Home Health & Hospice Week

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 jury in Houston convicted four defendants in the scheme after a 15-day trial, according to a separate DOJ release. Mary Ellis, Caroline Njoku, and Terrie Porter were patient recruiters accused of receiving kickbacks. Like Casas Sevilla, RN Ezinne Ubani fraudulently signed POCs when the benes weren't homebound or in need of nursing. Ubani is the wife of one of the agency's former co-owners.

The agency owners, Clifford Ubani and Princewill Njoku, already have pled guilty to paying kickbacks to beneficiary recruiters and billing for skilled nursing services that weren't medically necessary or weren't provided (see Eli's HCW, Vol. XX, No. 7, p. 55). They await sentencing in July, as does Casas Sevilla.

And Family Healthcare Group patient recruiter Cynthia Garza-Williams pled guilty last year to paying cash kickbacks to a physician to sign plans of care that were medically unnecessary (see Eli's HCW, Vol. XIX, No. 38, p. 304).

Finally, patient recruiters Erica Walker and Florida Holiday Island pled guilty "to conspiring to receive illegal kickbacks for referring a Medicare beneficiary and illegally receiving a kickback for referring a Medicare beneficiary," the DOJ adds.

In Minnesota, the U.S. Attorney's office charged two home health agency owners with Medicaid fraud. Harry Kwabena Ossei owned Midwest Home Health Care Systems Inc. and Midwest Health Care Systems Inc., but then pled guilty to health care and tax fraud and was excluded from federal health care programs. Samuel Akoto Danso owned Metwest Health Care Services and Minnesota Home Health Care Services.

"The current indictment alleges that the defendants agreed that Ossei would participate in the Medicaid program, despite his exclusion, and that the income Ossei derived from such participation would be hidden," the DOJ says.

The defendants also allegedly submitted to the Minnesota Department of Human Services false reimbursement claims for Personal Care Assistant services, the DOJ says. The "defendants provided payments to [PCAs] as well as Medicaid recipients in exchange for their participation in the phony PCA service arrangements," the indictment alleges. "The defendants, on many occasions,allegedly used without lawful authority the identification of others in connection with the fraud."

In a separate case, John Alemoh Momoh, owner of Hopecare Services Inc. in Brooklyn Park, Minn., was indicted for $400,000 worth of false Medicaid billing. Momoh billed Medicaid forunsupported claims, even after being investigated for the practice once before, the DOJ says in a release.

"The home health care fraud indictments returned this week are part of a larger effort involving federal and state law enforcement," the DOJ notes. "At the district level, the U.S. Attorney's Office participates in a task force with the Medicaid Fraud Control Unit at the Minnesota Attorney General's Office that focuses on home health care fraud trends."

"This sort of fraud is extremely dangerous and extremely hurtful to the most vulnerable membersof society," said U.S. District Court Judge Joan  N. Ericksen in sentencing a previous home care fraudster in Minnesota this year. "Fraud in the provision of health care services makes it easier for politicians to cut the funding to those services. It reduces public confidence in important government programs."