Home Health & Hospice Week

Authorities bust fraudsters nationwide.

Bad actors bilking Medicare and Medicaid home care programs are getting caught up in authorities' dragnet, but local home care providers may have to deal with the reputational fallout for the industry.

In Detroit, the Health care fraud prevention and Enforcement Action Team (HEAT) initiative has resulted in charges and arrests in two separate home care-related schemes that billed Medicare for $25 million and $40 million in false claims.

Case #1: Dr. Hicham Elhorr of House Calls Physicians submitted physician home visit claims that were never furnished or medically unnecessary, the Department of Justice says in a release. A complaint unsealed in Detroit federal court "alleges Elhorr submitted claims to Medicare for physician home visits purportedly rendered when he was out of the country, when beneficiaries were hospitalized or when the beneficiary was dead," the DOJ notes.

Elhorr also referred patients for nearly $31 million worth of medically unnecessary home care services. Elhorr accepted kickbacks for the referrals, prosecutors charge.

Case #2: The feds also have charged operators, employees, and marketers associated with home care agencies and psychotherapy clinics operating in and around Detroit. Defendants are Mohammed Sadiq, Jamella Al-Jumail, Firas Al-ky, Clarence Cooper, and Beverly Cooper. They join four defendants charged back in May (see Eli's HCW, Vol. XXI, No. 18).

The defendants paid kickbacks and bribes for beneficiary information used to fraudulently submit claims through Reliance Home Care, First Choice Home Health Care Services Inc., Asso-ciates in Home Care Inc., Haven Adult Day Care Center, Swift Home Care, ABC Home Care Inc., Accessible Home Care Inc., and Be Well Home Care for services that were medically unnecessary or never provided, prosecutors charge. And "Jamella Al-Jumail is charged with destroying records relating to Accessible's Medicare billings upon learning of the May 2012 arrest of Abdul Malik Al-Jumail, her co-conspirator and father," the DOJ says in a release.

The "Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers," the DOJ says in the release.

Other enforcement actions occurred in:

• Chicago: In suburban Skokie, Ill., the feds have charged nine defendants in a home care kickback scheme. The defendants include HHA owners and marketers as well as physicians.

According to an indictment, Rosner Home Healthcare Inc. co-owners Ana Nerissa Tolentino, a registered nurse, and Frederick Magsino, plus marketer Edgardo Hernal paid kickbacks to other physicians, physician office employees, and marketers for referrals to the agency. The amount of kickbacks generally ranged from $300 to $600 for each new patient's completion of five visits and for the repeat admission of a previous patient for a new episode, the feds allege. One physician received nearly $5,000 in kickbacks in five months of 2012 alone, the indictment says.

• Kansas: Former owner Gerard Lessard of ProActive Home Care in Wichita received a sentence of community confinement and was banned from doing business with Medicare following a guilty plea for filing false tax returns, reports The Wichita Eagle. Lessard also entered into an agreement requiring him to pay nearly $600,000 to the federal government and the state of Kansas to settle a claim under the federal False Claims Act.

Lessard and his wife attempted to evade taxes by omitting on their personal federal income tax returns $3.49 million worth of income they received from writing themselves checks and paying their personal expenses from their home care businesses' bank accounts, the DOJ said in a release last year. The Lessards used ProActive's financial accounts to pay for $1.4 million in personal expenses they did not report as income, including purchasing, leasing and restoring a Rolls Royce, a Bentley, a Porsche and several Mercedes Benz cars, landscaping at their home including a golf hole with two tee boxes, mortgage payments on their $2 million home, decorating their home, paying their personal credit card bills and paying bills for relatives.

In 2005 and 2006, Proactive was the highest paid home health agency in Kansas, averaging about $15,000 per patient, compared to the next highest paid, which averaged $10,000 per patient, the DOJ added. ProActive Director of Nursing Caela M. White-Kinchion was indicted last year for submitting claims for services that were upcoded, not provided, medically unnecessary, or supported by false documentation.

• Texas: It's not just shady providers that the feds are going after -- it's also the people helping them. In San Antonio, authorities arrested the owner of a consulting and billing company for helping an ambulance service provider fraudulently bill Medicare. Andey Gray of Crown Consulting and Billing helped clients bill Medicare for ambulance services performed by a non-Medicare provider or not performed at all, an indictment says.