Home Health & Hospice Week

Plus, VNSNY faces Medicaid fraud scandal.

The feds are racking up guilty pleas and lengthy jail sentences across the country as they keep the pressure on Medicare Fraud Strike Force cities. Recent announcements from the Medicare home care fraud capital of Miami include:

• The co-owner and operator of Profes-sional Medical Home Health has pled guilty to Medicare fraud, according to a Department of Jus-tice news release. Ernesto Fernandez agreed to forfeit more than $9 million in proceeds from the fraud scheme, and will face sentencing Feb. 3.

Fernandez admitted to billing for services that were not medically necessary or not provided; causing patient documentation to be falsified; and planning, organizing and overseeing the submission of fraudulent claims to Medicare, DOJ says. He also admitted to being a patient recruiter for Professional and two other agencies he owned, and for accepting kickbacks in exchange for recruited patients.

Fernandez is the eighth defendant to plead guilty in the scheme. Five other defendants pled guilty to violations including patient recruiting kickbacks just a few days earlier. And another co-owner and an administrator each received prison sentences of more than five years upon sentencing, DOJ notes.

• An HHA owner has been sentenced to more than six-and-a-half years in prison due to a Medicare fraud scheme at Professional Home Care Solutions Inc. and LTC Professional Consultants Inc. The agencies billed Medicare for services that weren’t provided or weren’t medically necessary, prosecutors say.

Elsa Ruiz pled guilty this summer to paying kickbacks to patient recruiters for the referral of patients and for the provision of prescriptions, plans of care, and certifications for medically unnecessary therapy and home health services, the DOJ says.

• Another HHA owner has pled guilty in a case centering around patient recruiters. Ramon Regueira of Nation’s Best Care Home Health Corp. also paid kickbacks for patients and plans of care, then fraudulently billed Medicare for unnecessary services, the DOJ says in a release. Nation’s Best submitted about $35 million in false claims. Regueira is scheduled for sentencing Jan. 21.

• Similar charges led to a guilty plea from Nursing Director Armando Buchillon with Anna Nursing. He’s been sentenced to nearly five years in prison for paying kickbacks for patients, falsifying documentation, and receiving kickbacks as a patient recruiter, the DOJ notes.

Physician Goes Down For Home Care Fraud

The runner-up for the city with the most Medicare home health fraud, Detroit, has also seen these recent guilty pleas:

• A physical therapy assistant is the latest to go down in a scam run through Physicians Choice Home Health Care, Quantum Home Care Inc., First Care Home Health Care, and Moonlite Home Care Inc. Beneficiaries signed blank medical paperwork that PTA Jigar Patel and others then completed with false information purporting to show that care was provided, when it was not, the DOJ says. Patel and others signed this paperwork, certifying that they had provided the services. “In the course of the conspiracy, Patel incorporated his own staffing company, MI Healthcare Staffing, through which he laundered proceeds of the fraud,” the DOJ notes in a release.

Patel received a prison sentence of more than four years, and was ordered to repay $1.9 million, according to the release.

• A physician has pled guilty to home care Medicare fraud, the DOJ says in a release. Dr. Rajesh Doshi referred Medicare beneficiaries for home health care that was not medically necessary, and then submitted false and fraudulent claims for the purported care to Medicare for reimbursement through his Home Physicians Services practice.

Among his misdeeds, Doshi paid kickbacks to patient recruiters, solicited kickbacks from agencies for those recruited patients, falsified medical documentation for home care billing, and upcoded physician home visit claims, he admitted.

• Two HHA owners have admitted to billing Medicare for home care services that were not actually rendered, not medically necessary, or where the referrals for those services had been obtained through the payment of illegal kickbacks. Attaullah Arain and Nadia Arain, founders of Angle’s Touch Home Health Care in Taylor, Mich., admitted to paying kickbacks via cash and check, the DOJ says in a release.

Venerable Agency Pays Big Fraud Tab

In a home care-related fraud announcement from another part of the country, the Visiting Nurse Service of New York has agreed to settle Medicaid fraud charges for $35 million, the DOJ says in a release. “VNS collected millions of dollars in Medicaid payments by enrolling ineligible persons into its managed care plan who clearly did not meet the criteria for long-term care,” says Manhattan U.S. Attorney Preet Bharara in the release. “The company developed a network of social adult day care centers [SADCCs] that were ill-equipped to provide the required level of care and instead served merely as a conduit to induce Medicaid beneficiaries to enroll.”

In the settlement agreement, VNS admits that 1,740 managed care members who had been referred by SADCCs or used SADCC services were not eligible to be members of the plan. And that various SADCCs in its provider network did not provide services that qualified as personal care services under the terms of its Medicaid contract.

VNSNY head Mary Ann Christopher has resigned since the announcement, according to press reports.