Home Health & Hospice Week

Owner on OIG's Most Wanted list caught.

Ready to get hit with a fraud reputation once again? The HHS Office of Inspector General continues to sing its "home care is fraud-prone" tune in its latest report to Congress.

One of the OIG "continuing priorities" is "strengthening care in noninstitutional settings, including home health care," Inspector General Daniel Levinson says in the OIG's Semiannual Report to Congress released Nov. 30. The report covers the six-month period ending Sept. 30.

"OIG's mission is to protect the integrity of HHS programs and the health and welfare of the people they serve," Levinson says. "We accomplish our mission by preventing and detecting fraud, waste, and abuse; identifying opportunities to increase the efficiency and effectiveness of HHS programs; and holding accountable those who do not meet program requirements or who violate Federal laws."

The OIG lists these examples of home care fraud cases with significant developments in the latest six-month period:

• The infamous Dr. Jacques Roy case wrapped up in August, when he was sentenced to 35 years in prison and $268.1 million in restitution with his co-defendants (see Eli's HCW, Vol. XXVI, No.

30). 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.

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 used patient recruiters for the scheme.

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.

"Five additional defendants involved in the scheme were previously sentenced to a combined 41 years and 6 months and ordered to pay joint and several portions of the $268.1 million restitution," the OIG notes in its semiannual report.

• In January, mother and son Delores Knight and Isaac Knight, who owned and managed, respectively, Just Like Familee II and Just Like Familee III in Cleveland Heights, Twinsburg, and Mentor, Ohio, were convicted of fraud and money laundering charges in an $8 million scheme where documentation was forged and services not provided.

In May the Knights were sentenced to 10 and seven years in prison, respectively, and ordered to each pay $8.1 million in restitution. Two other defendants in the case were also sentenced - Sonja N. Ferrrell received 18 months in prison and $1.1 million in restitution, and Juliet L. Bonner received eight months of home confinement, three years of probation, and $381,000 in restitution (see Eli's HCW, Vol. XXVI, No. 20).

• One of OIG's Most Wanted Fugitives, home health agency owner Hector Anca Soca, was captured during this reporting period. Anca Soca, owner of M&K Home Health in Miami, was indicted on charges of health care fraud in January 2016 and fled the United States, the DOJ says.

According to the indictment, from around October 2014 through September 2015, he obtained the names and Medicare ID numbers of beneficiaries, along with the names and provider numbers of physicians, to submit false claims to Medicare. Investigators believe that Anca Soca, through M&K, was paid about $3.7 million for services that the agency did not render. Anca Soca was detained while trying to enter the U.S. from an inbound flight originating in Cuba, according to a DOJ release.

• Hartford Hospital and Midstate Medical Center in Connecticut agreed to pay more than $2.8 million in assessments and penalties for submitting claims between February 2009 and March 2015 "for home health services that patients received within three days of being released from Hartford Hospital, with the release improperly coded as a discharge rather than a post-acute care transfer."