Home Health & Hospice Week

Unprecedented jail term for home health fraud handed down.

If you’ve been giving your compliance program short shrift in light of the myriad of business and regulatory concerns on your home health agency’s plate, the time has come to re-prioritize.

Why? Federal judges have just handed down two extremely lengthy prison sentences for home health fraud — one an astonishing 75 years, and another 35 years.

For well-intentioned providers, the lengthy sentences show “the government takes [home health fraud] very seriously and providers need to stay on top of compliance,” urges attorney Robert Markette Jr. with Hall Render in Indianapolis.

For providers looking to game the system, “both these cases reflect the government’s vigilance in punishing health care fraudsters,” notes attorney Liz Pearson with Pearson & Bernard in Edgewood, Kentucky. “Especially those that set up intentional schemes to defraud the program … and are using the much-hated and illegal patient recruiter model.”

Upside: “It is heartening to know that enforcers are identifying bad actors like these providers and that they are being punished, in some cases severely,” says Washington, D.C.-based attorney Elizabeth Hogue. “We don’t want providers like these in our industry,” Hogue stresses.

Downside: “I am always somewhat concerned when I read about such cases,” Hogue continues. “The headlines generated by cases like these are bad for our industry, in the sense that they reinforce the erroneous perception that our industry is rife with fraud and abuse.”

Case #1: Marie Neba

A federal judge sentenced Marie Neba, coowner of Fiango Home Healthcare Inc. in Houston, to the whopping 75-year term after her conviction last November in a $13 million home health fraud scheme, the Department of Justice says in a release. Neba and co-owner/husband Ebong Tilong paid kickbacks to physicians, patient recruiters, and patients themselves, prosecutors proved at trial. And they falsified medical records to make it appear patients qualified for and received home care services, when services weren’t provided (see Eli’s HCW, Vol. XXV, No. 42).

Key: “Neba also attempted to suborn perjury from a co-defendant in the federal courthouse, the evidence showed,” the DOJ says. In other words, she tried to get a witness to lie.

Ebong pled guilty one week into Neba’s trial. Three others have pled guilty in the scheme — physician Nirmal Mazumdar, Fiango’s former medical director, and patient recruiters Daisy Carter and Connie Ray Island. Island has been sentenced to nearly three years in prison, while the others await sentencing, the DOJ says.

“The 75-year sentence in the first case is extraordinary,” Pearson tells Eli. She says she’s “never seen such a long sentence.” The fact that “there were several things going on — kickbacks to recruiters and to beneficiaries” and “that they were paying the beneficiary to just bill on the HIC number” were likely contributing factors, she surmises.

Under federal sentencing guidelines, judges don’t have as much discretion as in state court, Markette notes. “It probably didn’t help [Neba’s] case that she tried to get at least one witness to lie during the trial,” he tells Eli. “She appears to have just kept piling on.”

“Likely what put the nail in the coffin [is that] she attempted to suborn perjury — to get one of the co-conspirators to lie,” Pearson agrees.

Case #2: Dr. Jacques Roy

The infamous Dr. Jacques Roy also is now paying the piper, to the tune of 35 years in prison.

Physician Roy owned and operated Medistat Group Associates in the Dallas area, which primarily provided home health certifications and performed patient home visits. Dr. Roy allegedly certified or directed the home health certification of more than 11,000 patients from more than 500 HHAs over five years. Many of those were for medically unnecessary services and services never provided as part of a massive $375 million fraud scheme. “Medistat’s office included a ‘485 Department,’ essentially a ‘boiler room’ to affix fraudulent signatures and certifications,” the DOJ says in a release.

Dr. Roy allegedly instructed Medistat employees to complete 485s by either signing his name by hand or by using his electronic signature on the document, prosecutors showed. Medistat and the HHAs — Apple of Your Eye, Ultimate Care Home Health Services Inc., and Charry Home Care Services Inc. — used patient recruiters for the scheme. (See Eli’s HCW, Vol. XXI, No. 9 for more details of the case.)

The government also proved that “when the Centers for Medicare & Medicaid Services suspended Roy and Medistat from receiving Medicare payments ... because of suspected fraud, Dr. Roy sought an ‘end-run’ around the suspension through the use of another company, Medcare House Calls,” the DOJ says.

In addition to suspending Roy and Medistat’s Medicare payments, CMS suspended payments for 78 HHAs that received a large percentage of their certs from Roy and Medistat.

“I would have thought Dr. Roy would have had the larger sentence of these two cases, because the loss was 20 times as much and the loss to the government is a big factor in these cases,” Markette points out. The DOJ pegs the Neba fraud at $13 million and the Roy fraud at $375 million.

In fact, U.S. Attorney John Parker of the Northern District of Texas said in the release that “the only thing more stunning than Jacques Roy and his co-conspirators’ shameless methods … is the staggering dollar amounts involved in this fraud scheme. This takes brazen to a whole new level.”

It’s hard to miss the fact that Roy’s “comprehensive scheme” involved “a whole office full of people making up false certifications for home health services” and “the much-hated and illegal patient recruiter model — which at least in part targeted homeless people,” Pearson notes.

Nevertheless, Roy got off with a lighter sentence than Neba — although still a very hefty one.

Roy’s sentencing comes on the heels of Charry owner Charity Eleda’s. RN Eleda recruited patients from a homeless shelter, sometimes paying recruiters $50 per beneficiary they found and directed to her vehicle parked outside the shelter’s gates. Eleda and other nurses would falsify medical documents to make it appear as though those benes qualified for home health care services that were not medically necessary. Eleda and the nurses prepared plans of care that were not medically necessary, and these POCs were delivered to Dr. Roy’s office.

Most of the other defendants in the case have seen their consequences already. Ultimate coowners and husband and wife Cyprian Akamnonu and Patricia Akamnonu entered guilty pleas in 2012 and 2015, respectively, and received 10 years each in federal prison as well as an order to pay $25 million in restitution.

And in June, Apple of Your Eye owner Wilbert James Veasey Jr. received a 17-and-a-halfyear prison sentence and was ordered to pay $21.1 million in restitution to Medicare and more than half-a-million dollars to Medicaid (see Eli’s HCW, Vol XXVI, No. 22).

Medistat office manager Terri Sivils pled guilty in 2015, and received three years’ probation, the DOJ says in its release. One defendant, recruiter Cynthia Stiger, awaits sentencing in October.