A 48 count indictment, was returned on Wednesday, November 16, charging Umar Adeyola of Amherst, NY, with health care fraud, conspiracy to commit health care fraud, aggravated identity theft, making false statements in a health care matter, wire fraud, and theft of government money. The charges carry a maximum penalty of 22 years in prison and a $250,000 fine.
According to the indictment: the defendant founded, organized, and management of the Heart Foundation, a not-for-profit organization intended to assist area youths, and Heart Community Alliances (“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 is accused of engaging 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 hat the services had 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 is accused of falsifying documents in response to an audit of HCA by Independent Health. During the course of the audit, the defendant allegedly 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 of 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.