Home Health & Hospice Week

Industry must combat fraud rep.

The feds just charged 107 individuals nationwide with Medicare fraud in a record-breaking fraud bust, and they're already seeing results.

Detroit-area residents Zahir Yousafzai and Dr. Dwight Smith pled guilty May 7 for their roles in a $13.8 million home care fraud and money laundering scheme, the Department of Justice says in a release. Four home health agencies that Yousaf-zai owned or helped operate, First Care Home Health Care, Moonlite Home Care Inc., Physicians Choice Home Health Care, and Quantum Home Care Inc., billed Medicare for services that were never provided, the feds say.

Yousafzai admitted to paying doctors, nurses, and other clinicians to create fictitious patient files and paying kickbacks to patient recruiters, the DOJ says. As a physical therapy assistant, he also falsified documentation himself.

Smith referred patients to home care whom he had not actually examined when the patients were not homebound, he admitted. Smith and his practice employed unlicensed physicians who did the same, the prosecutors say.

Other suspects charged in the scheme in-clude Bilal Akbar, Joann Terrell, Madhur Tha-wani, Shahzad Mirza, and Ankit Patel.

Many other home care providers still have charges pending in the nationwide bust that used more than 500 law enforcement agents in a coordinated "takedown" of 107 people suspected of $452 million in Medicare fraud (see Eli's HCW, Vol. XXI, No. 17, p. 136). In Florida, cases include:

• Two RNs working for Ideal Home Health, Odalys Fernandez and Kelvin Soto, are charged with furnishing medically unnecessary services, or never furnishing services at all, and falsifying paperwork, according to a release from Florida U.S. Attorney Wifredo Ferrer. And four patient recruiters, Yumidia Naranjo, Jose Guerra, Ya-nuris Lima and Servando Raya, allegedly paid beneficiaries to be Ideal patients.
• Willsand Home Health Inc. owner Eulises Escalona paid kickbacks to Medicare benes to become patients and receive medically unnecessary services, according to Ferrer. Escalona also paid kickbacks to patient recruiters and to doctors who signed fraudulent prescriptions and plans of care (POCs), and falsified documentation.
• Ronat Home Health Care Inc. owner Rodolfo Nieto, Jr. accepted kickbacks in return for recruiting Medicare beneficiaries for placement at Nany Home Health Inc., prosecutors charge.
• Superstar Home Health owner Pablo Orama and 15 other individuals, including four Medicare beneficiaries, are accused of paying and accepting kickbacks for patients.
• In Los Angeles, employees of Greatcare Home Health Inc. have already pled guilty to furnishing medically unnecessary services or never furnishing billed services at all, according to a release from the DOJ. Greatcare owner Hee Jung Mun paid illegal kickbacks to doctors, marketers, and patients themselves.

Two other cases in L.A. involved durable medical equipment suppliers.

• In the Detroit area, two individuals are charged in a $33 million scheme involving false claims and kickbacks at Access Care Home Care Inc., Patient Care Home Care Inc., Hands On Healing Home Care Inc., and All State Home Care Inc., according to a release from U.S. Attorney for the Eastern District of Michigan Barbara McQuade. Those charged are Badar Ahmadani and Falusic Ashford.
• And four people are charged in a $23 million scheme involving three HHAs in Madison Heights and Sterling Heights, Mich. -- Reliance Home Care, First Choice Home Health Care Ser-vices Inc., and Associates in Home Care Inc. Those charged are Sachin Sharma, Dana Sharma, Abdul Malik Al-Jumail, aka "Tony," and Felicar Williams.

Fallout: High-profile busts that involve so many home care providers make legitimate pro-viders' lives harder. "The fraud committed by the very few, hurts all of home care and the patients we serve," says Val Halamandaris with the National Association for Home Care & Hospice. "The in-dustry must be a leader in health care compliance and program integrity."

NAHC is calling for CMS to implement a number of program integrity measures, including credentialing of home health owners and managers and a requirement that all HHAs have a corporate compliance plan, the trade group notes.