Six Indicted in Scheme to Defraud D.C. Medicaid Program

Press Release

Defendants Allegedly Conspired to Overbill for Mental Health Services

WASHINGTON - Omolere Omomowo, 43, a resident of Laurel, Maryland and Fort Lauderdale, Florida, who led several companies that claimed to provide mental health rehabilitative services to some of the District's most vulnerable citizens, was indicted on August 1, 2024, along with five "community support workers" (CSWs) employed by his company, on charges that they conspired to and did defraud the D.C. Medicaid program of over $10 million by engaging in a scheme to submit bills for mental-health related services that were not medically necessary, not reimbursable, and did not occur.

The indictment was announced U.S. Attorney Matthew M. Graves, FBI Special Agent in Charge David J. Scott of the Washington Field Office, and Daniel W. Lucas, Inspector General for the District of Columbia.

Law enforcement arrested Omomowo earlier today in Fort Lauderdale. He made his initial appearance earlier today in the U.S. District Court for the Southern District of Florida. Co-defendant Zilah Bessem, 36, a resident of Frisco, Texas, who previously lived in Maryland, was charged in the same indictment and arrested Thursday evening at Dallas-Fort Worth International Airport. She made her initial appearance earlier today in the U.S. District for the Northern District of Texas and was detained pending trial.

The remaining four co-defendants - Gregory Clark of Washington, D.C., Ernest Ikomi of Beltsville, Maryland, Diane Mochi of Adelphi, Maryland, and Seraphine Nwufor of Bowie, Maryland - are expected to make their initial appearances in the U.S. District Court for the District of Columbia in the next week.

According to the indictment, Omomowo hatched the conspiracy in early 2020, while serving as the chief financial officer of a D.C.-based mental health provider, Prestige Healthcare Resources. After Prestige obtained certification from D.C.'s Department of Behavioral Health to start an Assertive Community Treatment (ACT) program, Omomowo took the lead in implementing the program. In the District, the ACT program provides intensive, integrated services to the most at-risk adults, individuals with an "intractable, serious, and persistent mental illness." Under Medicaid rules, ACT providers were authorized to submit bills for a greater number of hours and at a higher rate given the seriousness of the mental-health and substance-abuse issues faced by program participants.

The indictment alleges that, shortly after Prestige obtained its ACT authorization, Omomowo orchestrated a scheme by which most, if not all, of the consumers on certain CSWs' caseloads were stepped up from receiving standard mental health services into receiving services as part of the ACT Program. Omomowo and his co-conspirators allegedly implemented this scheme by directing the submission of false and fraudulent assessments despite knowing that ACT services were not medically necessary for the consumers. Omomowo and his co-defendants then allegedly billed Medicaid for ACT services that were not medically necessary as well as for services that did not occur.

According to the indictment, in April 2021, following an employment dispute with the CEO of Prestige, Omomowo resigned and started a new company, The Marcaulay Group, to continue the fraudulent billing scheme. At Omomowo's direction, the co-defendant CSWs also left Prestige and joined The Marcaulay Group. The Marcaulay Group, however, was not certified with the Department of Behavioral Health, so Omomowo partnered with D.C.-based mental health service providers Affordable Home Healthcare LLC and later Goshen Healthcare Management Services LLC.

Because Affordable did not have an ACT Program, the Medicaid beneficiaries Omomowo and his CSWs sought to transfer from Prestige required medical assessments to determine whether they continued to need ACT services. The indictment alleges that Omomowo and an unnamed co-conspirator directed the CSW co-defendants to initiate a blanket ACT step-down process without regard to medical necessity and on the basis of false and fraudulent assessments. Omomowo and his co-defendants then conspired to and did submit false and fraudulent encounter notes for standard mental health services to Medicaid that (1) grossly inflated the amount of time spent conducting the mental health services; (2) were based on activities not authorized to be reimbursed by Medicaid; and (3) for mental health service encounters that did not occur.

For this conduct, the indictment charges all six defendants with conspiracy to commit health care fraud. It also charges Omomowo with an additional 10 counts of substantive health care fraud, and each of the five co-defendants with an additional two counts of health care fraud. In addition, Omomowo is charged with four counts of expenditure money laundering for making large purchases with the proceeds of the fraud scheme.

If convicted, each defendant faces a maximum statutory sentence of 20 years in prison for the conspiracy charge and lesser penalties for the other offenses. The maximum statutory sentence for federal offenses is prescribed by Congress and is provided for informational purposes. The sentence will be determined by the court based on the advisory Sentencing Guidelines and other statutory factors.

This case is being investigated by the Federal Bureau of Investigation and the D.C. Office of the Inspector General's Medicaid Fraud Control Unit. Valuable assistance was provided by the Department of Health and Human Services and Internal Revenue Service Criminal Investigation.

It is being prosecuted by Assistant U.S. Attorney Christopher Howland of the U.S. Attorney's Office for the District of Columbia and Special Assistant United States Attorney Jason Facci, on detail from the D.C. Office of the Inspector General.

An indictment is merely an allegation, and all defendants are presumed innocent until proven guilty beyond a reasonable doubt in a court of law.

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Updated August 2, 2024