- The Washington Times - Tuesday, February 15, 2011

What began as an investigation into a fatal traffic accident five years ago has turned into a False Claims Act lawsuit against a company that received federal and local tax dollars to drive D.C. Medicaid patients to and from medical appointments.

The federal government’s recent lawsuit against Nile Express Transport Inc. accuses the company of years of overbilling, marking the latest case in which a D.C. Medicaid provider faces scrutiny from city and federal regulators over their billing practices.

The probe began after a D.C. Medicaid investigator looking into a fatal traffic accident during the summer of 2006 involving Nile Express was turned away after asking for records at the company’s headquarters, according to the U.S. attorney’s office.

Later, federal investigators from both the FBI and U.S. Department of Health and Human Services looking into the accident discovered “fraudulent billing practices” at Nile Express from June 2002 to August 2006, according to the federal government’s lawsuit.

The False Claims Act lawsuit filed in federal court in Washington accuses the company of overbilling on approximately 21,540 claims worth more than $300,000. Under the False Claims Act, defendants can be sued for three times the amount of damages. The government hasn’t yet placed an exact figure on how much money is being sought in the case.

The U.S. attorney’s office said in court records that Nile Express was billing the government under a code that required an extra attendant or assistant on duty, but that no additional employee was being used on the companies medical transports.

Medicaid, which provides health care for low-income people, is funded jointly by federal and D.C. governments and is managed by city officials. Among other services, the program pays companies to take patients for non-emergency medical visits such as doctors appointments and dialysis.

James Bacon, an attorney for Nile Express and the company’s president, Bushra E. Hamid, said Tuesday that the government’s lawsuit “is very much in dispute.” At issue is whether the company was informed that it was allowed to bill under the extra attendant code at times when the driver of a Medicaid van also provided services such as getting out to assist patients in and out of their homes and medical offices.

In recent court filings, Mr. Bacon also asked a judge to dismiss the government’s claim of “unjust enrichment” against the company and Mr. Hamid, arguing that the statute of limitations had run out.

The lawsuit doesn’t provide any details on the accident that first prompted the billing investigation. But according to federal court records filed in another case, Nile Express was transporting a foster child and ward of the D.C. government to Progressive Life Center in July 2006 when the child was struck and killed in the street.

The False Claims Act lawsuit against Nile Express, which is no longer providing Medicaid transportation in the District, marks the latest among several recent cases involving the city’s Medicaid program.

Lois Diane Fant, 60, was sentenced to three years probation and 180 days home detention last year after authorities accused her of tricking D.C. officials into paying her company more than $100,000 for services that were never performed.

Another transportation provider, Olakunle Macanthony, 50, was sentenced to 10 months in prison and home confinement over more than 3,100 Medicaid claims that authorities said he filed that turned out to be phony.

Meanwhile, former D.C. Medicaid employee Mable Dinkins in September was sentenced to two years probation for taking cash to steer business to a transportation company.