Home Health & Hospice Week

Fraud takedown highlights Medicare fraud.

Convincing lawmakers you need a break might be even more difficult after the HHS Office of Inspector General and Department of Justice’s joint announcement of their “largest ever health care fraud enforcement action by the Medicare Fraud Strike Force.”

The stats: The “National Health Care Fraud Takedown” conducted on July 13 involved 412 charged defendants across 41 federal districts, including 115 doctors, nurses, and other licensed medical professionals, for their alleged participation in healthcare fraud schemes involving about $1.3 billion in false billings, the DOJ and OIG say in a release. HHS has initiated suspension actions against 295 providers, including doctors, nurses, and pharmacists, and 30 state Medicaid Fraud Control Units participated in that day’s arrests.

While a large portion of the cases involved opioid abuse and other drug prescribing problems, there were also a fair number of home health and hospice cases including:

In Nevada: Two defendants, including a physician, were charged in a scheme involving false hospice claims. Angel Eye Hospice received about $7.1 million in Medicare payments from 2012 to 2015 despite its owner, physician Camilo Primero, being excluded from Medicare for a previous hospice fraud case with California-based West Coast Hospice, the indictment in the case says. When Angel Eye had its Medicare payments suspended, Primero and another defendant bought Vision Home Health Care, formed Adventist Hospice, and received another $1.8 million in Medicare reimbursement from 2015 to the present. The defendants concealed Primero’s ownership in Angel Eye, Vision and Adventist, and submitted claims for patients who weren’t terminally ill, prosecutors allege.

In Illinois: Fifteen individuals were charged in cases related to six different schemes concerning home care and physical therapy fraud, kickbacks, and mail and wire fraud. These schemes involved more than $12.7 million in fraudulent billing. “One case allegedly involved $7 million in fraudulent billing to Medicare for home health services that were not necessary nor rendered,” the OIG and DOJ say.

In Florida: Seventy-seven defendants were charged with offenses relating to various fraud schemes involving more than $141 million in false billings for services including home care.

Ohio Case Features Kickbacks

Meanwhile, non-takedown enforcement actions continue as well, including these cases:

In Ohio: Tridia Hospice Care Inc. is one of three companies that has agreed to pay $19.5 million to settle charges that they falsely billed Medicare for medically unnecessary hospice and SNF rehab services. From 2011 through 2013, Tridia submitted false claims to Medicare for hospice services provided to patients who were ineligible for the Medicare hospice benefit because Tridia failed to conduct proper certifications or medical examinations, the DOJ alleges in a release. The settlement also resolves allegations that from 2008 through 2012, Tridia owners and managers Brian Colleran and Daniel Parker solicited and received kickbacks to refer patients from SNFs managed by their management companies to Amber Home Care.

In New York: VNS Choice, VNS Choice Community Care, and the Visiting Nurse Service of New York have agreed to pay $4.4 million to settle charges that VNS-Choice improperly collected Medicaid payments for 365 Medicaid beneficiaries whom it failed to timely disenroll from the VNS Choice Managed Long-Term Care Plan, according to a release from Joon Kim, the Acting U.S. Attorney for the Southern District of New York. Most of the beneficiaries who should have been disenrolled were no longer receiving healthcare services from VNS.

Note: See links to the takedown indictments at www.justice.gov/opa/documents-and-resourcesjuly-13-2017.