Home Health & Hospice Week

Both federal and state authorities are getting ever-more-serious about combatting fraud in Medicaid home health programs, as shown by a flurry of enforcement activity in recent months.

For example: In Maryland on March 7, Joseph Tamjong was sentenced to 20 months in prison for defrauding the D.C. Medicaid program of more than $700,000, the Department of Justice says in a release. Tamjong was also ordered to serve three years of supervised release following his prison sentence, to pay more than $730,000 in restitution, and to forfeit nearly $400,000.

Tamjong submitted false timesheets for aide services he did not provide, including billing for about 3,400 hours of services “that he purportedly provided when he was traveling outside the country,” the DOJ notes. And “on 156 separate occasions, he claimed he provided 24 hours of services in a single day,” the release adds.

Since December 2018, 12 former personal care aides have been sentenced in D.C. federal court for defrauding the District’s Medicaid program, the DOJ notes.

Another example: The Kansas Attorney General’s Office has prosecuted multiple Medicaid home care fraud cases in recent months. Most recently, a father and daughter admitted to submitting false claims for PCA services when they were actually working other jobs, the AG says in a release.

Johnson Kongvongsay was sentenced to an 18-month suspended sentence, 12 months of probation, and to repay the Kansas Medicaid program nearly $15,000, while Kyla Kongvongsay received 12 months of supervised probation and had to repay the Kansas Medicaid program more than $16,000.

In another case, Lavanda Duncan was sentenced in state court to pay about $2,550 in restitution to the Kansas Medicaid program, and to serve 12 months of supervised probation for attempting to falsely bill Medicaid on behalf of her three sons who served as her personal care attendants, the AG says. Duncan attempted to receive payment on their behalf while her sons were incarcerated in county jail.

And in yet another Kansas case, Seunghee Lee falsely billed the Medicaid program while serving as a personal care attendant for her mother-in-law who was a Medicaid beneficiary. Lee continued submitting claims after her mother-in-law was hospitalized and then died.

Lee was sentenced to pay more than $3,500 in restitution to Kansas Medicaid, a $1,000 fine and to serve 12 months of supervised probation, the AG says.

And another example: Idaho has also cracked down on Medicaid home care fraud lately.

After pleading guilty to submitting false claims for services not provided through his agency Canyon County Home Care Inc., Jeffrey Stoker has been sentenced to a seven-year suspended sentence, seven years of probation, 90 days’ in county jail, and to repay nearly $250,000, the Idaho AG says in a release. In addition to the false claims, Stoker lied to auditors, including falsifying an employment contract and tax forms with a nurse.

And after pleading guilty to fraud, Mariah C. Ross received a suspended sentence of four years in prison, three years probation, and was odered to pay $1,700 in restitution and a $1,000 fine, the AG says in a release. Ross submitted timesheets to Brightstar Care for times she was working for another agency.

In Twin Falls, Patricia Anderson was sentenced to a suspended sentence of three years and supervised probation for three years, and was ordered to pay $2,000 in fines and serve 300 hours of community service. She already had paid nearly $1,800 in restitution.

Anderson had billed for services to a relative when she was actually out of state, the AG says in a release. She also was not truthful with investigators about her travels.

Other recent cases include:

In Missouri: Missouri claimed more than $52.5 million for unallowable consumer-directed personal care assistance services during fiscal years 2018 and 2019, estimates an HHS Office of Inspector General report released on Feb. 23. Seventeen of 150 sampled items “were at least partially unallowable because of errors related to: timesheets that could not be provided or that lacked detail; units of service charged that exceeded the number authorized; lack of documentation that attendants were registered, screened, and employable; and recipients with plans of care that were not signed,” the report details. The state also “did not have established and implemented pandemic emergency preparedness standards and protocols within the consumer-directed PCA program,” the OIG adds in the 48-page report at https://oig.hhs.gov/oas/ reports/region7/72003243.pdf.

In Minnesota: State investigators took computers and documents from Bridges MN after authorities said they had tracked $4 million in fraudulent billing over five years, according to news reports. The Minnesota Department of Human Services had already revoked Bridges MN’s license after finding instances of maltreatment and non-compliance, but the company is appealing that decision and has continued to operate, reports KSTP News.

In Tennessee: The Tennessee Bureau of Investigation has prosecuted half a dozen aides for submitting fraudulent aide timesheets in the past six months. Most recently, Edwin Hendrix was arrested for submitting 37 claims of overlapping caregiver services for multiple patients in Shelby County, the TBI says in a release. Other aides submitted timesheets for patients who had died, were in the hospital, and who had disenrolled from the program; and for overlapping times.

In Maryland: Jemina Saka was indicted on Medicaid fraud charges for submitting timesheets indicating she was providing home health services to a Medicaid recipient when she was not in the State of Maryland at the time. She was arrested in Florida, the Maryland AG’s Office says in a release.

In Nevada: Tonda Renee Ward was sentenced to a year in jail for submitting false claims and failure to maintain adequate records related to her Las Vegas home health agency Southwestern Health Solutions, the Nevada AG’s Office says in a release. The Nevada Medicaid Fraud Control Unit investigated Ward and Southwestern after receiving information from Nevada Medicaid’s Surveillance and Utilization Review (SUR) Unit that the agency was billing as though its service providers were rendering more than 24 hours of service per day. “Southwestern also submitted false documentation to Medicaid on behalf of a physician who never worked for the company,” the AG says in the release. Ward was also ordered to pay $800,000 in restitution, costs and penalties.

In Colorado: Stephanie Hudgins, Quinetta Hunter, and Bobby Hunter have been charged with fraud for filing claims for home care services that did not occur. Hudgins and Bobby Hunter claimed that Quinetta Hunter provided aide services to them while Quinetta Hunter was in state prison, the Colorado AG says in a release. The “value of the theft” is more than $134,000, the AG says.

Also in Colorado: Dejane Reaniece Lattany, owner of Aggie’s Angels Care Providers in Aurora, is charged with routinely filing aide claims and receiving more than $370,000 in Medicaid reimbursement for services that were not provided, the Colorado AG says in a release. Lattany also tried to convince patients to sign documents saying they had received the services, the AG alleges.

In Massachusetts: Eric Melendez and his employee Angelica Pierni have been charged with billing MassHealth’s PCA program for services never provided, the Massachusetts AG says in a release. Melendez submitted claims for Pierni and other aides “indicating hours that could not have been worked because the PCA was working at another job, were more hours than the PCA actually worked, or were hours that were billed after the PCA quit working for Melendez,” the AG says. Melendez also would submit false claims and split the proceeds with the aide. Overall, the scheme bilked MassHealth of more than $250,000, according to prosecutors. The AG’s Office also alleges several instances of inappropriate sexual conduct by Melendez towards his employed PCAs, including tricking one aide into watching “a live video feed of him engaging in a sex act with another person,” the AG says.

In Connecticut: Jhanannie Singh has been sentenced to 57 months in federal prison for stealing nearly $250,000 in U.S. Savings Bonds from an elderly woman for whom she provided home health services, the Department of Justice says in a release. The patient intended the bonds for her children and grandchildren. Singh, a citizen of Guyana, faces immigration proceedings when she completes her prison term, the DOJ says.

In Florida: Florida authorities arrested Kimberly Greene Byrd on charges of submitting more than $11,000 worth of fraudulent claims to the Agency for Persons with Disabilities. Greene Byrd billed for hours not worked and submitted service logs that didn’t match claims, the Florida AG says in a release.

In New York: Denise Lewis was sentenced to a three-year “conditional discharge” after pleading guilty to submitting false timesheets, according to press reports. Lewis submitted more than 20 fraudulent timesheets and was paid more than $6,000 for more than 400 hours not worked, according to the New York State Inspector General’s Office.