A registered nurse from Bowie, Maryland, pleaded guilty September 17 to a health care fraud conspiracy tied to a $14 million scheme that billed D.C. Medicaid for youth mental health services that were never provided or were grossly inflated. Vera Nyiawung, 34, entered the plea in federal court in Washington to one count of conspiracy to commit health care fraud, the U.S. Attorney’s Office for the District of Columbia said. Investigators determined her own part in the scheme cost Medicaid more than $550,000.
A nurse who approved the notes behind the billing
According to court documents described by the Justice Department, Nyiawung began working in January 2023 as a nurse at a D.C. Medicaid provider authorized to deliver mental health rehabilitative services to children and adolescents. The company was not named in the announcement.
Her role went beyond nursing. She also performed the duties of a Community Support Worker, supervised other staff and reviewed encounter notes, the written records of each patient contact, before they were approved. Those notes are what a provider relies on to bill Medicaid, which placed her at a checkpoint in the process that was supposed to catch bad claims.
U.S. Attorney Jeanine Ferris Pirro described that position directly. “Padding call lengths, recycling notes, and billing Medicaid for care that never happened isn’t healthcare—it’s organized theft,” Pirro said. “Vera Nyiawung was trusted to oversee care for vulnerable youth but instead used her position to validate fake records and facilitate a multi-million-dollar fraud scheme.”…