What is Medicare Fraud?

Medicare fraud occurs when a hospital, nursing home, doctor's office, hospice care facility, ambulance service, pharmacy, rehabilitation center, or any other type of healthcare provider overbills Medicare.


Who can report Medicare fraud?

Medicare fraud whistleblowers are almost always healthcare professionals. They are commonly employed as hospital administrators, nurses, hospice or nursing home workers, ambulance drivers, pharmacists, or as any other type of healthcare professionals.

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Houston-area Nurses Sentenced in $5.2 million Medicare Scheme
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A Houston court sentenced two area nurses, as well as two of their co-conspirators, for their roles in a $5.2 million Medicare fraud scheme, the Department of Justice, FBI and Department of Health and Human Service announced.
Licensed vocational nurse Mary Ellis, 56, was sentenced Feb. 13 to 63 months in prison to be followed by supervised release for an additional three years. She must also pay $401,000 in restitution. The court found Ellis guilty of conspiracy to commit health care fraud, three counts of receiving illegal kickbacks, conspiracy to pay kickbacks, and two counts of making false statements after a trial in May 2011.

Also sentenced the same day to 63 months in prison was licensed vocational nurse Caroline Njoku, 46. Her sentence will be followed by only one year of supervised release. Njoku will be required to pay $631,295 in restitution. In a May 2011 trial, Njoku was previously sentenced to two conspiracy charges, one to commit health care fraud and the other to pay kickbacks.

Co-conspirator Florida Holiday Island, 62, was also sentenced Feb. 13. Holiday will serve five months of home detention after 20 days in prison. This will be followed by two and a half years of supervised release. Island must also pay $59,739 for restitution after pleading guilty in May of last year to receiving illegal kickbacks and conspiracy to receive kickbacks.

Terrie Porter, 48, was also a co-conspirator in this case and was convicted of conspiracy to receive and receiving illegal kickbacks in a May 2011 trial. On Feb. 13, Porter was sentenced to two years in prison and another two of supervised release, with the requirement to pay $482,380 in restitution.

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