Home Health & Hospice Week

Sham consulting arrangement leads to one physician’s guilty plea.

A group of guilty pleas resulting from a home care fraud investigation includes one from a physician that allegedly accepted a sham consulting arrangement with Abide Home Care Services in New Orleans.

Threasa Adderley didn’t perform the services set out in her consulting agreement, and she “routinely compromised her medical judgment by certifying ineligible Medicare beneficiaries,” the Department of Justice says in a release. Three of the other defendants in the case, including Abide owner Lisa Crinel, also pled guilty to fraud, the DOJ notes. They face sentencing in January.

One of the other guilty pleas was from an Advanced Practice RN. The agency also pled guilty and agreed to $16 million in restitution and could face a half-million dollar fine at sentencing. Twenty people have been indicted in the case (see Eli’s HCW, Vol. XXIV, No. 14).

Other physician-focused home care fraud cases include:

In Miami: Physician Henry Lora faces indictment on charges that he accepted kickbacks for writing home care orders for ineligible patients, the FBI says in a release. Lora was employed by clinic Merfi, whose owner Isabel Medina drew a nineyear prison sentence after pleading guilty to a $20 million Medicare fraud scheme involving Flores Home Health (see Eli’s HCW, Vol. XXIII, No. 12).

In Chicago: Just because a physician does not direct patients to your agency, doesn’t mean you can pay him for his patients that you do admit. A federal appeals court ruled earlier this year that under the Anti-kickback Statute, a physician still makes a “referral” even if he offers a variety of choices for home health agencies and doesn’t direct a patient to choose a specific one.

Physician Kamal Patel was compensated by Grand Home Health in the Chicago area at a rate of $400 cash for each new patient and $300 cash for each re-certification, according to reports of the decision. Patel was allegedly one of 20 physicians who shared in a financial relationship with Grand. Even though the majority of Patel’s patients were served by other agencies, he still violated the Anti- Kickback Statute, the appeals court ruled in U.S. v Patel earlier this year. Patel was sentenced to eight months in prison, community service, required to forfeit $31,900, was stripped of his medical license and excluded from Medicare and Medicaid, notes attorney George Indest III with The Health Law Firm in Orlando, Fla.

“The health care industry should closely monitor whether other courts apply this expansive interpretation, which goes well beyond the weight of precedent under the AKS,” said attorneys Hope Thomas and Laurence Freedman with law firm Mintz Levin Cohn Ferris Glovsky and Popeo in case analysis on their website.