Home Health & Hospice Week

Kickbacks a common feature in many cases.

Chicago continues to garner a reputation for home care-related fraud and abuse, judging from recent cases.

For example: An HHA’s owners, DON, and QA nurse are among seven individuals indicted for a Medicare fraud scheme at HCN Home Healthcare Inc. The husband-and-wife owners paid kickbacks to employees and marketers in exchange for referring elderly and disabled patients to the company for unnecessary or non-existent treatment, according to a 23-count federal indictment, the Department of Justice says in a release.

Owners Estrellita and Miguel Duquilla, Quality Assurance Nurse Grace Mendez, Director of Nursing Daniel Fajardo, Nursing Assistant Sherrod Harris, RN Zenaida Dimailig, and Dimailig’s husband, marketer Roberto Jonson of Berzen Home Care Services Inc., have been charged in the case.

The “lengthy federal investigation” by the Medicare Fraud Strike Force “included the execution of a search warrant at HCN’s office,” the DOJ notes. In some cases, the employees and marketers paid cash to the patients in exchange for allowing their information to be used in paperwork submitted to Medicare, the indictment states.

Another example: Claiming you’re “just the biller” won’t get you out of fraud charges. The lead administrator of a Chicago-area visiting physician practice was sentenced to more than seven years in prison for his role in a $4 million fraud scheme, after being convicted of fraud earlier this year.

Rick Brown was the President of Home Care America Inc., which managed the daily business operations of Medicall Physicians Group Ltd. in Schaumburg, Ill. Medicall billed Medicare for Care Plan Oversight when its physicians rarely furnished it, the DOJ says in a release. Brown and his co-conspirators also billed Medicare for services that were never provided, including services rendered to patients who were deceased, services provided by staff no longer employed by Medicall, and services provided by staff who, based on billing records, worked over 24 hours per day, according to the evidence shown at trial. Medicall’s medical director Roger A. Lucero pled guilty in the case and biller Mary Talaga was also convicted at trial. They await sentencing.

Other home care fraud cases include:

In Texas: A doctor’s assistant in McAllen pled guilty to soliciting and obtaining kickbacks for home health referrals, the DOJ says in a release. Argentina Cavazos received 11 kickback checks in exchange for providing patient information gleaned from physician records. Cavazos is scheduled for sentencing next month. The marketer who issued the checks, Martha Lidia Flores, had also pled guilty in the case, the DOJ says in a separate release. Flores admitted to using the patient information she bought from Cavazos to create fraudulent referral forms to submit to the numerous home health agencies where she was employed. She also admitted to forging the signatures of physicians on the referral forms. Flores is scheduled for sentencing in November.

In Boston: After a four-day trial, the former clinical director of At Home VNA was convicted of fraud and money laundering charges. Janice Troisi and fellow RN and At Home owner Michael Galatis billed Medicare for home care services that weren’t medically necessary or furnished, the DOJ says in a release. Galatis and Troisi trained VNA nurses to recruit seniors through wellness clinics held at senior residential facilities, then the nurses fudged documentation to make the patients appear homebound and eligible for services. The VNA’s paid medical director signed certifications for the ineligible patients, prosecutors said. Troisi and Galatis ignored requests from patients’ physicians and VNA staff to discontinue seeing patients who didn’t need home care services.

Galatis was convicted in the scheme last year and sentenced to more than seven years in prison (see Eli’s HCW, Vol. XXIV, No. 9). The medical director, Spencer Wilking, pled guilty in the scheme last year and is scheduled for sentencing Sept. 22 (see Eli’s HCW, Vol. XXIII, No. 9). Troisi is scheduled for sentencing in November.

In New York: The campaign against Medicaid home care fraud continues. Brooklyn-based Empire State Home Care Services Inc. has settled fraud charges for $6 million, New York Attorney General Eric T. Schneiderman says in a release. The settlement resolves claims that Empire underreported its home health aide hours and improperly reported expenses on cost reports filed between 2002 and 2005, inflating the agency’s reimbursement by more than $3 million.