A Doctor's Health Insurance Fraud With Tax Evasion

Ndubuisi Joseph Okafor, M.D., had practiced primary care medicine through the Okafor Group in the Washington D.C. metropolitan area.  He was however, sentenced in U.S.A. v. Okafor, to 65 months in prison followed by three years of supervised release for health insurance fraud and tax evasion.  He was also ordered to pay restitution in the amount of $769,192 to tax authorities and $33,060 to Medicare.


As partly described by his July 18, 2008 criminal judgment, Dr. Okafor had entered a plea agreement for violating 18 U.S.C. §1347 (Healthcare Fraud) along with 26 U.S.C. §§7201 (Tax Evasion) & 7206 {2} (False Income Tax Returns).  According to a press release about Dr. Okafor's plea agreement, Dr. Okafor had: submitted phony bills to Medicare and other health care providers; filed false tax returns; and diverted business revenue by using a corporate checking account to pay for personal expenses. 


Based on that same press release, Dr. Okafor had also engaged in an abusive offshore tax avoidance scheme.  This was true because Dr. Okafor had used his two offshore shell companies formed in the Bahamas to transfer undeclared revenue from his Washington D.C. Okafor Group.  As suggested by "Asset Search Indicia For Divorce, Debt Collection & Bankruptcy", the use of shell companies and a high-risk geographical location like the Bahamas, is a red flag that assets may have been hidden.


Copyright 2008 Fred L. Abrams

Nominees & Hidden Assets

A beneficial owner will sometimes use a nominee (i.e. representative) to hide money with complete anonymity in a bank account.  As the website of www.offshoresimple.com explains, a beneficial owner may hire a nominee incorporation service to supply a bank signatory.   This suggests that a beneficial owner can use a nominee to circumvent the know your customer / customer identification procedures at a bank.  For example, through the bank signatory service offered by www.offshoresimple.com, a beneficial owner can use a nominee to:      
  • Open / manage an offshore bank account.
  • Act as an account's bank signatory.
  • Supply a bank with the necessary customer identification documents.
  • Execute the incorporation documents needed to form an offshore corporation.
The above-described use of nominee incorporation services is widespread.  As page 64 of the 2007 National Money Laundering Strategy mentions, nominee incorporation services that arrange U.S. bank accounts and shell companies are believed to annually launder as much as $36 billion just from the former Soviet Union.

Instead of retaining a nominee incorporation service, some beneficial owners hide assets by using friends or relatives as nominees.  According to his twenty-one count forty-four page July 26, 2005 indictment, Mr. Edwards for example, had stolen insurance premiums and then concealed them in nominee financial accounts in the names of his wife and two shell companies.  Mr. Edwards had also used his wife as the nominee purchaser of his mountain chalet and a  "palatial" home-- both of which were bought with stolen insurance premiums.


All of the foregoing had been part of Mr. Edward's insurance and tax fraud scheme which lasted from about January, 1999 through April 30, 2001.  Via his indictment, Mr. Edwards was charged with: mail fraud (18 U.S.C. § 1341 & 18 U.S.C. § 1342); wire fraud ( 18 U.S.C. § 1343); making false statements to a  financial institution (18 U.S.C. § 1014);  theft from a health care benefit program (18 U.S.C. § 669); money laundering (18 U.S.C.§ 1957 [a] & [b]); and tax evasion (26 U.S.C. § 7201)

 
Mr. Edwards was specifically accused of collecting insurance premiums from various employers while unlicensed to do so.  Instead of providing thousands of employees with workers' compensation insurance, he converted their insurance premiums for his own use.  Between January 1, 2000 and April 30, 2001 Mr. Edwards also allegedly stole $2.5 million from his company Fidelity Group, Inc., which was a health care benefit group as mentioned by 18 U.S.C. § 24 (b).  Furthermore, when Mr. Edwards actually did apply for some workers' compensation insurance coverage, he allegedly understated payroll and the type / number of employees to fraudulently secure lower insurance premiums.


When Mr. Edwards administered an employer's self-insured health insurance plan, he also had  allegedly delayed or denied medical benefits the employees were entitled to.  Mr. Edwards indictment also alleged that he had filed a false joint Income tax return for 1999, by underreporting taxable income.  In 2000, Mr. Edwards also supposedly filed a false joint tax return by underreporting taxable income and paying just $724 in taxes.  He was additionally accused of failing to file any tax return for 2001, as was required. 


As the Court's June 26, 2006 Judgment demonstrates, Mr. Edwards ultimately pleaded guilty to four of the twenty-one counts mentioned by his indictment: two counts of mail fraud; one count of theft from a health care benefit program; and one count of tax fraud.  Pursuant  to his plea agreement, Mr. Edwards was sentenced to serve 150 months in prison and ordered to pay fines, make restitution, etc.  As Mr. Edwards' motion executed on August 13, 2007 however indicates, he seeks to vacate his guilty plea / sentence pursuant to 28 U.S.C. § 2255 by alleging ineffective assistance of counsel among other things.


Copyright 2007 Fred L. Abrams

Hidden Assets & Insurance Fraud

To avoid detection, those who commit insurance fraud typically hide assets.  In August 2001 for instance, a father and son in Florida were charged with money laundering after fraudulently billing over forty health and insurance auto companies more than $1million dollars.  As part of their scheme, monies paid by insurance companies for blood tests were converted to cash via a Florida Bank of America account. This account had been opened in the name of a phony Miami medical laboratory (Biolab Clinical Inc.), which was actually just a rented mailbox.

More recently, a Westchester New York dentist and his wife were arrested for money laundering in connection with a $2.8 million Medicaid fraud.  The N.Y.S. Attorney General's July 30, 2007 press release claimed that the two had submitted fraudulent Medicaid bills for dental cleanings, x-rays, and oral surgeries, and then made ".... financial transactions and fil[ed] false financial disclosure statements in an effort to hide assets from the courts."  According to the Attorney General, there was also an attempt to use the name of  the couple's 18 year old son on an account at a foreign based bank with $828,817 deposited in it.


Because assets can be hidden in a wide variety of ways during an insurance fraud, I asked Stan Tice for a briefing.  Stan consults with the insurance industry about detecting and investigating insurance fraud through his New York  based  private investigation  firm.  Furthermore, he had: lectured annually about insurance fraud at New York's College of Insurance, served as a deputy director of the Insurance Frauds Bureau for New York's Insurance Department, and had even worked for New Jersey's Insurance Department where he was the founding director of its former Insurance Frauds Prevention Division.


During my briefing, Stan mentioned how one policyholder had hidden his collection of Hummel & Lladr? figurines and then filed a property/casualty insurance claim for them, alleging a loss in the  hundreds of thousands.  According to the policyholder, debris from the figurines demonstrated that they had been accidentally destroyed.  Stan however submitted these remains to a forensic lab for testing-- only to discover that they could not have originated from the policyholder's figurine collection.  Because of Stan's efforts, the policyholder was eventually criminally prosecuted for fraud and attempted grand larceny.


Given the fact that the insurance industry's National Insurance Crime Bureau advises that 10% or more of all property/casualty claims are fraudulent, I wanted Stan's opinion.  Stan then advised that since the above statistic was limited to just property/casualty claims, that the actual number of all fraudulent claims was likely astronomical.  This of course means that our insurance premiums are not going to be reduced any time soon.


Copyright 2007 Fred L. Abrams