11/27/2021
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Lewiston men sentenced in health care fraud scheme


Sunday July 18, 2021

Two Lewiston men who came to that city as Somali refugees were sentenced in federal court Friday for their respective roles as interpreters in a health care fraud scheme that bilked MaineCare out of more than $1.8 million through a Lewiston office providing mental health and substance abuse counseling services.

At a daylong hearing in U.S. District Court, Chief Judge Jon D. Levy sentenced Abdirashid Ahmed, 41, to two years in prison, plus three years of supervised release.

Defense attorney Daniel Dube said after the hearing his client planned to appeal his sentence.

Co-conspirator Garat Osman, 35, was sentenced to three years of probation.

Ahmed, who was considered by Levy to be one of the leaders of the conspiracy, was ordered to pay $1,863,264.83 in restitution to Maine's Medicaid program in whole or in part with other co-defendants. Levy said Ahmed received the largest share of the ill-gotten proceeds.

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Osman was ordered to repay MaineCare $544,097.78 in restitution in whole or part.

Both men pleaded guilty in May 2019 to a single count of multiple charges in a grand jury superseding indictment: Ahmed to health care fraud; Osman, to conspiracy to commit health care fraud.

The remaining charges were dismissed Friday by prosecutors.

In deciding on the two sentences, Levy considered the fact that both men were born in Somalia and suffered severe trauma before reaching this country.

Ahmed witnessed the fatal shooting of his father, brother and sister before he was shot six times, he said.

"They left me for dead," he told Levy on Friday in a courtroom, which was packed with more than 50 men, women and children from the Lewiston Somali community.

The gunshots broke his shoulder and three of the bullets remained in his back for two years until they were removed, he said.

He apologized for his wrongdoing, expressing regret for his conduct.

Ahmed urged Levy to allow him to stay home with his wife and seven children, including a 15-year-old boy who has the most severe form of autism, as well as digestive issues that require round-the-clock supervision that only Ahmed and others said he could provide.

Assistant U.S. Attorney Daniel Perry told the judge that Ahmed's son would qualify for therapeutic residential placement by MaineCare and that agency also could provide transportation to doctors' appointments to which Ahmed has been shuttling his son.

Defense attorney Peter Rodway argued that the much of the money Ahmed earned was legitimate for professional services provided to authentic clients of Facing Change, the Lewiston office that offered mental health counseling.

But Levy rejected that argument.

Ahmed's wife, Fartun, said tearfully that her husband was the only person who could calm her son when he is agitated and who is larger and stronger than she is.

Although federal sentencing guidelines set Ahmed's sentence closer to four years, Levy considered many factors favorable to Ahmed, including his many children who rely on him as a household provider, his traumatic time in Somalia and his history of depression, anxiety and other mental health disorders for which he takes eight medications daily.

Osman's attorney, Julia Pitney, told Levy her client faces a high probability of deportation after his sentencing.

Unlike Ahmed, who is a U.S. citizen, Osman is not.

He has a wife and two young children who he is likely to never see again if he is forced to leave the country, Pitney said.

She told Levy Osman was orphaned in Somalia by age 5. He was found in a ditch crowded with dead bodies and adopted by a family that took him to several Kenyan refugee camps, where he spent his teen years.

Unlike the other four codefendants in the case, who worked as counselors, Ahmed and Osman were arrested and jailed; they were later bailed and fitted with electronic monitors.

Shortly before imposing sentence on each of the two men, Levy told them they performed a disservice to the members of the Somali community by their actions and treated them as "pawns" in their scheme.

Levy said many of them likely had suffered similar trauma in Somalia, but never received the treatment they should have gotten because of the conspiracy that was perpetrated on them.

In deciding the two men's sentences, Levy said he considered their more than three years on pretrial confinement by electronic monitoring.

Levy said he also took into account the fact that Osman will awake each morning wondering whether he'll be sent back to Somalia where his attorney said he has no known biological family.

Co-defendant Nancy Ludwig, who owned Facing Change, was convicted at trial and was sentenced to 42 months in prison.

She was released early due to health reasons, but remains in the custody of the Bureau of Prisons.

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Prosecutors said that from about November 2015 until May 2018, Ludwig and Ahmed led a conspiracy to commit health care fraud by submitting claims to MaineCare for services that were not rendered as billed.

Beginning in February 2015, Ludwig agreed to pay Ahmed kickbacks in return for Ahmed bringing MaineCare beneficiaries to Facing Change. Ludwig, Ahmed and other employees at Facing Change then caused false and fraudulent claims to be submitted to MaineCare for both counseling and interpreter services. The false claims included claims for visits that never occurred and claims that inflated the level of service provided, according to prosecutors.

In 2016, in response to a MaineCare regulatory change, Ludwig and Ahmed conspired to change the diagnosis of many of Ahmed's clients to schizophrenia so they could remain eligible to receive MaineCare reimbursement for the services at Facing Change, according to prosecutors.

In the fall of 2016, auditors with the MaineCare Program Integrity Unit audited Facing Change. Ludwig and many of her employees conspired to manufacture false and fraudulent records in an attempt to deceive the auditor, according to prosecutors.

Osman joined the scheme in December 2016 and established an interpreter company that received all the fraudulent payments from that time until early May 2019.

That's when agents with the U.S. Department of Health and Human Services, Office of Inspector General, the FBI and the Maine Attorney General's Office executed search warrants at Facing Change and Ahmed's business.

Investigators eventually determined that MaineCare was defrauded a total of $1,863,264.83 in this fraud scheme.

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