Harrisburg, Pennsylvania’s United States Attorney announced that Rose Umana, age 49, of Mechanicsburg, Pennsylvania, was sentenced to 3 years in federal prison on Medicaid fraud related charges. She was convicted of making false statements relating to health care matters, engaging in monetary transactions involving criminally-derived property (money laundering), and identity theft.
Prior to her arrest, Umana ran a business called Vision Healthcare Services. Court records indicate that she owned the business since at least 2006. Vision Healthcare claimed to be a medical staffing service.
Umana’s Indictment for Pennsylvania Medicaid Fraud
According to the indictment, Umana defrauded Medicaid for at least two years between January 2012 and January 2014. During that time, prosecutors say that Umana and her company defrauded Medicaid in several ways.
Umana used unqualified people to see patients but passed them off as trained and legitimate. She would do this by creating false IDs and occupational licenses. Sometimes she would even bill for services never even provided. Specific allegations in the criminal complaint include:
- Creating “false identification documents including driver’s license and social security cards which were maintained in employee packets.” (The false identification documents allowed Umana to pass off unlicensed healthcare workers as other people.)
- Creating “fictitious occupational licenses for workers who were not licensed or not licensed at the level represented on the license.” (The false occupational licenses were used to make unqualified people appear legitimate.)
- Submitting “bills to Medicaid for services purportedly provided by the fraudulently – represented health care provider and thus [receiving] Medicaid compensation she was not entitled to receive.”
- Billing “Medicaid for services provided by someone other than the listed provider.”
- Billing “Medicaid for services not provided or provided by someone other than the listed provider.”
- “[Inflating] the service time billed”.
Evidence presented at the sentencing hearing indicated one of the Umana’s unqualified workers was an individual named China Scott. Prosecutors say that Scott lost her nursing license and had previously been convicted of healthcare fraud. Despite losing her license and being barred from treating Medicaid patients, Umana allowed her to make patient home visits and billed Medicaid for those visits.
Medicaid Funded with Tax Dollars – PA Taxpayers Lose $1.1 Million to Umana
Pennsylvania’s Medicaid program is operated by the state Department of Human Services. The program provides healthcare to lower income individuals and families. Medicaid is funded with both state and federal tax dollars.
According to a press release from the Justice Department, Umana’s scam cost taxpayers $1,184,224. In addition to the three- year-term of imprisonment, the court ordered Umana to pay back the stolen money.
Whistleblower Tip Leads Prosecutors to Umana
It appears that Rose Umana’s million dollar Medicaid fraud scheme was uncovered by whistleblowers in an unrelated case! Three whistleblowers had previously a lawsuit against different companies. The whistleblowers, one of whom was a licensed nurse and one a licensed therapist, learned that these companies were using improperly credentialed healthcare workers to treat patients.
As prosecutors investigated the whistleblowers’ complaints, they stumbled upon the staffing companies that were supplying these workers including Umana’s Vision Healthcare.
Whistleblower Awards for Medicare and Medicaid Fraud Whistleblowers
As noted above, Medicaid is funded by both state and federal tax dollars. Unfortunately, Pennsylvania is one of 21 states without a Medicaid fraud whistleblower award program. Fortunately, the U.S. Department of Justice can still pay awards in these cases since Pennsylvania accepts federal funding.
Under the federal False Claims Act whistleblowers with inside information about Medicaid and Medicare fraud can earn a cash award. Whistleblowers – called “relators” - can receive up to 30% of whatever the government collects from the wrongdoer. In this case that could be almost $400,000.
How to Report Medicaid Fraud in Pennsylvania
Insiders with knowledge of healthcare fraud and mismanagement in the Keystone State have several choices. They can ignore the greed and fraud going on in front of them, call the government’s toll free hotline or call a lawyer and file a sealed False Claims Act case. Awards paid through hotlines are generally limited to $1000. The large percentage awards are paid through the False Claims Act
Interested in a large award but don’t have a lawyer? The Coalition can help. Call our operators at 888.742.7248. They will have a lawyer call you back with 1 business day. No cost. No obligation. You can also submit online.