Home Health & Hospice Week

Plus: Medicaid home health agency to fork over whopping $2.9 million for ghost hours.

It’s not always the home health agency and its personnel who have to pay big for kickback-related schemes. So shows a new Louisiana fraud case.

Internal medicine physician Llewelyn Simon has agreed to pay the United States $640,000 to resolve allegations that he accepted payments for home health referrals, the Department of Justice says in a release.

“Simon served as a medical director for the now defunct United Home Care home health agency and in that capacity, received monthly payments,” the DOJ says. “The medical director fees exceeded the fair market value of the services provided by Simon and … the excess fees were for referrals of patients, many of whom were Medicare beneficiaries,” the feds allege.

“We will continue to ensure that health care decisions are based on the needs of patients rather than the financial interests of providers,” Acting U.S. Attorney Alexander Van Hook says in the release.

Other recent fraud cases include:

In Texas: Nursemind Home Health Inc. owner Zenia Chavez and her nephew, Nursemind employee Raul Alejandro Fuentes, were arrested on Medicare fraud charges last month, the DOJ says in a release. Chavez and Fuentes “sought out people in boarding homes and senior living facilities for enrollment in a Nursemind hospice program although they did not need hospice care or have a terminal illness,” the DOJ alleges. The defendants then created bogus medical records for them, forged signatures, and submitted fraudulent claims to Medicare. Chavez also offered kickbacks for client referrals to Nursemind, according to the Justice Department.

In Michigan: A home health agency owner was sentenced to a year in prison for tax fraud related to the agency, the DOJ says in a release. Robert Nakfoor pleaded guilty to claiming fraudulent expenses for his business, Jessi Kay Home Care in Lansing, on his 2011 through 2015 tax returns. “Nakfoor deducted expenses for insurance, legal and professional services, wages, and contract labor that he knew his business did not incur,” the DOJ says. “For example, just on his 2015 return, Nakfoor claimed over $1 million in bogus contract labor and legal and professional services expenditures.” Nakfoor was also sentenced to one year of supervised release and to repay the IRS $481,465.

In Oregon: Kevin Cox and his agency At Home Care Group will pay $1.86 million to the United States and $1.04 million to the state of Oregon to settle Medicaid fraud allegations, the DOJ says in a release. Between March 2013 and September 2018, “AHCG altered caregiver scheduling calendars and billed the Oregon Medicaid program for hours of in-home care not actually performed,” the feds say. AHCG and Cox will be excluded from Medicare, Medicaid, and all other federal health care programs for 15 and eight years, respectively.