BUFFALO, N.Y. - U.S. Attorney James P. Kennedy, Jr. announced today that Umar Adeyola, 48, of Amherst, NY, pleaded guilty to conspiracy to commit health care fraud before U.S. District Judge Lawrence J. Vilardo. The charge carries a maximum penalty of 10 years in prison and a $250,000 fine.
Assistant U.S. Attorney Maura K. O’Donnell, who is handling 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.
The plea 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 Peter Nozka, Acting Special Agent-in-Charge of the New York Region; the Federal Bureau of Investigation, under the direction of Acting Special Agent-in-Charge Kevin P. Lyons; 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.
Sentencing is scheduled for July 23, 2018, before Judge Vilardo.
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