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Amherst man sentenced on health care fraud charge

STAFF REPORTS

BUFFALO, N.Y. -- U.S. Attorney James P. Kennedy, Jr. announced today that Umar Adeyola, 48, of Amherst, NY, who was convicted of conspiracy to commit health care fraud, was sentenced to serve 60 months in prison by U.S. District Judge Lawrence J. Vilardo. The defendant was also ordered to pay restitution totaling $135,739 to the U.S. Department of Labor, and $228,638 to health insurance companies.

Assistant U.S. Attorney Maura K. O’Donnell, who handled the case, stated that the defendant founded, organized, and managed the HEART Foundation, a not-for-profit organization intended to assist area youths, and Heart Community Alliance (“HCA”), a related for-profit organization, intended to provide clinical services, such as counseling and psychotherapy, to youths. Through his role with those organizations, Adeyola engaged in two major fraud schemes.

The first scheme involved attempts by the defendant, on behalf of HCA, to defraud private insurance companies Blue Cross Blue Shield, Independent Health, and Univera. Adeyola arranged for the submission of false and fraudulent bills for office visits using the names and/or provider numbers of healthcare providers who had not actually rendered the services claimed. The bills falsely represented that the services had been rendered by properly licensed and credentialed social workers when, in fact, the services had actually been provided by other individuals, including interns. The scheme included the submission to the same insurance companies of bills for services which purported to have been rendered by a social worker who was actually hospitalized and/or deceased on the dates of service claimed.

In addition, Adeyola falsified documents in response to an audit of HCA by Independent Health. During the course of the audit, the defendant made materially false statements to representatives of Independent Health, with respect to the deceased social worker who he claimed had rendered services at HCA.

The second scheme involved Adeyola’s theft of government funds in the form a federally funded grant received by the Heart Foundation. Specifically, in April 2013, the Heart Foundation was selected to be a recipient of a Department of Labor grant, administered by the Latino Coalition, an entity in California.  Adeyola submitted in excess of 30 false and fraudulent reimbursement requests for grant funds, resulting in payment of approximately $135,000 to the Heart Foundation.

“While the stated mission of the HEART Foundation and Heart Community Alliance—to assist young people in need in our community—was laudable, the motive of their founder, this defendant, was criminal,” said U.S. Attorney Kennedy. “Our office will not stand by when any individual attempts to defraud the health insurance industry or steal from the government. Such behavior drives up costs for all taxpayers and keeps funding from other organizations in need.”     

“Umar Adeyola defrauded the U.S. Department of Labor’s (DOL) Employment and Training Administration by submitting dozens of fraudulent reimbursement requests for Workforce and Investment Act grant funds intended for those who were entitled to such benefits. We will continue to work with our law enforcement partners to aggressively pursue those who defraud DOL programs,” stated Michael Mikulka, Special Agent-in-Charge, New York Region, U.S. Department of Labor Office of Inspector General.
       
“Adeyola schemed to fatten the bottom line by defrauding taxpayer-funded government programs. Instead he will be imprisoned and forced to pay restitution,” said Scott J. Lampert, Special Agent-in-Charge for the Office of Inspector General of the U.S. Department of Health and Human Services. “Those considering such schemes should be prepared for harsh consequences.”   

Today’s sentencing is the result of an investigation by the U.S. Department of Labor, Office of Inspector General, Office of Investigations – Labor Racketeering and Fraud, under the direction of Michael Mikulka, Special Agent-in-Charge of the New York Region; the Federal Bureau of Investigation, under the direction of Special Agent-in-Charge Gary Loeffert; and the Department of Health and Human Services, Office of Inspector General, Office of Investigations under the direction of Special Agent-in-Charge Scott Lampert.