Home Health & Hospice Week
Fraud Hot Spots Continue To Generate HEAT
Two physicians receive home care-related fraud convictions.
The feds are keeping fraudsters’ feet to the fire in HEAT cities across the nation, judging from the latest convictions and guilty pleas.
HEAT Hot Spot: Chicago
Case #1:Avelina Fiel, director of nursing at Pathways Home Health Services, pled guilty to Medicare fraud in Illinois federal court July 18, according to news reports. Fiel admitted that the majority of Pathways’ patients were “recycled,” to pressuring staff to falsify documentation, and to doctor shopping for home health certifications, among other things. More defendants in the case await trial later this year.
Case #2: Suburban Home Physicians manager Diana Jocelyn Gumila has been sentenced to six years in prison for Medicare fraud, the Department of Justice says in a release. At Gumila’s direction, Suburban, which did business as Doctor at Home, upcoded services and billed for patients who could leave home, according to prosecutors. Gumila was also ordered to pay $15.6 million in restitution.
Two other defendants in the case, an agency owner and a certifying physician, have been convicted as well, the DOJ notes.
“Home health fraud has become a significant problem nationally and particularly in the Chicago area,” Assistant U.S. Attorney Stephen Chahn Lee said, according to the release.
HEAT Hot Spot: Miami
Case #1: Jorge Lorenzo, Yahima Pardo, and Roberto De Jesus Alonso, who were owners and shell owners of eight Miami-area HHAs, have received prison sentences of 15 years, 3-and-a-half years, and three years, respectively, after pleading guilty to Medicare fraud in May, according to a DOJ release. The defendants also must pay $40.4 million in restitution. An additional co-conspirator, Sonmy Rodriguez, also was sentenced to nearly two years in prison in the scheme. “Lorenzo, Pardo, and De Jesus Alonso participated in massive health care fraud, money laundering and kickback schemes,” Justice says. Lorenzo used the fraud proceeds to buy real estate, luxury vehicles, artwork and jewelry.
Case #2: Among many other charges, nursing home and assisted living facility operator Philip Esformes has been accused of taking kickbacks to steer patients to home health agencies, according to an indictment unsealed July 22. Esformes is at the top of a wide-ranging scheme, mostly focused on non-home care providers, that bilked Medicare of $1 billion, the DOJ claims.
HEAT Hot Spot: South Texas
Houston physician Warren Dailey has received a five-year prison sentence for falsely certifying Medicare patients for home care, the DOJ says in a release. Dailey received a flat fee from a Houston HHA for signing the false certifications, according to prosecutors. Dailey was convicted of the fraud back in March.
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