HispanicBusiness

"All I know is that Mr. Nzeocha worked for City Nursing (as an aide) and was paid for that," O'Suji said. "He has certification as an aide."

The last known clue of the missing Ise came from the Port of Houston and an FBI affidavit filed by agent Kevin Lammons. In it, details about shipping container No. TRLU7416095 resulted in a phone call to the FBI. The container was being shipped by Ise.

Inside, a 2009 Lexus was marked for delivery to the southeastern Nigerian seaport of Calabar. But the container, examined at the St. George U.S. Customs exam warehouse near the Houston Ship Channel, held more than the luxury automobile.

Tucked in a box and a bin were financial books, contracts, banking information and patient files related to Ise's billing work for City Nursing.

The Chronicle's review of court documents and business records shows the criminal enterprise was long in the making, its ill-gotten gains spreading across two continents. The records show Imo used Medicare money from City Nursing's American bank accounts to pay himself $1 million to fund his fledgling Nigerian businesses

Another $1.7 million was spent for "purchase of tanks (tanker-trucks)" and "eighty trucks to Lagos (Nigeria)," for his petroleum transport business and a bottling company.

List of creditors

The bounty amounted to a boon for a man who just a few years before was down on his luck.

In 2004, the Sugar Land resident's Wellcare Rehabilitation Services venture, operating out of his home, had driven him to bankruptcy. His creditors were piling up: Texas Children's Hospital, Baylor Med Care, Fort Bend ISD, Memorial Hermann Hospital System and the IRS. A $400-a-month payment plan was set up for 60 months.

But just two years later, he was back in business with City Nursing Services, located on the second floor of 9888 Bissonnet, a six-story building between U.S. 59 and the Sam Houston Tollway. The building is one of a handful of mid-rises that house a honeycomb of medical offices: pain clinics, Medicaid pharmacies, private EMS companies, home health agencies, physical therapy and rehab outfits.

This pot-holed strip of Bissonnet is an unlikely Rodeo Drive of low- income medicine, its parking lots often crammed with cars of the working poor and destitute. At least 54 companies with National Provider Identifiers, the number needed to bill Medicare and Medicaid, are or have been housed at 9888 Bissonnet, and defendants in at least three different federal health care fraud cases worked for companies in the building.

One, the owner of Double Daniels EMS of Houston, is accused of billing more than $1.7 million in phony claims to Medicare. Another, who ran Houston Compassionate Care, is accused of using her business's Medicare number to access Medicare's database to find and solicit potential patients.

Links with doctor

Imo's choice of address signaled his arrival in a Medicare and Medicaid mecca.

But he needed a doctor to diagnose patients and prescribe the physical therapy services his company provided. Through a Nigerian go-between, he contacted Dr. Christina Clardy, who was living with her family in a $1 million-plus home in West University.

Imo plucked Clardy from the city's northwest side, where she was working for two pain clinics that later were shut down by state investigators as pill mills. Clardy was charged with engaging in an organized criminal activity for writing prescriptions for "other than valid" reasons. The state's charges were dropped when she was sentenced in the Medicare case.

Even City's Nursing's so-called physical therapy office setup seemed a beacon for fraud. Inside Suite 248 was one exercise room with a couple of treadmills and bikes.

"Not much else," federal prosecutor Julie Redlinger told jurors in one of the trials.

Documents show a former employee in 2009 tipped off investigators that she had seen Imo pay patients up to $150 to visit City Nursing. She told them only one physical therapist came to the office and he came just 20 minutes a day. It was later determined that no certified physical therapists worked at the clinic.

In laying the case out to jurors, Redlinger said the scheme relied on just five easy steps.

Pay recruiters to bring patients. Pay the patients to sign blank treatment forms and offer up their Medicare number.

Pay doctors to write the orders for physical therapy never provided or supervised. Bill Medicare.

And finally, create phony patient files about their nonexistent physical therapy treatment.

"Five easy steps, $30 million," she concluded.