Home Health & Hospice Week

Texas HHA exec receives 10-year sentence.

Physicians furnishing a large volume of home care certifications — and the home health agencies who receive referrals and certs from them — are under the microscope, some recent fraud cases illustrate.

Case #1: After pleading guilty to falsely certifying home care patients, a Chicago-area physician has received a two-year prison sentence. Dr. Arthur Davida, an employee and part-owner of Bloomingdale- based Home Care Physicians Inc., knew that at least 20 percent of the patient referrals he received from home health agencies were not homebound, but he still provided the certifications — allowing the agencies to bill Medicare for treatment that Davida knew was not medically necessary, the Department of Justice says in a release. Davida acknowledged in a plea agreement that he provided the certs because he feared the agencies would stop sending him the referrals otherwise.

Case #2: After a four-day trial in Chicago federal court, the jury convicted Mobile Doctors physician Banio Koroma for falsely certifying patients for home care, the DOJ notes in a release. “By referring patients to home health agencies that did not warrant Medicare payments, Mobile Doctors received more referrals from those agencies for services provided by its physicians,” the DOJ said in a release about the case in 2013. From 2010 through 2013, more than 200 HHAs submitted Medicare claims and were paid more than $10 million for services listing Koroma as the referring physician.

Between 2006 and 2013, Mobile Doctors physicians certified or recertified for home care about 15,598 patients about 83,133 times, many of which were allegedly false, the DOJ said. More than 6,000 of the certs were attributed since 2007 to Koroma, with Mobile Doctors billing Medicare for about 17,439 patient visits he made during that time, more than any other Mobile Doctors physician.

The case was initiated in part due to complaints from Mobile Doctors’ own employees. The company closed in 2013. Mobile Doctors’ CEO Dike Ajiri pleaded guilty to upcoding charges in October and faces sentencing in April, the DOJ says.

Case #3: Even when the feds don’t join in a whistleblower suit against an agency, it can still cause damage. The government declined to intervene in a False Claims Act suit against Addus Homecare Corp. which was brought by a corporation formed expressly to file the suit, reports law360.com. Stop Illinois Marketing Fraud’s 2013 qui tam suit, unsealed last month, claims Addus would target dual beneficiaries of Medicare and Medicaid to make them sign up for home health care services that they weren’t qualified for, and then Cigna’s Home Physicians Management would provide doctors to sign off on the necessity.

Addus tried to convert unskilled patients to skilled services with unethical marketing practices such as offering clinicians bonuses and by steering patients exclusively to HPM for certification when primary care physicians wouldn’t sign off, the suit claims. Addus sold most of its Medicare business to LHC Group in 2013, law360 notes.

Case #4: Another physician-centered case in Texas, focusing on the infamous Dr. Jacques Roy, has racked up another lengthy prison sentence. After pleading guilty to Medicare fraud charges last year, Patricia Akamnonu has received 10 years in federal prison. Akamnonu co-owned Ultimate Care Home Health Services Inc. with husband Cyprian Akamnonu, who pled guilty in the scheme in 2012 and is currently serving a 10-year sentence as well. Both were ordered to pay $25 million in restitution, the DOJ notes in a release.

Ultimate billed for home care services that were never provided or were medically unnecessary to patients who were falsely certified by Dr. Roy or other physicians at Medistat Group Associates, according to prosecutors. From 2006 through 2011, more than 78 percent of Ultimate’s beneficiaries were certified by Dr. Roy or another Medistat physician, the DOJ says.

One of the other seven defendants charged in the Roy case, Medistat office manager Teri Sivils, also has pleaded guilty and faces sentencing in March, the DOJ adds. March is also the date the remaining four defendants — Roy, patient recruiters Cynthia Stiger and Wilbert James Veasey, Jr., and RN Charity Eleda — will face trial.

Reminder: In 2012, Medicare suspended payments for 78 HHAs to which Roy and his practice referred patients (see Eli’s HCW, Vol. XXI, No. 9).