A Kenyan nurse living in the United States pleaded guilty in a federal court in Boston in connection with a Sh12 billion ($100 million) home health care fraud scheme.
According to a statement from the US Department of Justice, the 42-year-old Waruru pleaded guilty to four charges on September 8, 2022. These were conspiracy to commit health care fraud, aiding and abetting fraud, giving and receiving kickbacks and making false statements.
She is set to be sentenced by Senior District Court Judge George A. O’Toole on January 12, 2023.
Waruru was arrested and charged along with co-defendant Faith Newton in February 2021. Newton has pleaded not guilty and is pending trial.
According to the indictment, from January 2013 to January 2017, Newton was part owner and operator of Arbor Homecare Services LLC.
Waruru was a Licensed Practical Nurse employed as a home health nurse at Arbor.
The two allegedly engaged in a conspiracy to use the company to defraud MassHealth and Medicare of at least Sh12 billion by committing health care fraud and paying kickbacks to induce referrals.
Newton then allegedly laundered the ill-gotten money.
It is alleged that Arbor failed to train staff, billed for home health services that were never provided or were not medically necessary and billed for home health services that were not authorized.
The company developed employment relationships as a way to pay kickbacks for patient referrals, regardless of medical necessity.
They also allegedly entered sham employment relationships with patients’ family members to provide home health aide services that were not medically necessary and routinely billed for fictitious visits that did not occur.
The suspects were accused of targeting particularly vulnerable patients with low incomes, on disability and/or suffering from depression and/or addiction.
Waruru is said to have billed MassHealth for her skilled nursing visits, many of which she did not perform, were medically unnecessary, or were not approved by a physician.
The prosecution accused her of being personally responsible for the fraudulent billion and passing cash payments allegedly from Newton to two Arbor patients to retain those patients.
The charges of health care fraud, conspiracy to commit health care fraud, money laundering conspiracy and money laundering each attract a sentence of up to 10 years in prison, three years of supervised release and a fine of up to Sh30 million ($250,000) or twice the amount of the money involved in the laundering.
The conspiracy to pay kickbacks, making false statements and making false statements in a health care matter each provides for a sentence of up to five years in prison, three years of supervised release and a fine of up to Sh30 million.
Sentences are imposed by a federal district court judge based on the U.S. Sentencing Guidelines and statutes which govern the determination of a sentence in a criminal case.
According to the statement from the US Department of Justice, Newton who pleaded not guilty is presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.