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Kenyan nurse in US faces 15 years in jail over Sh12 billion fraud scheme

A Kenyan-born nurse in the United States is facing up to 15 years in jail after she pleaded guilty to an Sh12.3 billion ($100 million) home healthcare fraud and kickback scheme.

Winnie Waruru pleaded guilty in Boston on September 8, 2022, in federal court and will be sentenced on Thursday, January 12, 2023.

Waruru, 42, pleaded guilty to one count of conspiracy to commit health care fraud; one count of health care fraud – aiding and abetting; one count of conspiracy to pay and receive kickbacks; two counts of making false statements; and one count of making a false statement in a health care matter.

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Waruru pleaded guilty before US Senior District Court Judge George A. O’Toole Jr, who scheduled her sentencing for January 12, 2023, according to a release by US Attorney Rachael Rollins.

She was arrested in February 2021 and charged with her Kenyan co-accused, Faith Newton, who has denied the charges and is pending trial.

Detectives allege that between January 2013 and January 2017, the two used Arbor Homecare Services LLC as a conduit to siphon $100 million from MassHealth and Medicare – a program that provides health coverage primarily for people with low incomes – by claiming refunds and filing false statements. They then closed down the company.

With a budget running into billions of dollars, MassHealth, which pays for personal care attendants, medical equipment, and specific prescription, has been a target of swindlers who first apply to become providers through registered companies. The healthcare company nurses are supposed to attend to vulnerable members and then bill the program for reimbursement.

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Waruru and Newton were accused of “conspiracy to commit health care fraud” and of billing for healthcare services they never provided. They are also charged with making false statements to MassHealth.

The federal government has filed a civil action to seize the duo’s properties and freeze their bank accounts, which held millions of dollars.

Before the law caught up with them, Waruru, and Newton, 52, lived ostentatious lifestyles in America.

One drove a Maserati, an Italian luxury brand known for its exclusive styling, and the other a Range Rover. As dollar millionaires, they kept their lives private, and few Kenyans had heard about the two nurses whose fortunes seemed endless.

In addition to their lavish lifestyles, they had five properties in the US and operated 40 bank accounts.

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The court records indicate that they also alleged to have 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.

“As alleged in the civil complaint, Newton either directly or through Arbor, targeted particularly vulnerable patients who were low-income, on disability and/or suffering from depression and/or addiction,” US Attorney’s Office added.

Prosecutors say Waruru and Arbor billed MassHealth for Waruru’s skilled nursing visits, many of which she did not perform, were medically unnecessary, or were not approved by a physician.

Waruru, who faces up to 15 years in prison, was personally responsible for causing Arbor to bill MassHealth for over $1.2 million in skilled nursing visits, much of which was fraudulent. She also passed cash payments allegedly from Newton to two Arbor patients to retain those patients.

US Senior District Court Judge George A. O’Toole Jr will deliver the sentence.

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