(CN) - The former owner of two Houston-based medical equipment companies was sentenced to 12 years in federal prison for defrauding the Texas Medicaid program; his father and sister await sentencing.
Benjamin Essien, 34, of Houston, had pleaded guilty to conspiring to commit healthcare fraud, five counts of health-care fraud and two counts of aggravated identity theft. He also was ordered to pay back more than $1.45 million to Medicaid.
In April, Bassey Essien, 60, his father, was convicted of 19 counts of conspiracy, health-care fraud and aggravated identity theft, and Rose Essien, 31, his sister, was convicted of 11 counts of health-care fraud and five counts of aggravated identity theft. They are to be sentenced by U.S. District Judge Grey Miller in January.
Prosecutors said that through the Essiens' Logic World Medical and Roben Medical they received Medicaid beneficiaries' information - names, addresses and Medicaid numbers - which they used to file false claims with Medicaid.
Trial evidence showed that the Essiens routinely billed Medicaid for adult urinary incontinence supplies they did not deliver, which beneficiaries did not need and that physicians had not prescribed, or for delivering supplies in amounts significantly less than the amounts billed.
"The defendants continued to bill Medicaid for incontinence supplies even after their delivery staff and/or delivery contractors were told by the beneficiaries they did not need or want the supplies," prosecutors said in a statement. "They regularly billed Medicaid for the delivery of 300 diapers - the maximum allowed amount of incontinence supplies each month per beneficiary - and for extra large size diaper briefs - which have the highest Medicaid reimbursement rate - without consideration to the actual size needed by the beneficiary. They even billed Medicaid for delivering a quantity of extra large adult size diapers far in excess of the amount they purchased from wholesale suppliers. The evidence showed the defendants only purchased 6 percent of the amount of extra large diapers they claimed to have delivered."
Prosecutors said the scheme began in April 2004 under Logic World, with the last false claim filed in February 2010 under the name Roben Medical. The Essiens billed Medicaid for claims of more than $2.34 million and received more than $1.45 million in payments.
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