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Frisco Man Sentenced For $5 Million Healthcare Fraud Scheme

The man pleaded guilty and was sentenced to 54 months in federal prison
Photo: Gorodenkoff | Shutterstock

On July 7, 2023, U.S. Attorney Damien M Diggs announced the sentence of 54 months in federal prison for Oscar Simon Ndereva from Frisco, for wire fraud violations in the Eastern District of Texas.

According to the Attorney’s Office statement, Ndereva created an intricate scheme: using a fraudulent healthcare pharmacy called “Healogix” he submitted fake claims to defraud private pay health insurance payors. When he fraudulently obtained the funds, he asked for them to be paid directly into a bank account opened under someone else’s name. The money was then moved around through various accounts in order to conceal the nature and source of the money while also structuring check-cashing transactions to avoid financial reporting requirements.

In the time the scheme worked, Ndereva’s Healogix submitted over 780 fraudulent claims that totaled over $5 million.

In 2018, the National Health Care Anti-Fruad Association (NHCAA), a private-public partnership of private health insurers and federal and state government officials, released a report that estimated that healthcare fraud costs tens of billions of dollars each year. However, since the pandemic began the Justice Department seized over $1.2 billion in relief funds that criminals were attempting to steal, and charged over 1,500 defendants with crimes in federal districts across the country according to a statement by U.S. Attorney General Merrick B. Garland.

According to the Department of Justice (DOJ), during the 2022 fiscal year the department saw 351 False Claims Act settlements and judgments, the second-highest number of settlements and judgments in a single year. From the $2.2 billion in recoveries that resulted from the settlements, over $1.7 billion related to matters that involved the healthcare industry, including drug and medical device manufacturers, durable medical equipment, home health and managed care providers, hospitals, pharmacies, hospice organizations and physicians.