Lewiston man, sister sentenced for Medicaid fraud

Posted Dec. 18, 2010, at 7 a.m.

PORTLAND, Maine – A Lewiston man was sentenced to prison Friday for defrauding the government out of health care and other benefits.

At a court hearing Friday, Ahmed Yusuf Guled, 75, was ordered to serve four months in prison and to pay restitution of $119,440 and forfeit property totaling $109,733.

His sister, Dahabo Abdulle Osman, 59, of Portland was sentenced to six months of home confinement and five years of probation for the same offenses.

Senior U.S. District Judge D. Brock Hornby also ordered Osman to pay restitution totaling $102,509 and forfeit property totaling $88,642.02.

Guled and Osman were convicted in U.S. District Court on June 24, 2010, of conspiring to defraud the United States and commit health care fraud offenses, and separate charges of health care fraud.

The jury found that they fraudulently obtained Medicaid funds through MaineCare’s Home and Community Based Care Program, also known as the Waiver Program.

Guled was also convicted of making false statements in connection with this program. The evidence at trial established that Guled, with the help of Osman, deceived nurse assessors into believing he was nursing-home eligible and, therefore, entitled to receive home-based personal care services.

Prosecutors said Osman was then paid wages through three local personal care agencies, reimbursed by MaineCare, for supposedly providing care to Guled.

However, prosecutors said they established that the services were not medically necessary and Osman did not provide all of the services billed by the home health agencies.

Guled and Osman were also convicted separately of making false statements to the Social Security Administration in connection with the receipt of Supplemental Security Income benefits, making false statements to housing officials with respect to public housing benefits and to the Maine Department of Health and Human Services in connection with the receipt of MaineCare, food stamps or TANF benefits.

The evidence at trial established that Guled failed to disclose to these agencies that he owned bank accounts with balances that exceeded $2,000; Osman failed to disclose wages she received from personal care agencies.

The defendants were also convicted of theft of government funds with respect to SSI, food stamps or TANF benefits that they were not entitled to receive.

According to U.S. Attorney Thomas E. Delahanty II, in sentencing Guled to four months in prison rather than the recommended 15 to 21 months, Judge Hornby cited Guled’s age and failing health as mitigating factors.

Osman avoided a prison term due in part to the fact that she is the sole caretaker of a 12-year-old grandson with health issues.

The case was investigated by the offices of Inspector General with the U.S. Department of Health and Human Services, the U.S. Department of Housing and Urban Development, the Social Security Administration and the U.S. Department of Agriculture, as well as by agents and investigators with the Federal Bureau of Investigation, Immigration and Customs Enforcement, the Healthcare Crimes Unit of the Maine Attorney General’s Office, the Fraud, Investigation and Recovery Unit of Maine DHHS, and the U.S. Attorney’s Office.

Copyright (c) 2010, Sun Journal, Lewiston, Maine

Distributed by McClatchy-Tribune Information Services.

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