Two Lewiston men sentenced to pay $2.4M for defrauding MaineCare
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Two Lewiston men were sentenced Friday to pay a total of $2.4 million in restitution for defrauding MaineCare, the state's Medicaid health benefits program.
Two Lewiston men must pay $2.4 million in restitution, and one will face prison time, under sentences issued Friday in a federal health care fraud prosecution.
In U.S. District Court in Portland, Judge Jon D. Levy sentenced Abdirashid Ahmed, 41, to two years in prison and three years of supervised release, and Garat Osman, 35, to three years of probation. Levy also ordered Ahmed to pay $1,863,265 and Osman to pay $544,098 to MaineCare, the state’s Medicaid health benefits program.
Both men pleaded guilty to federal charges in May 2019.
Ahmed and Osman were interpreters who conspired with several mental health counseling services in the Lewiston-Auburn area to defraud MaineCare, according to a news release from Acting U.S. Attorney Donald Clark.
One of the counselors was Nancy Ludwig, who was the owner of Facing Change, a counseling agency in Lewiston. From November 2015 to May 2018, Ludwig and Ahmed led a conspiracy to commit fraud by submitting claims to MaineCare for services that were not provided as billed, Clark said. Ludwig's legal status was not addressed in Clark's release.
The false claims included ones for visits that never occurred and claims that inflated the level of services provided. In 2016, in response to a MaineCare regulatory change, Ludwig and Ahmed conspired to change the diagnosis of many of Ahmed’s clients so they could remain eligible to receive MaineCare reimbursement for the services at Facing Change.
In the fall of 2016, auditors with the MaineCare Program Integrity Unit audited Facing Change. Ludwig and many of her employees conspired to manufacture false records in an attempt to deceive the auditor, according to Clark.
Osman joined the scheme in December 2016 and established an interpreter company that received all the fraudulent payments until May 2019.
In May 2019, agents with the U.S. Department of Health and Human Services, the FBI and the Maine Attorney General’s Office executed search warrants at Facing Change and Ahmed’s business.
“Federal and state investigators did tremendous work in uncovering this fraud scheme,” Clark said in the release. “The U.S. Attorney’s Office was proud to be part of the team that brought these defendants to justice. We will always aggressively pursue those who attempt to defraud the public in this fashion.”
Phillip M. Coyne, special agent in charge for the DHHS Office of Inspector General, added, “Today’s sentencing is a strong reminder that we will spare no resources to bring to justice those that undermine the integrity of our federal health care system and those served by it. I appreciate the continued partnership with the Maine U.S Attorney’s Office to protect public funds.”
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