Two Inglewood women who operated a drug and alcohol abuse treatment program in the Vermont Knolls neighborhood of South Los Angeles pleaded guilty to running a fraudulent healthcare billing scheme that claimed at least $500,000 for ineligible services, authorities announced Tuesday.
Mesbel Mohamoud, 47, and Erlinda Abella, 66, each pleaded guilty to one count of health care fraud in separate hearings Tuesday for submitting fraudulent Medi-Cal claims for services that did not qualify for reimbursement or were never provided, the U.S. Attorney’s Office for the Central District of California said in a news release.
Mohamoud was the owner and executive director of The New You Center Inc., while her mother-in-law, who co-founded the company in 2005, is the firm’s program director. TNYC had contracts to provide medically necessary substance abuse treatment services through the Drug Medi-Cal program to adults and teenagers in Los Angeles County, prosecutors said.
In their plea agreements, Mohamoud and Abella said that from January 2009 to December 2015, TNYC submitted approximately $527,313 in bogus bills for counseling sessions that weren’t conducted at all, were not conducted at authorized locations, or did not comply with Drug Medi-Cal regulations regarding the length of sessions or the number of clients. Both women also admitted that their company was paid $260,101 for those claims.
Mohamoud and Abella’s company also billed for clients who did not have a substance abuse problem, falsified documents about services that were supposedly provided to patients, and forged client signatures on sign-in sheets and other documents, according to the U.S. Attorney’s Office.
In September 2013, for example, TNYC submitted a fraudulent claim to be reimbursed $62.15 from Medi-Cal for a client’s three-hour counseling session on Aug. 17, 2013. In reality, the patient had been hospitalized that day and did not receive counseling from TNYC, prosecutors said.
Mohamoud also admitted in court documents that she knew Abella directed TNYC counselors to enroll clients with no substance abuse problems into the facility’s treatment program, according to the U.S. Attorney’s Office.
Abella is scheduled for a sentencing hearing on Jan. 25, 2021, while Mohamoud’s sentencing hearing has been set to Feb. 8, 2021. Both will face a maximum sentence of 10 years in federal prison.