A Bowie, Md., nurse has pleaded guilty to conspiracy to commit healthcare fraud for her role in a $14 million scheme that billed D.C. Medicaid for mental health services that were never provided or were grossly inflated.
Vera Nyiawung pleaded guilty to the single count before the U.S. District Judge Emmet Sullivan, according to a Sept. 17 news release from the U.S. Attorney’s Office for the District of Columbia. Ms. Nyiawung worked as a nurse at a D.C. Medicaid provider authorized to deliver mental health rehabilitative services to youth and adolescents beginning in January 2023, and also performed community support worker duties, supervised staff and reviewed encounter notes for approval.
Company employees directed Ms. Nyiawung and other workers to bill the maximum allowable time per patient regardless of medical necessity or actual service, the release said. Workers billed a full hour for telephonic encounters that sometimes lasted only a few minutes and were trained to evade fraud detection by selecting call times just under the 60-minute cap. They were also directed to bill three hours, and later one hour, for diagnostic assessments regardless of how much time was spent with the patient, and to recycle information from a single telehealth session into multiple fabricated encounter notes. This resulted in bills to D.C. Medicaid for several days of service based on only one actual phone call.
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