A now former federal employee has been sentenced to 16 years in prison for health care fraud, conspiracy, payment of illegal kickbacks and gratuities, money laundering, and conflict of interest charges according to an announcement from the Justice Department.
Joseph Prince of Aurora, CO was one of two Case Management Liaisons for the VA’s Spina Bifida (SB) Health Care Benefits Program. The program covers the medial needs of children of certain veterans of the Korea and Vietnam wars with SB. He acted as a subject matter expert in this area working in a Denver call center, speaking with health care providers and SB beneficiaries or their families regarding their health care needs and reimbursement for care under the program.
According to the indictment and evidence presented at the trial, Prince created an elaborate conspiracy based on a fictional VA home health program under which he recruited friends and family members to open “home health agencies” knowing they lacked the necessary medical licenses or credentials to bill the VA for SB beneficiaries’ home health services. He directed every aspect of the home health agencies; no changes were made to business operations without his knowledge, review, and approval.
Further, with direct access to the SB beneficiaries and their family members, Prince identified himself to them as the one in charge of the fictional program. He represented that he had the authority on behalf of the VA to approve family members as home health care providers for the SB beneficiaries, even though the caregivers had no specific training certifications.
Prince instructed these family members to sign up as contractors with “vetted” home health agencies, which were those companies owned by his friends and family and then directed the completion and submission to the VA of fraudulent and inflated claims for home health services by unapproved providers through unlicensed home health companies.
Prince would often pre-populate the number of hours the beneficiary was eligible for home health care on a physician’s written plan before submitting the plan for the physician’s signature. Then when speaking to the beneficiaries, Prince would instruct them to submit logs reflecting the maximum hours of plan service even when beneficiaries said they did not or could not provide that many hours of service, often presenting false information to the beneficiaries about what they were permitted to bill for under the program.
He instructed the home health companies regarding how much to charge the VA for the fraudulent claims, directing them to keep approximately 80% of the paid amount for the company and send just 20% to the caregiver family member. When beneficiaries questioned the disparity between the caregiver’s pay and the agency’s pay on statements of benefits, Prince lied about agency expenses incurred to operate the home health entities.
Between June, 2017 and June, 2018, Prince referred approximately 45 SB beneficiaries to the sham home health entities during which time the home health entities submitted fraudulent claims totaling over $20 million to the VA, and approximately $18 million of that was paid out to five home health entities from the SB Health Care Benefits Program. He received approximately $1.5 million in kickbacks from two of the home health entities during this time period.
In addition to the prison sentence, Prince is ordered to serve 3 years of supervised release and pay $18,777,134.68 in restitution to the Veteran’s Health Administration.
“The defendant [Prince] stole from taxpayers and from a program designed to help those who served our nation,” said U.S. Attorney Jason R. Dunn. “The defendant will be spending a substantial amount of time in prison because of his fraudulent behavior.”