Home Health & Hospice Week

Patient recruiter draws 15-year prison sentence.

Fraud and abuse scrutiny of home health and hospice providers appears to be on the upswing, based on the OIG reports, convictions, prison sentences, guilty pleas, and other enforcement actions that have come down the pike in recent weeks.

For example: In addition to audits of three “at risk” home health agencies (see story, this page), the OIG has issued its Semiannual Report to Congress, highlighting multiple home health fraud cases. The report recounts a Houston case where physician John Ramirez and Amex Medical Clinic owner and operator Ann Shepherd were sentenced to a combined 55 years in prison and were ordered to pay up to $26.7 million in restitution after being convicted of selling home health orders and other documentation to Houston area home health agencies (see Eli’s HCW, Vol. XXVII, No. 35).

The report also reviews the case of Detroit area HHA owners Hafiz and Tasneem Tahir, who pled guilty to paying illegal kickbacks in exchange for the referral of Medicare beneficiaries to HHAs that they owned. The defendants further admitted that between 2009 and 2017, they submitted false claims to Medicare for home health services that were never provided (see Eli’s HCW, Vol. XXVII, No. 42).

And the report highlights the $5.9 million settlement that SouthernCare Inc. agreed to pay to settle charges that it billed for hospice patients in Pennsylvania that were ineligible or for whom there was not sufficient documentation. Two whistle­blowers got a big share of that settlement at $1.1 million (see Eli’s HCW, Vol. XXVII, No. 45).

See the Semiannual Report at https://oig.hhs.gov/reports-and-publications/archives/semiannual/2019/2019-spring-sar.pdf.

Other fraud and abuse actions around the nation include:

In Florida: The Department of Justice has intervened in a whistleblower lawsuit claiming that Doctor’s Choice Home Care Inc. in Sarasota paid kickbacks to physicians via sham medical director payments, the Department of Justice says in a release. The suit also names Doctor’s Choice partial owners Timothy Beach and Stuart Christensen. Doctor’s Choice also “allegedly paid some employees in a manner that accounted for the volume of referrals by their physician spouses,” according to the release. Doctor’s Choice called the charges “wholly uncorrob­orated and provably false” in a statement, reports WWSB News. The agency plans to “vigorously defend against these claims,” adding, “The government’s distorted rendition of the facts is in direct contrast with this reality,” Doctor’s Choice reportedly told the TV station.

In Miami: A patient recruiter in Hialeah was sentenced to more than seven years in prison for her part in a home care fraud scheme. Yamilet Diaz was convicted on kickback charges after a four-day trial in February. Diaz received at least $710,000 in kickbacks in return for referring Medicare beneficiaries to five South Florida home health agencies to serve as patients, resulting in more than $1.6 million in false payments to the agencies, the DOJ says in a release.

Also in Miami: Juliette Anais Tamayo, owner of Miami-based physician clinic Sunshine Medical Care Group, was sentenced to more than seven-and-a-half years in prison for home health-related fraud. Tamayo pled guilty to selling medically unnecessary home health care prescriptions to HHA owners, soliciting and accepting kickbacks from patient recruiters, and passing on kickbacks to docs who wrote the bogus prescriptions, the DOJ says in a release. Sunshine also billed for physician services that weren’t necessary or weren’t provided. Tamayo was also ordered to pay $2.5 million in restitution.

And again in Miami: The owner of a now- closed HHA received a 2.5-year prison sentence for a fraud scheme in which the agency billed for services that were never provided to anyone. Dennys Hernandez, who was an undisclosed owner of Medsel Home Health Care Corp., was also ordered to repay nearly $1 million, the DOJ says in a release. Hernandez pled guilty to the scheme in March. Two of Hernandez’s co-conspirators were charged in separate cases related to Medsel. Medsel nominee owner Elanier Gonzalez Moncho was sentenced to 18 months in prison for his role in the fraud. And Rafael Arias, the owner and operator of numerous Miami-area HHAs including Medsel, was sentenced to 20 years in prison last year for his role in a $66 million conspiracy to defraud the Medicare program, according to the DOJ.

In Houston: Patient recruiter Egondu “Kate” Koko has been sentenced to more than 15 years in prison after pleading guilty to Medicare fraud last October. Koko admitted to being a patient recruiter for Houston HHAs Criseven Health Management, Beechwood Home Health, JMM Home Health, and Trinity Healthcare Service, as well as the owner and operator of Circuit Wide Home Health Services. Koko also admitted to paying illegal kickbacks and bribes to physicians and patients for paperwork necessary for the agencies to bill Medicare, to laundering money with the help of a Nigerian national, and to buying a home with fraud proceeds.

In Dallas: Paul Emordi has been sentenced to five years in prison after being convicted of health care fraud in a six-day trial. Emordi concealed his ownership in Medicare and Medicaid provider Elder Care, even though he was excluded from partici­pation in any federal health care benefit program. Emordi was also sentenced to repay nearly $3.6 million. Three co-defendants were also convicted in the trial and await sentencing, the DOJ says in a release.

In Chicago: After a seven-day trial, a federal jury has found the owner of a now-defunct HHA guilty of fraud and kickback charges, the DOJ says in a release. Jacqueline Tuanqui was convicted of paying kickbacks in return for home health referrals to her agency, Hexagram Home Health Care. Witnesses admitted to facilitating kickback payments and forging patient files. Tuanqui faces sentencing July 1.

Also in Chicago: Husband-and-wife HHA co-owners Carmencita Agno and Emmanuel Agno have pled guilty to kickback charges. Each admitted they caused Renaissance Home Health Services Inc. of Elk Grove Village to pay kickbacks to “patient marketers” and other referral sources, the DOJ says. They also admitted to causing Axis Healthcare Services Inc. of Rolling Meadows, another HHA co-owned by Carmencita Agno and for which Emmanuel Agno served as the adminis­trator, to make about $365,000 in illegal kickback payments to patient recruiter Maristel Canete. They hid the kickbacks by disguising them as sham payments to a company owned by Canete.

In Massachusetts: An HHA owner was sentenced in state court after being convicted after a 10-day trial in a $2.5 million Medicaid fraud scheme. Hellen Kiago and her agency, Lifestream Healthcare Alliance, were also ordered to pay $130,000 in fines, says a release from the state Attorney General. Kiago billed for services that weren’t authorized and falsified physician signatures and orders, among other violations.

The Centers for Medicare & Medicaid Services, “working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers,” the DOJ says in the Renaissance release.