Home Health & Hospice Week

The OIG reviews the case of Karel Felipe and Tamara Quicutis, “faux owners of three home health companies, for their roles in a wide-ranging conspiracy to defraud Medicare by billing more than $93 million for home health therapy services that were never rendered.”

Specifically, they “conspired with others to submit false claims to Medicare for three home health agencies in Michigan,” the Department of Justice said in an earlier release. Their co-conspirators recruited individuals from Cuba to sign Medicare enrollment documents and appear as the owners of the HHAs to conceal the identities of Felipe, Quicutis, and others involved in the scheme.

Using lists of stolen patient identities, the scammers submitted claims for services that were not rendered, then used dozens of shell companies and hundreds of bank accounts to launder the Medicare fraud proceeds and convert the proceeds into cash at Miami-area ATMs and check cashing stores, the feds proved at trial. Felipe and Quicutis were convicted last October.

Felipe was sentenced to eight years and four months in prison, and Quicutis five years and 10 months. The court also ordered forfeiture of fraud proceeds. Co-conspirators were also sentenced in the case, including Jesus Trujillo, who drew a 14-year prison term.

In contrast, the report doesn’t mention any hospice examples.

The OIG makes its customary pitch for more oversight funding. “OIG’s health care work consistently yields a positive return on investment of around $10 returned to every $1 invested. However, our budget has not kept up with the growth in the size and breadth of HHS programs,” Grimm notes. “OIG oversees more than $2 trillion in HHS expenditures, almost 24 percent of the Federal budget. Additional investment … in the President’s Fiscal Year 2024 Budget would provide OIG with critically needed resources to deliver on our mission to safeguard taxpayer dollars and protect HHS programs and the people they serve,” she tells Congress.

Note: The 33-page report is at https://oig.hhs.gov/documents/sar/9905/Spring_2024_SAR.pdf.