civil investigation.
The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).
If you are wondering whether the patients knew their protected health information was being misused, consider this explanation by the DOJ in a previous press release about this case:
Between 2017 and 2020, Shabazz conspired with other individuals to carry out an extensive health care fraud scheme involving the fraudulent submissions of fake reimbursement claims to Medicaid, for services that were never provided to Medicaid beneficiaries. Court records show that Shabazz obtained the personal identifying information (PII) of Medicaid beneficiaries through community outreach programs, including football and mentoring programs, and misused the beneficiaries’ PII to create and submit hundreds of fraudulent reimbursement claims and to receive payment for services that were never in fact provided by R&I. Over the course of the scheme, Shabazz used the beneficiaries’ PII to submit more than 1,500 fraudulent reimbursement claims to Medicaid, some of which claimed that R&I provided services that exceeded 24 hours in a single day.
Do people ever check their Explanation of Benefits statements? Did anyone spot that some doctor unknown to them had billed Medicaid for services to them that they never needed or received?
