Two Kenyan nurses indicted in Ksh.12 billion fraud scheme in the U.S

A Kenyan-born nurse based in the U.S has pleaded guilty in connection with a Ksh.12 billion home health care fraud scheme.

Winnie Waruru was charged alongside her co-accused Faith Newton for swindling Massachusetts State of USD 100 million (Ksh.12 billion) through making false claims and billings to a programme that provides health coverage for low-income earners.

According to details of the case, the two allegedly billed MassHealth and Medicare for fraudulent home health services and paid kickbacks to induce patient referrals, some of which were unnecessary.

The US government has also filed a civil action seeking forfeiture of five properties and 40 financial accounts and investments funded by proceeds of the multi-billion shillings fraud scheme.

Before the long arm of the law caught up with them, 41-year-old Winnie Waruru and 52-year-old Faith Newton were living large in Massachusetts, USA.

Newton is said to be driving a Maserati, a luxurious brand car, and owns five mansions worth millions of US dollars in different parts of Massachusetts.

One is said to be along 2 Woolsack Drive in Westford, another at 440 Great Pond Road in North Andover, and two apartments in Dracut one located along 12 Mountain View Drive and another along 18-20 Middle Street. She has another property in Chelmsford at 3 Courthouse Lane.

This lifestyle, US detectives now say, is allegedly funded by proceeds of the multi-billion shilling health care fraud scheme.

According to a statement by the U.S. Attorney’s Office for the District of Massachusetts, between January 2013 and January 2017, Newton was part owner and operator of Arbor Homecare Services LLC where Waruru was a Licensed Practical Nurse employed as a home health nurse.

The two women allegedly conspired to use Arbor to defraud MassHealth and Medicare.

Further details of the indictment demonstrate how Arbor, through Newton and others, including Waruru orchestrated the fraud through billing for home health services that were either never provided, not medically necessary or were not authorized by a physician and also payment of kickbacks to induce patient referrals some of which were unnecessary.

It is alleged that in order to siphon more money the defendants in some instances entered sham employment relationships with patients’ family members to provide home health aide services that were not medically necessary and routinely billed for fictitious visits that did not occur.

Waruru was arrested and charged along with co-defendant Newton in February 2021, each indicted on one count of conspiracy to commit health care fraud; one count of aiding and abetting health care fraud and one count of conspiracy to pay and receive kickbacks.

Waruru was also indicted on two counts of making false statements and one count of making a false statement in a health care matter while Faith Newton was further indicted on one count of money laundering conspiracy and seven counts of money laundering.

Waruru pleaded guilty to all the counts and will be sentenced on January 12, 2023. She is facing a sentence of up to 15 years if found guilty of the charges brought against her.

Meanwhile, Newton has pleaded not guilty and is pending trial.

Newton is said to be the wife of Francis Nderitu Kimaru, a Kenyan man who was arrested in 2016 after investigators established that his company, Compassionate Homecare Inc, had been filing fake claims under the US Medicaid programme which saw the US government lose USD 43 million (Ksh. 5.2 billion).