Home Health & Hospice Week

HHAs with patients from indicted doc see no suspensions -- yet.

Legitimate home care providers are paying the price for the fraudsters infiltrating the industry, both via reputational injury and increased scrutiny from authorities.

"The home health industry is once again front and center in the fraud allegations," laments attorney Liz Pearson with Pearson & Bernard in Edgewood, Ky., referring to the record-breaking $492 million in fraud schemes for which the government recently issued indictments (see related story, p. 286).

The indictments list these individuals and agencies in $230 million in home care schemes:

In Dallas: Dr. Joseph Megwa of Raphem Medical Practice in Arlington, Texas signed about 33,000 prescriptions for more than 2,000 Medicare beneficiaries from 2006 to 2011 and was responsible for about $100 million in home care fraud, the Department of Justice says in a release. "In order to handle the volume of prescriptions, Megwa allegedly signed stacks of documents without reviewing them," the DOJ alleges.

Megwa signed off on claims for a fee from PTM Healthcare Services of Irving and at least 230 other home health agencies in the area, reports the Dallas Morning News. In some instances, he certified that he attended patients at their homes while he was traveling overseas, the Justice Department alleges. Two nurses associated with PTM, Ferguson Ikhile and Ebolose Eghobor also were indicted.

Lawrence Dale St. John and his son Jeff-rey Dale St. John of A Medical House Calls also were indicted for conspiracy and fraud. And Dr. Nic-olas Alfonso Padron was charged in the indictment, the News says. Among other things, they are accused of billing Medicare for patient visits by Padron while the physician was away on a cruise.

Multiple billers in the Dallas area tell Eli that no home health agencies have yet seen suspensions related to Dr. Megwa or Dr. Padron when billing for his patients, unlike in the fraud case against Dr. Jacques Roy earlier this year.

Update: The agencies suspended in the Roy case received letters in August extending their suspensions another six months, billers in the area report. CMS has not released information about the suspensions.

One HHA owner indicted in the Roy case, Cyprian Akamnonu of Ultimate Care Home Health Services Inc., has pled guilty to directing his wife Pat and others to recruit ineligible patients for home care, then having Roy's practice, Medistat, certify and sign orders for the patients. Physician practice manager Teri Sivils often would sign the certifications for Roy, prosecutors said. Ultimate then would bill Medicare for services that were medically unnecessary or not performed, the DOJ says in a release.

Ultimate had 78 percent of its beneficiaries' certs signed by Roy or another Medistat physician. Six co-defendants await trial in the case, which is set for July 2013, the DOJ says.

In Florida: Authorities indicted many individuals in the Miami area for paying and receiving kickbacks, as well as submitting claims for services (often insulin injections) that were never provided or medically unnecessary.

Those indicted include Rogelio Rodriguez and Raymond Aday of Caring Nurse Home Health Corp. and Good Quality Home Health Inc. ($53 million in alleged false claims); Sila Luis, Elsa Ruiz, and Myriam Acevedo of LTC Professional Consultants Inc. and Professional Home Care Solutions Inc. ($74 million); Vladimir Jimenez and Manuel Lozano of Serendipity Home Health ($20 million); Yanier Betancourt of Musomed Health Care Corp.; Maria Eugenia Rueda (president), Jorge Sell (RN and office manager), Arminda Reyes, Rene Suarez-Basanta, Maria Esther Valdez, Manuela Edelia Rodriguez, Francisco A. Rizo, Cristobal Jorge Garcia, and Marta Gonzalez of Safe Home Health Care Agency Inc. The last case indicts the beneficiaries who received the kickbacks as well as the agency officials who paid them.

In Chicago: Two physicians recently were found guilty of home care and visa fraud, the DOJ says. Bhair Haj Khalil, co-owner of House Call Physicians in Palos Hills, and business partner Mohammed Khamis Rashed billed for home health services as if they were performed by physicians when they were actually performed by physicians' assistants and falsely certified patients for home care, prosecutors said at trial.

In Los Angeles: Prosecutors charged Vivi-an Neri with soliciting home care referrals in ex-change for kickbacks. Neri is associated with at least $40,000 in home health services claims submitted to Medicare, the DOJ says.