Houston Women Indicted for Massive Medicaid and Medicare Fraud

News Summary

Three women from Houston face serious charges for allegedly defrauding the government of over $87 million in Medicaid and Medicare reimbursement funds. Dera Ogudo, Victoria Martinez, and Evelyn Shaw are accused of exploiting vulnerable populations in group homes to bill for unnecessary services. The indictment includes 42 felony charges, highlighting extensive fraudulent activities over several years. With arrests made, the government seeks to seize associated assets as the defendants await trial. This case emphasizes ongoing issues within the healthcare system regarding fraud and abuse in billing practices.

Houston Women Indicted for Massive Medicaid and Medicare Fraud

Houston, Texas – Three women from the Houston area have been indicted for allegedly defrauding the U.S. government of over $87 million in Medicaid and Medicare reimbursement funds. The individuals facing charges are Dera Ogudo, the owner of United Palliative & Hospice Care (UPHC); Victoria Martinez, an employee of UPHC; and Evelyn Shaw, a psychiatric hospital employee.

Federal prosecutors have filed a total of 42 felony charges against the three women: 28 against Ogudo, eight against Martinez, and six against Shaw. They stand accused of running several group homes that served elderly, disabled, and mentally ill Medicare beneficiaries in the Houston vicinity.

Allegations of Systematic Fraud

The indictment details a scheme in which Ogudo, her family, and co-conspirators purportedly obtained over $87 million in kickbacks across a span of seven years. Prosecutors claim Ogudo exploited the vulnerabilities of group home residents by enrolling them in hospice services, despite many not being terminally ill. In support of this allegation, an unnamed physician is reported to have falsified documents to legitimize the hospice care referrals.

It is alleged that Ogudo instructed her staff to inaccurately label hospice services as “palliative care,” a distinction that would render them ineligible for Medicare reimbursement. Over the course of the fraud, Ogudo and Martinez are said to have billed Medicare and Medicaid over $110 million but received payments exceeding $87 million from these services.

Duration and Warnings Ignored

This fraudulent operation reportedly commenced in 2019 and continued until the recent indictments. Despite receiving warnings from a Medicare auditing contractor concerning fraudulent claims, Ogudo and Martinez allegedly persisted in enrolling unqualified individuals into hospice care programs.

Government Action and Consequences

In response to this extensive fraud, the government has initiated actions to seize more than $4.5 million from bank accounts and properties associated with the accused. Seized assets include multiple properties in Richmond, including a multimillion-dollar estate, an empty lot, and a third property located in Cypress.

If convicted, the three women face severe penalties, with the most serious charges potentially bringing sentences of up to 110 years in prison. The gravity of the charges reflects the extensive nature of the alleged fraudulent activity.

Operations Structure and Partnerships

Further insights from court documents suggest that Ogudo delivered care items to various facilities to falsely bill for hospice care, exacerbating the fraudulent claims. Additionally, Shaw allegedly referred over 100 psychiatric patients to Ogudo’s hospice services in exchange for kickbacks, showcasing an organizational structure designed to maximize their illicit profits.

Arrests and Current Status

Ogudo was arrested in Richmond, while Martinez and Shaw were apprehended in both Richmond and Houston, respectively. Following their arrests, all three women were granted bond, allowing them to be released pending their court proceedings.

Broader Implications

The charges against Ogudo, Martinez, and Shaw highlight a significant issue within the healthcare industry related to fraudulent billing practices and the exploitation of vulnerable populations. As authorities continue to address healthcare fraud, the outcomes of these indictments will likely set a precedent for similar cases in the future.

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Additional Resources

• ABC13: Houston Women Indicted for Massive Medicaid and Medicare Fraud
• Houston Chronicle: Fort Bend County Women Indicted
• Fox News: House Oversight Committee Investigating Claims of Fraud
• Latin Times: Texas Children’s Hospital Whistleblower Fired
• Wikipedia: Health Care Fraud