Home Health & Hospice Week

From bogus medical director payments to travel and sporting event tickets to ownership dividends, a Texas home health agency, hospice, and their owners racked up a number of ways to pay physicians for illegal patient referrals.

Onder Ari and Sedat Necipoglu, owners of Allstate Hospice and Verge Home Care in McAllen, have paid $1.85 million to settle charges of improper payments to docs, the Department of Justice says in a release. For one, Ari and Necipoglu “offered compensation to physicians who were responsible for a significant majority of their patient referrals,” the DOJ says. They made monthly payments to docs that “were in excess of fair market value for the services the physicians actually provided,” the feds maintain.

Ari and Necipoglu also “sold interests in Allstate to five different physicians which ultimately netted them substantial quarterly dividends” and “provided physicians other gifts and benefits, such as travel and tickets to sporting events,” the DOJ adds.

“Paying physicians to steer patients to one provider over another unacceptably subverts patient choice,” OIG Special Agent in Charge Miranda Bennett says in the release. “We will continue to work with our law enforcement partners to investigate improper payments to physicians.”

State Home Care Crackdown Continues With Arrests, $10 Million Settlement

Meanwhile, Massachusetts continues to focus on Medicaid home health fraud enforcement.

A co-owner and an LPN at a Chelmsford home health agency have been charged in connection with a $100 million home health care fraud scheme, state Attorney General Maura Healey says in a release. Faith Newton, Winnie Waruru, and Arbor Homecare Services billed MassHealth for services that were never rendered, were medically unnecessary, or weren’t authorized; developed employment relationships as a way to pay kickbacks for patient referrals; and entered into sham employment relationships with patients’ family members, according to the AG.

Newton used the laundered proceeds of the $100 million scheme to purchase multiple homes and a Maserati and “to fund investment accounts, a lavish lifestyle and numerous financial transactions,” the state alleges. The government also has filed a civil action seeking forfeiture of five properties and 40 financial accounts and investments, the release says.

Massachusetts has also reached a settlement with Lawrence-based Maestro-Connections Health Systems and CEO George Kiongera. They have agreed to pay $10 million to settle charges that “they knowingly submitted false claims to MassHealth and MassHealth managed care entities for home health services that had not been appropriately authorized by a physician,” Healey says in a separate release.

The settlement is the latest in the state’s crackdown on Medicaid providers. “Since 2016, my office has recovered $40 million for MassHealth by combating fraud, waste, and abuse in the home health industry,” Healey says.

Maestro also agreed to “not resume providing services to MassHealth members until it has hired an independent compliance monitor to oversee a three-year compliance program,” which includes “updated policies and procedures, new training for staff, and yearly audits conducted by the monitor,” according to the release.

Other recent fraud developments include:

In Texas: A federal grand jury has indicted SierCam Healthcare Services co-owners Tataw Charlz Bisong and Angela Bisong on charges of Medicare billing fraud. The Bisongs and SierCam billed for care that wasn’t medically necessary nor provided; falsified documentation supporting the fraudulent services; and gave patients free transportation and covered their copayments and other fees at doctor’s office visits in exchange for signing up for the bogus services, the DOJ alleges in a release.

In California: A former hospice administrator has been sentenced to two-and-a-half years in prison after pleading guilty to Medicare fraud last November. Antonio Olivera also has been ordered to repay $2.2 million in restitution, the DOJ says in a release. The 80-year-old admitted that from 2011 to 2018, while acting as administrator for Mhiramarc Management, a hospice in Downey, he and others paid illegal kickbacks to patient recruiters for referrals. “Further, when clinical staff at Mhiramarc determined beneficiary referrals did not qualify to receive hospice services, Olivera overruled those determinations and nonetheless caused the beneficiaries to be put on hospice service,” the DOJ says. Mhiramarc submitted about $28 million in claims to Medicare, which resulted in the company being paid more than $17 million. Three co-conspirators have pleaded guilty and are awaiting sentencing, Justice adds.

In Tennessee: Effective Jan. 20, the HHS Office of Inspector General excluded Grace and Theophilus Egbujor, owners of Friendship Home Healthcare and related agencies, for a period of five years based on a material breach of their Corporate Integrity Agreement with the agency. The Egbujors failed to abide by a Departmental Appeals Board decision affirming an Administrative Law Judge’s order to pay $1.3 million in Stipulated Penalties assessed under their CIA, the OIG says on its website. The penalties “were assessed as a result of their failure to repay overpayments identified by the Independent Review Organization in the second and third CIA annual reports,” the OIG notes. The Egbujors entered into the CIA in 2015 when they also paid $6.5 million to settle allegations that they billed false claims to Medicare, TennCare and TriCare. An LPN whistleblower alleged they falsified documentation and paid kickbacks to patients’ family members, among other misdeeds (see HCW by AAPC, Vol. 24, No. 21).

In Florida: If you’re wondering why patients are sometimes hesitant to engage home care workers, a story from the Miami area may help explain it. Home health aide Jamie Jakia Cofer, a/k/a “Anna Bell,” has been indicted on 22 counts of stealing elderly patients’ identity, banking, and credit card information to commit fraud, the DOJ says in a release. Cofer used the proceeds to send money to a prison inmate and buy a mannequin head and wig stand, among other things, the DOJ notes.