Winnie Waruru, 42, and Faith Newton, 52, lived big in America before the law caught up with them.
The first drove a Maserati, an Italian luxury brand known for its distinctive styling, while the second drove a Range Rover.
They kept their lives private as dollar millionaires, and few Kenyans knew about the two nurses whose fortunes seemed limitless. In addition to their extravagant lifestyles, they owned five properties in the United States and had 40 bank accounts.
According to the US government, the two Kenyans defrauded Boston state of $100 million (Sh12 billion) in healthcare fraud.
They are accused of paying kickbacks to obtain referrals and retain patients over a five-year period.
For months, US detectives monitored their multimillion-dollar transactions.
According to a release from US Attorney Rachael Rollins, Waruru pleaded guilty last week before US Senior District Court Judge George A. O’Toole Jr, who has scheduled sentencing for January 12, 2023. Newton’s case will continue.
Detectives allege that between January 2013 and January 2017, the two used Arbor Homecare Services LLC as a conduit to steal $100 million from MassHealth and Medicare – a program that provides health coverage primarily to low-income people – by claiming refunds and filing false statements. They then shut down the company.
MassHealth, which pays for personal care attendants, medical equipment, and specific prescriptions and has a budget in the billions of dollars, has been a target of swindlers who first apply to become providers through registered companies. Nurses from the healthcare company are supposed to care for vulnerable members and then bill the program for reimbursement.
Waruru and Newton were both charged with “conspiracy to commit health care fraud” and billing for healthcare services that they did not provide. They are also accused of giving false information to MassHealth.
The federal government has filed a civil action in order to seize the duo’s properties and freeze their bank accounts, which contained millions of dollars.
According to the court documents, Newton was a co-owner and operator of Arbor Homecare Services LLC, and Waruru was a licensed practical nurse. Waruru was “employed” by Arbor Care Homecare Services on paper, but she was more, according to court records.
They are said to have entered into “sham” employment relationships with family members of MassHealth patients in order to obtain more money, and to have purported to provide unnecessary medical care, billed as “visits.” In a scheme that went undetected between January 2013 and January 2017, Arbor, for example, would reimburse a relative staying with a relative member for fictitious nurse visits. After that, it would submit claims to MassHealth.
The two are also accused of paying kickbacks to patients under their care in order to keep them on board with Arbor Homecare Services LLC. Waruru allegedly “caused Arbor to bill MassHealth over $1.2 million (Sh120 million) in fraudulent nursing visits” and “passed money from Newton to two Arbor patients in order to retain them,” according to detectives.
By luring patients into the scheme, the two were able to bill for services that were neither rendered nor required.
According to the prosecutor, “Arbor, through Newton and others, developed employment relationships” with patients’ relatives who purported to offer services. They would also pay kickbacks for patient referrals, regardless of medical necessity requirements, in a scheme that saw Arbor’s income run into millions. By entering into “sham” employment relationships with patients’ family members, according to the prosecution, it was easy for Arbor to purport “to provide home health aide services that were not medically necessary and routinely billed for fictitious visits that did not occur”.
“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,” the charge sheet read in part.
Newton, according to the civil complaint, targeted low-income, disabled, and/or mentally ill people. Newton is also accused of laundering illegally obtained wealth.
Arbor was registered by Mr. Njoroge Muiruri, a registered nurse, according to court records, and it ceased to exist in 2017 after he filed a certificate of cancellation with the Massachusetts Secretary of State. It is unclear whether the company went bankrupt as a result of the investigations.
Health care fraud, conspiracy to commit health care fraud, money laundering conspiracy, and money laundering each carry a jail term of up to ten years, three years of supervised release, and a fine of up to $250,000, or twice the amount involved in the laundering.
The conspiracy to pay kickbacks, and make a false statement in health care matters each carry a five-year prison sentence, three years of supervised release, and a fine of up to $250,000.
