When United Airlines Flight 143 hit Bush Intercontinental's tarmac at 5:18 a.m., the Lagos overnighter came with a long-sought passenger: a handcuffed Nigerian fugitive who absconded from Houston days after his boss and co-workers were indicted in a $45 million Medicare scam.
The extradition of Godwin Chiedo Nzeocha marked a beguiling chapter in the case of a bogus Houston physical therapy clinic called City Nursing Services and accusations of Medicare fraud, money laundering and luxury living with American tax dollars.
Indictments of multiple characters in the scheme include allegations of using proceeds from the fraud to ship money and vehicles -- including 80 18-wheelers -- from Houston to Nigeria and stashing cash in Nigerian bank accounts. More than $831,000 sits idle in a Bank of America account in the United States.
Nzeocha's unusual return to Houston in June punctuates the intricate connections between him and Nigerian associates who have been arrested, convicted, sentenced or sent to prison in a conspiracy to steal from the nation's largest insurer for the elderly and the disabled.
All are accused of conspiring to pay recruiters to find patients, who also were paid to fill out bogus or blank claims forms submitted to Medicare for treatment never delivered.
After prodding from U.S. prosecutors, Nzeocha was arrested by Nigerian police at the home he shared with his parents in Lagos, having traced him through the address he used when he opened the Nigerian accounts. His attorney, Edmond O'Suji says there's no proof, despite his name on the account, that they belong to his client.
"He said they're (accounts) not his," the defense attorney said.
Pamela Ise, another player who supposedly helped orchestrate phony billing claims, also is a fugitive and believed to be in Nigeria.
9 are indicted
Of the $45 million City Nursing tried to bill to Medicare from its now-locked offices on the second floor of 9888 Bissonnet, $30 million landed in the hands of its employees, all of it approved by the nation's Centers for Medicare and Medicaid Services.
Nine people were indicted; six have been convicted and sent to prison.
"This is not your usual case because of the amount of the fraud in the (single) indictment," Assistant U.S. Attorney Julie Redlinger said of City Nursing after leaving Nzeocha's initial appearance before U.S. Magistrate George Hanks Jr.
City Nursing's owner Umawa Oke Imo is serving a 27-year federal prison sentence, and a West University anesthesiologist he hired to evaluate the phony patients is serving 11 years. His office manager was sentenced to 12.
Three others who were paid to recruit patients for the scam pleaded guilty, and a fourth worker has yet to be tried.
Sean Buckley, attorney for Imo, says the scheme's architects were Nigerian fugitives Ise and Nzeocha, who acted as physical therapist aide.
"He (Imo) did not realize that Pamela Ise and Godwin Nzeocha had been fictitiously billing the Medicare program for services that had no basis in reality," Buckley said.
But records reviewed by the Houston Chronicle show Imo in 2008 paid Nzeocha $109,000. When asked why such a check would be paid to an unlicensed physical therapy aide, the defense attorney had no comment.
Nzeocha is accused of paying patient recruiters and doctoring patient files and documents so it would appear that City Nursing provided physical therapy services. Nzeocha's attorney said he believes his client did nothing illegal.
"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.
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