Not Even a Prince

 9/9/26 City Journal recounts how a Nigerian tribal chief has earned $30 million from Medicaid, bought mansions in California, while submitting inadequate documentation to California:

That business, CHHA, dates back at least to 2013, when Agnes submitted its first publicly listed utilization report. She appears to have filed that mandatory form for every year through 2019. California’s Health Care Access and Information department told City Journal that since then, it has not received a report from CHHA “despite continued requests.”

In the years that followed, CHHA’s Medicaid revenues exploded. In 2018, the agency received just $89,570. In 2022, CHHA pulled in nearly $4 million. Across the following two years, the company garnered over $17 million and $13 million, respectively.

Do You Ever Wonder What Old Football Players Do When They Get Too Old to Play?

 5/8/26 U.S. Department of Justice:

A former NFL player who owned a marketing company and was the beneficial owner of eight durable medical equipment (DME) companies was sentenced yesterday to 196 months in prison for his role in a yearslong scheme to bilk Medicare and the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) out of nearly $200 million by selling patient information and sham doctors’ orders for orthotic braces that patients did not want or need.

In addition to the prison sentence, the defendant, Joel Rufus French, 47, of Armory, Mississippi, was ordered to pay $110,753,619 in restitution and to forfeit approximately $17 million that the government seized from bank accounts and other assets.  

“Fueled by lies, bribes, and overseas telemarketers, this corrupt scheme preyed on senior citizens and disabled veterans to flood the country with unnecessary medical devices — and then billed the taxpayer for it,” said Assistant Attorney General Colin M. McDonald of the Justice Department’s National Fraud Enforcement Division. “Today’s sentence makes clear that if you target America’s elderly, sick, or vulnerable — and rob America’s purse doing so — you will be targeted and brought to justice.”

This is at least in the "Never steal anything small" category.  8/13/26 Ohio Attorney-General:

(COLUMBUS, Ohio) — Indictments filed this week by the office of Ohio Attorney General Andy Wilson accuse six Medicaid providers of stealing a combined $558,383 from the government healthcare program for the needy....

Among those indicted:

• Rasheedah Biles, 42, of Pickerington, is charged with Medicaid fraud and theft in connection with Reset Tomorrow, a Columbus behavioral-health program for children that she owns and operates. The MFCU began investigating Biles after a referral in May 2025 flagged her for excessive billing. The investigation revealed that she allegedly directed employees to inflate claims for services to children in Reset Tomorrow’s after-school program and summer camp, and to residents of a group home for foster children. The fraudulent claims included upcoding and billing for services that were never provided, resulting in a $404,810 loss for Medicaid between November 2023 and October 2025.
   
• Dorika Carter, 41, of Columbus, is accused of falsifying timesheets. She claimed to have provided home-health services while a client was hospitalized, when she was working a separate full-time job and during a six-month period when she could not work due to medical reasons. The loss to Medicaid totaled $6,661.
   
• Carol Dawes-Willis, 59, of Hillsboro, allegedly billed for homemaker and personal care services on dates that she did not visit the client. Electronic visit-verification data, text messages and other documentation confirmed that no services were provided on the billed dates. The loss to Medicaid between January 2024 and October 2025 totaled $4,510.
   
• Yvette Johnson‑Woodall, 58, of Youngstown, faces charges after allegedly defrauding Medicaid of $83,857 between April 2021 and February 2026. Investigators found that she billed for therapeutic behavioral services for four clients during extended periods when no services were provided, including stretches when the clients were homeless or hospitalized. Records also show that some of her billed service hours overlapped with her shifts at a job as a school bus aide.
   
• Sasi Kaza, 55, of Clinton, was charged following an investigation that revealed a $53,405 loss to Medicaid. As the owner of Moonlight Home Health Care in Austintown, Kaza is accused of routinely billing for the maximum number of authorized hours regardless of whether services were provided. The fraudulent claims included billing for dates when clients were hospitalized and, in some cases, after they had died.
   
• Binetou Ndao, 37, of Columbus, allegedly billed for full shifts as a home-health aide despite routinely arriving late and leaving early. Data from her employer’s electronic visit-verification system showed her clocking in and out at locations other than the client’s residence. The loss to Medicaid between January 2025 and January 2026 totaled $5,140.

Medicare Fraud Guilty Plea

 8/27/26 KTLA:

An Anaheim woman pleaded guilty Thursday to submitting more than $2.2 million in fraudulent Medicare claims for hospice care for patients who were not terminally ill, federal prosecutors announced.

Lynn Galbraith, 60, pleaded guilty to one count of health care fraud, according to the U.S. Attorney’s Office for the Central District of California.

Galbraith was the co-owner and operator of Garden Grove-based Azure Hospice Care Inc. from September 2019 until July 2022, when she became its sole owner. She remained the owner until February 2024.

During that time, prosecutors said Galbraith knowingly submitted claims to Medicare for hospice services provided to patients who did not have a terminal illness with a life expectancy of six months or less, as required to qualify for the benefit.

According to her plea agreement, Galbraith either knew the patients did not qualify for hospice care or knew there were insufficient medical records to support diagnoses and prognoses that would make them eligible.

Prosecutors said she also did not routinely coordinate with patients’ primary care physicians about their purported conditions or terminal prognoses.

In one example cited by federal officials, Galbraith submitted a $6,600 Medicare claim in October 2022 for hospice services provided to a patient despite knowing there was insufficient medical documentation to establish that the person was eligible for hospice care.

Can we balance the budget. Sure "A million here, a million there, after a while it adds up to real money." And put off the inevitable bankruptcy of Medicare. 

4/16/26 U.S. Attorney's press release:

SAN DIEGO – Former teacher Jeanett Valenzuela Ayub pleaded guilty in federal court today, admitting that she conspired with others to launder millions of dollars of health care fraud proceeds.

In total, Valenzuela admitted that she and her co-conspirators billed Medicare nearly $51 million for bogus prescriptions and were paid approximately $20 million, ultimately laundering at least $14 million dollars of Medicare proceeds and paying $3.7 million in unlawful kickbacks.

On April 7, the Department of Justice announced the creation of the National Fraud Enforcement Division. The core mission of the Fraud Division is to zealously investigate and prosecute those who steal or fraudulently misuse taxpayer dollars.  Department of Justice efforts to combat fraud support President Trump’s Task Force to Eliminate Fraud, a whole-of-government effort chaired by Vice President J.D. Vance to eliminate fraud, waste, and abuse within Federal benefit programs

According to her plea agreement, Valenzuela and co-conspirators owned and operated multiple durable medical equipment (DME) companies, which sold orthotics – including back, wrist, and knee braces – to Medicare beneficiaries.

Valenzuela admitted that in operating the DME companies, she and co-conspirators paid unlawful kickback payments to sham marketing companies who provided bogus prescriptions for DME. The prescriptions were signed by physicians who had no legitimate doctor-patient relationship with the beneficiary; had not conducted a legitimate medical evaluation of the beneficiary; and had not impartially determined that the beneficiary actually needed the DME.