Group Home Owners Convicted in $1 Million Medicare Fraud Scheme | OPA

A federal jury convicted a Texas husband and wife yesterday for a $1 million Medicare fraud scheme, including violations of the federal Anti-Kickback Statute.

According to court documents and evidence presented at trial, Lindell King, 52, and Ynedra Diggs, 44, both of Missouri City, were patient recruiters who owned and operated group homes in which Medicare beneficiaries lived. In exchange for sending their group home residents to Behavioral Medicine of Houston (BMH), a community mental health center that purported to provide partial hospitalization services, BMH paid Diggs, King, and other patient recruiters kickbacks in cash and by check, often concealed as payment for “transportation” or other sham services. Over the course of the conspiracy, BMH billed approximately $1 million to Medicare based on kickbacks paid to Diggs and King.

Both Diggs and King were convicted of a conspiracy to defraud the United States and to pay and receive health care kickbacks, and several substantive violations of the Anti-Kickback Statute. Diggs and King are both scheduled to be sentenced on Aug. 4. King faces up to 20 years in prison on all charges and Diggs faces up to 15 years in prison on all charges. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division; U.S. Attorney Jennifer B. Lowery of the Southern District of Texas; Special Agent in Charge Miranda Bennett of the Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Region; Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division; Special Agent in Charge James H. Smith III of the FBI’s Houston Field Office; and Major William Marlowe of the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.

The HHS-OIG, FBI, and MFCU investigated the case.

Trial Attorneys Monica Cooper and Brynn Schiess of the Criminal Division’s Fraud Section are prosecuting the case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, comprised of 15 strike forces operating in 24 federal districts, has charged more than 4,200 defendants who collectively have billed the Medicare program for more than $19 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes. More information can be found at https://www.justice.gov/criminal-fraud/health-care-fraud-unit.