Advanced Search

Home Health & Hospice Week

Fraud & Abuse:

Authorities Crack Down On Home Care Fraudsters

Published on Wed Apr 20, 2011

More fraud-fighting activity takes place in Minnesota, Texas. Ironically, a clean-up of the home care industry may lead to lower payment rates for you. In Houston, a $5.2 million Medicare fraud scheme keeps churning out guilty pleas and convictions. Registered nurse Adelma Casas Sevilla, employed by Family Healthcare Group, has pleaded guilty in federal court to one count of conspiracy to commit health care fraud, says the Department of Justice in a release. "According to court documents, Family Group hired co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided," the DOJ says. "After the Medicare beneficiaries were recruited, Casas Sevilla ... fraudulently signed plans of care stating that the beneficiaries needed home health care when in fact she knew the beneficiaries were not homebound and not in need of skilled nursing."  Earlier this month, a federal [...]
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Home Health & Hospice Week

View All