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Document and Benefit Fraud

2 sentenced in Maine for health care fraud and federal benefits fraud

PORTLAND, Maine - Ahmed Yusuf Guled, of Lewiston, Maine, and Dahabo Abdulle Osman of Portland, Maine, were sentenced yesterday in U.S. District Court for health care fraud offenses, federal benefits fraud, and theft of government funds, announced U.S. Attorney Thomas E. Delahanty II of the District of Maine. This case was investigated by U.S. Immigration and Customs Enforcement's (ICE) Homeland Security Investigations (HSI) and other federal and state government agencies.

Senior U.S. District Judge D. Brock Hornby sentenced Guled, who is 75 years old, to four months in prison, to be followed by a three-year term of supervised release. He also ordered Guled to pay restitution totaling $119,440 and ordered him to forfeit property totaling $109,733. Judge Hornby sentenced Osman, who is 59 years old, to five years of probation, with a special condition that she serve a six-month term of home confinement. She was also ordered to pay restitution totaling $102,509 and forfeit property totaling $88,642.02.

Guled and Osman were convicted in U.S. District Court on June 24, 2010, of conspiring to defraud the United States and commit health care fraud offenses, and the separate offense of health care fraud. The jury found that they fraudulently obtained Medicaid funds through MaineCare's Home and Community Based Care Program, also known as the Waiver Program. Guled was also convicted of making false statements in connection with this program. The evidence at trial established that Guled, with the help of his adopted sister, Dahabo Osman, deceived nurse assessors into believing he was nursing home eligible and, therefore, entitled to receive home-based personal care services. Osman was then paid wages through three different local personal care agencies, reimbursed by MaineCare, for supposedly providing care to Guled. However, the evidence established that the services were not medically necessary and Osman did not provide all of the services billed by the home health agencies.

Guled and Osman were also convicted separately of making false statements to the Social Security Administration in connection the receipt of Supplemental Security Income (SSI) benefits, to housing officials with respect to public housing benefits, and to Maine Department of Health and Human Services (DHHS) in connection with the receipt of MaineCare, food stamps or temporary assistance to needy families (TANF) benefits. The evidence at trial established that Guled failed to disclose to these agencies that he owned bank accounts with balances that exceeded $2,000 while Osman failed to disclose wages she received from personal care agencies. The defendants were also convicted of theft of government funds with respect to SSI, food stamps or TANF benefits that they were not entitled to receive.

According to U.S. Attorney Delahanty, in sentencing Ahmed Guled to four months in prison rather than the recommended fifteen to twenty-one months, Judge Hornby cited Guled's age, and failing health as mitigating factors. Osman avoided a prison term due in part to the fact that she is the sole caretaker of a twelve-year old grandson with health issues.

The prosecution of this case was successful because of the combined investigative efforts of the Offices of Inspector General with the U.S. Department of Health and Human Services, the U.S. Department of Housing and Urban Development, the Social Security Administration, and the U.S. Department of Agriculture as well as agents and investigators with ICE HSI , the FBI, the Healthcare Crimes Unit of the Maine Attorney General's Office, the Fraud, Investigation and Recovery Unit of the Maine Department of Health and Human Services, and the U.S. Attorney's Office.