A Kenyan-born nurse in the U.S has pleaded guilty in connection with a $100 million (Sh12 billion) home health care fraud and kickback scheme.
Winnie Waruru of Lowell, Massachusetts, pleaded guilty in federal court in Boston on September 8th, according to a press release from the U.S. Attorney’s Office for the District of Massachusetts.
The 42-year-old Kenyan nurse pleaded guilty to one count of conspiracy to commit health care fraud; one count of health care fraud – aiding and abetting; one count of conspiracy to pay and receive kickbacks; two counts of making false statements; and one count of making a false statement in a health care matter.
U.S. Senior District Court Judge George A. O’Toole Jr. scheduled her sentencing for January 12th, 2023.
Waruru was arrested in February 2021 and charged along with her co-accused Faith Newton, who has denied the charges and is pending trial. She is set to appear in court for a motion hearing on October 3rd.
From January 2013 to January 2017, Newton was part owner and operator of Arbor Homecare Services LLC while Waruru was a Licensed Practical Nurse employed as a home health nurse at Arbor, according to the indictment.
The two are alleged to have engaged in a conspiracy to use Arbor to defraud MassHealth and Medicare of at least $100 million by committing health care fraud and paying kickbacks to induce referrals. Newton then allegedly laundered the ill-gotten gains.
“Specifically, it is alleged that Arbor, through Newton, Waruru and others, failed to train staff, billed for home health services that were never provided or were not medically necessary and billed for home health services that were not authorized,” the U.S. Attorney’s Office said in the press release.
Arbor, through Newton and others, developed employment relationships as a way to pay kickbacks for patient referrals, regardless of medical necessity requirements. They are also alleged to have entered sham employment relationships with patients’ family members to provide home health aide services that were not medically necessary and routinely billed for fictitious visits that did not occur.
“As alleged in the civil complaint, Newton either directly or through Arbor, targeted particularly vulnerable patients who were low-income, on disability and/or suffering from depression and/or addiction,” U.S. Attorney’s Office added.
Prosecutors say Waruru and Arbor billed MassHealth for Waruru’s skilled nursing visits, many of which she did not perform, were medically unnecessary, or were not approved by a physician.
Waruru, who faces up to 15 years in prison, was personally responsible for causing Arbor to bill MassHealth for over $1.2 million in skilled nursing visits, much of which was fraudulent. She also passed cash payments allegedly from Newton to two Arbor patients to retain those patients.