How Kenyan in the US ran a 7-year-con game that stole Sh116m
Mr Oscar Simon Ndereva, a Kenyan living in the United States (US), is accused of defrauding Insurance firms of Sh116 million. He is set to face the law this January as District Judge Sean Jordan will be making a ruling.
Mr Ndereva is facing several charges for allegedly running a con game in the US since 2015 after he impersonated a man only identified as JK.
Mr JK left the US in 2005 and has never returned. However, 14 years later, detectives noticed that something was amiss which led to the arrest of Mr Ndereva.
In 2019, the detectives kicked off an investigation on Mr Ndereva after he made claims on Health Insurance companies numbering 780 as he demanded Sh500 million.
On August 4, 2019, Mr Ndereva submitted claims that would have been paid until January 2020.
“Beginning in or around August 2019 and continuing to around January 2020, Mr Ndereva, under the guise of Healogix (the pharmacy), submitted fraudulent claims to commercial health insurance payers requesting payment for services,” the prosecution in court said, adding that medical doctors prescribed the medications.
However, the US detectives realised that the claims submitted to the people were not in any way from a doctor or a physician. In addition, the listed people also said they never received any medication.
According to the prosecution, the suspect used a fake driving license and went ahead and opened several bank accounts, which he used to register companies.
He opened a pharmacy using JK’s name, and several pharmacies sent bills to the insurance firms for medicines provided by the insured.
The Insurance companies would follow up before remitting the money to cover the insured.
Pharmacies in the United States submit bills to insurers for medicines issued to the insured.
Payers of those insurance firms then follow up and remit the money.
The suspect, however, is alleged to have duped several agencies into settling bills for patients that were practically non-existent.
“From in or around 2015 to the date of this indictment, in the Eastern District of Texas and elsewhere, Ndereva devised… a scheme to defraud BlueCross Blueshield and to obtain money by means of materially false and fraudulent pretence, representations and promises.
It is said Mr Ndereva studied the system used to make health insurance claims and found a way of duping companies to pay even when there was no patient.
The prosecution team says that in May 2019, he used two accounts; JP Morgan Chase and BBVA Compass receive the money he claimed from insurers.
The prosecutors say Healogix opened an account at JP Morgan Chase in May 2019 with a person identified as NP being the only signatory.
Two months later, Mr Ndereva added JK as a signer. He then removed NP as a signatory, leaving only JK on July 9, 2019.
Investigations by the Nairobi news reveal that in 2010, Mr Ndereva was running a company known as Green Energy Global Solutions Limited. The company was based in Dallas, Fort Worth Area.
His LinkedIn profile reads, “we are dedicated to bringing renewable energy technology to Eastern Africa and the rest of the world.”