In a case of health care fraud, a Collin County man has been sentenced to federal prison for wire fraud violations. Oscar Simon Ndereva, a resident of Frisco, Texas, pleaded guilty to wire fraud and has been sentenced to 54 months in federal prison. The scheme involved the use of a fraudulent healthcare pharmacy called “Healogix” to submit fraudulent claims to private pay health insurance payors. Ndereva funneled the fraudulently obtained funds into bank accounts he had opened under another individual’s name, moving the money through various accounts to conceal its nature and source. The total amount of fraudulent claims submitted by Ndereva’s company, Healogix, exceeded $5 million. The case was investigated by the FBI and Health and Human Services-Office of Inspector General.
Title
Collin County Man Sentenced for Federal Violations Related to Health Care Fraud Scheme
Overview
Summary of the case
A Frisco man named Oscar Simon Ndereva has been convicted and sentenced to federal prison for wire fraud violations in the Eastern District of Texas. Ndereva was involved in an intricate scheme to defraud private pay health insurance payors by using a fraudulent healthcare pharmacy called “Healogix” to submit fraudulent claims. He caused the fraudulently obtained funds to be paid directly to bank accounts opened in the name of another individual. Ndereva moved the money through various accounts to conceal its nature and source, and also structured check cashing transactions to avoid financial reporting requirements and evade law enforcement detection. Healogix submitted over 780 fraudulent claims totaling over $5 million.
Sentencing details
Oscar Simon Ndereva has been sentenced to 54 months in federal prison by U.S. District Judge Sean D. Jordan. The sentencing came after Ndereva pleaded guilty to wire fraud. The investigations into the case were conducted by the FBI and the Health and Human Services – Office of Inspector General.
Background
Introduction to Collin County Man’s case
The case of Oscar Simon Ndereva, a Frisco man, involves his participation in a health care fraud scheme. Ndereva used a fraudulent healthcare pharmacy called “Healogix” to submit fraudulent claims and defraud private pay health insurance payors. He concealed the nature and source of the fraudulently obtained funds by moving money through various accounts. Ndereva also engaged in check cashing transactions to avoid financial reporting requirements and evade law enforcement detection.
Overview of health care fraud scheme
The health care fraud scheme carried out by Ndereva involved the submission of fraudulent claims through the fictitious healthcare pharmacy, Healogix. These claims were aimed at defrauding private pay health insurance payors. Ndereva orchestrated the scheme to obtain funds that were then paid directly to bank accounts opened in the name of another individual. In total, Healogix submitted over 780 fraudulent claims, amounting to more than $5 million.
Key Players
Oscar Simon Ndereva
Oscar Simon Ndereva is the main individual involved in the health care fraud scheme. He used a fraudulent healthcare pharmacy, Healogix, to submit fraudulent claims and defraud private pay health insurance payors. Ndereva orchestrated the movement of fraudulently obtained funds through various accounts and engaged in check cashing transactions to evade law enforcement detection.
U.S. District Judge Sean D. Jordan
U.S. District Judge Sean D. Jordan presided over the case of Oscar Simon Ndereva. He sentenced Ndereva to 54 months in federal prison for his wire fraud violations related to the health care fraud scheme.
Scheme Details
Involvement of Healogix
Healogix is a fraudulent healthcare pharmacy that played a central role in the health care fraud scheme carried out by Ndereva. Ndereva used Healogix to submit fraudulent claims to private pay health insurance payors, aiming to defraud them and obtain funds.
Fraudulent claims submitted
Ndereva and his company, Healogix, submitted over 780 fraudulent claims as part of the health care fraud scheme. These claims amounted to over $5 million. The claims were aimed at defrauding private pay health insurance payors.
Money laundering and check cashing transactions
To conceal the nature and source of the fraudulently obtained funds, Ndereva engaged in money laundering activities. He moved the funds through various accounts, making it difficult to trace their origin. Ndereva also structured check cashing transactions to avoid financial reporting requirements and evade detection by law enforcement authorities.
Investigation
FBI involvement
The Federal Bureau of Investigation (FBI) played a crucial role in investigating the health care fraud scheme carried out by Oscar Simon Ndereva. The FBI worked alongside other law enforcement agencies to gather evidence, track the movement of funds, and build a case against Ndereva.
Health and Human Services – Office of Inspector General involvement
The Health and Human Services – Office of Inspector General (HHS-OIG) was also involved in the investigation into the health care fraud scheme. The HHS-OIG worked in collaboration with the FBI and other agencies to uncover the fraudulent activities carried out by Ndereva and Healogix.
Sentencing and Conviction
Oscar Simon Ndereva pleaded guilty to wire fraud in relation to the health care fraud scheme. He was subsequently sentenced to 54 months in federal prison by U.S. District Judge Sean D. Jordan. The sentencing reflects the seriousness of Ndereva’s crimes and serves as a deterrent to others engaged in similar fraudulent activities.
Related Cases
California Man Convicted of Health Care Kickback Conspiracy
In a separate case in the Eastern District of Texas, a California man was convicted of federal violations related to a health care kickback scheme. The case involved a conspiracy to receive kickbacks in exchange for patient referrals. The conviction highlights the ongoing efforts to crack down on health care fraud across different regions.
California Man Sentenced to Federal Prison for Role in Health Care Kickback Conspiracy
A California man was sentenced to federal prison for his role in a health care kickback conspiracy. The conspiracy involved receiving kickbacks in exchange for patient referrals. The sentencing serves as a warning to those involved in fraudulent activities within the health care industry.
21 Charged, Including Hospital and Lab CEOs, in Connection with Multistate Healthcare Kickback Conspiracy
In another case involving health care fraud, 21 individuals, including CEOs of hospitals and labs, were charged in connection with a multistate healthcare kickback conspiracy. The charges highlight the extent of the fraudulent activities carried out within the health care industry and the collaborative efforts to hold those responsible accountable.
Impact and Consequences
The health care fraud scheme carried out by Ndereva and Healogix had significant consequences for the private pay health insurance payors who were defrauded. The submission of fraudulent claims resulted in substantial financial losses, totaling over $5 million. The scheme also undermined the integrity of the health care system and eroded public trust. The sentencing of Ndereva to federal prison serves as a deterrent to others engaged in similar fraudulent activities and demonstrates the commitment of law enforcement agencies to combat health care fraud.
Conclusion
The sentencing of Oscar Simon Ndereva for wire fraud violations related to a health care fraud scheme highlights the seriousness of such crimes. Ndereva’s involvement in the scheme, through the fraudulent pharmacy Healogix, resulted in substantial financial losses and compromised the integrity of the health care system. The collaboration between the FBI and the Health and Human Services – Office of Inspector General was instrumental in investigating and prosecuting the case. The sentencing serves as a warning to individuals engaged in health care fraud and demonstrates the commitment of law enforcement agencies to combat these crimes.