Home Health & Hospice Week

The feds' crackdown on health care fraud continues, with a home health agency owner now under indictment for a whopping $20 million in alleged false claims to Medicare.

The indictment charges Jacinto "John" Gabriel Jr., owner of Perpetual Home Health Inc. in Oak Forest, Ill., and Legacy Home Healthcare Services in Chicago's north side, with submitting false claims to Medicare. Perpetual alone received $38 million in Medicare payments from 2006 to 2011, making it one of the biggest Medicare HHAs in the state, says a release from the U.S. Attorney's office for the Northern District of Illinois. The agencies are no longer operating.

"Gabriel and his co-schemers allegedly obtained personal information of Medicare beneficiaries to bill Medicare without the beneficiaries' knowledge or consent; created false patient files to support fraudulent Medicare claims and submitted false claims based on those records; used Medicare proceeds to pay himself, co-schemers, employees, and others who assisted him in carrying out the scheme; and concealed the fraud proceeds by directing Perpetual and Legacy to issue checks payable to fictitious entities, his friends and associates," says the release from U.S. Attorney Patrick Fitzgerald.

Gabriel also paid kickbacks to referring physicians and his own employees who generated referrals, prosecutors charge. And Gabriel and others cold-called Medicare beneficiaries to persuade them to take services from the agencies.

"As part of allegedly falsifying patient records, Gabriel directed Perpetual and Legacy personnel to systematically complete standard forms by listing the same false diagnoses, including arthropathy (joint disease) and hypertension, which enabled them to claim a higher level of Medicare reimbursement, according to the charges," the release adds. Gabriel also faces money laundering charges.

Gabriel and his co-schemers allegedly used more than $5.5 million in cash to maintain lavish lifestyles, including gambling at casinos in the Chicago area and Las Vegas, and to buy cars, jewelry, and real estate in the United States and the Philippines, prosecutors say. He also gave gifts to his employees.

Gabriel has remained free on bond since he was arrested on preliminary charges in February, the U.S. Attorney notes.

The HHS Office of Inspector General "is determined to aggressively investigate Medicare fraud and will continue to work with our law enforcement partners to ensure that those who perpetrate these types of crimes are held accountable," says Lamont Pugh III, Special Agent-in-Charge ofthe Chicago Region for the HHS OIG, in the release.

The Medicare Fraud Strike Force conducted the investigation under the Health Care Fraud Prevention & Enforcement Action Team (HEAT) initiative. It included participation from the FBI, IRS, and Railroad Retirement Board Office.