Home Health & Hospice Week

The rate at which federal authorities are busting fraudulent Medicare home care providers continues to increase.

Just in the last few weeks, the Department of Justice and other law enforcement agencies have announced indictments, convictions, and other enforcement actions against nearly a dozen home care-related individuals under the Health Care Fraud Prevention & Enforcement Action Team (HEAT). HEAT cases include:

• Miami. Yet more defendants associated with ABC Home Health in Miami have pled guilty in the $25 million fraud scheme allegedly perpetrated at the home health agency. Manager and patient recruiter Lisandra Alonso admitted to teaching the owners and operators of ABC how to operate a fraudulent home health agency from 2006 to 2009. "Alonso explained the structure of the corrupt scheme, specifically the importance of recruiters, kickbacks, doctors, beneficiaries and Medicare billing," the DOJ says in a release.

Alonso also negotiated kickback payment rates between patient recruiters and the ABC owners and operators, and distributed the kickback payments to patient recruiters on behalf of ABC, prosecutors say. As a patient recruiter, she paid kickbacks and bribes to beneficiaries in return for those beneficiaries allowing ABC to bill Medicare for services that were medically unnecessary and/or never provided.

Alonso also taught nurses at ABC how to falsify patient files for Medicare beneficiaries. She taught the nurses to describe in the nursing notes and patient files non-existent symptoms such as tremors, impaired vision, weak grip, and inability to walk without assistance. ABC nurses also paid Alonso kickbacks for being assigned to patients. RN Luisa Morciego falsified patient records, she admitted.

Alonso is scheduled for sentencing Oct. 3 and Morciego Dec. 5, according to the release. Two physicians indicted in the scheme are scheduled to start trial Oct. 10.

ABC patient recruiter Vicente Guerra- Nistal also pled guilty in the scheme, according to a separate DOJ release. "Guerra offered and paid kickbacks and bribes to Medicare beneficiaries in return for those beneficiaries allowing ABC to bill Medicare for home health care and therapy services that were medically unnecessary and/or never provided," the release says. In turn, ABC paid Guerra kickbacks and bribes in return for recruiting the Medicare beneficiaries for ABC.

Guerra is scheduled for sentencing Oct. 17.

Meanwhile: In a separate Miami case, a husband and wife have been charged with home health fraud. Elizabeth Acosta Sanz and Luis Alejandro Sanz, owners of Ideal Home Health, have been indicted on fraud, kickback and money laundering charges, according to a release from U.S. Attorney Wifredo A. Ferrer.

From 2006 to 2009, The Sanzes offered and paid kickbacks to recruiters and others and billed Medicare $11.3 million for medically unnecessary and not-provided services, often to diabetics, the indictment alleges.

Luis Alejandro Sanz served five years for cocaine smuggling and money laundering in the 1990s, reports The Miami Herald. The judge denied their bid for bond, calling the couple a flight risk.

"Medicare contractors are supposed to be responsible for enrollment and screening applicants, but the process is broken and ineffective," said Ryan Stumphauzer, a former federal prosecutor who ran the healthcare fraud section in the Miami U.S. Attorney's office and now heads his own firm. "Felons and crooks can get as many provider numbers as they want by recruiting nominees or family members to sign documents," he told the Herald.

The newspaper outlined other convicted drug traffickers and murderers who have entered the Medicare business to perpetrate fraud.

• Chicago. The owners of House Call Physicians in the Chicago suburb of Palos Hills have been arrested and charged with health care fraud. Bahir Haj Khalil and Mohammed Khamis Rashed falsely certified that patients were eligible for home health services, when in fact they were not homebound, says a release from U.S. Attorney Patrick J. Fitzgerald. The false certifications were in exchange for patient referrals from corrupt home care providers, prosecutors say. House Call also ordered medically unnecessary durable medical equipment, they add.

The investigation, which included the FBI and HHS Office of Inspector General, is being conducted by the HEAT Medicare Fraud Strike Force, which expanded to Chicago earlier this year, the release notes.

• Kentucky. The federal government has intervened in a qui tam lawsuit against Nurses' Registry and Home Health Corp. in Lexington, Ky. The whistleblower suit was filed by two former Nurses' Registry employees, Alicia Robinson-Hill and David Price, the DOJ says in a release.

According to the whistleblower complaint, Nurses' Registry exaggerated the medical conditions and needs of its patients for home care services, both at the start of service and for additional and continuing care.

"Home health care providers furnish essential services to some of our most vulnerable citizens," Tony West, Assistant Attorney General for the Justice Department's Civil Division, says in the release. "Those who misstate the conditions of their patients for their own financial gain erode the integrity of the health care system, and they do it at taxpayers' expense."

• Minneapolis. The owner of Minneapolisbased HHA Palm Healthcare Services has admitted that he cheated Medicaid out of more than $400,000 by submitting bogus claims. Joseph Vah Lavien admitted to billing for services not provided to patients, for more services than authorized, for more services than could be performed in a particular day or month, and for supervision services rendered by an ineligible provider, according to a DOJ release. Vah Lavien was originally indicted in June (see Eli'sHCW, Vol. XX, No. 24, p. 190).

Unlike the other fraud enforcement actions, this one did not involve the HEAT program, but instead was conducted in conjunction with the state's Medicaid Fraud Control Unit.