Home Health & Hospice Week

2 home visit physicians called on the carpet.

If more than 97 percent of a physician practice’s Medicare patients receive home care services, you can bet the authorities are going to take a look.

That’s what happened with US Physician Home Visits and related Dallas home health agencies A Good Homehealth, a/k/a “Be Good Healthcare Inc.,” and Essence Home Health, a/k/a “Primary Angel Inc.,” says the Department of Justice.

“While the three companies appeared to be set up as three separate entities, the companies worked as one; the same employees often worked for all three companies and were often paid by all three companies,” the DOJ says in a release. “Had Medicare known about the improper relationship and true nature of the businesses, that is, the companies shared almost all of their beneficiaries, these companies would not have been allowed to enroll in the program and bill for services.”

Codefendants Myrna Parcon, Oliva Padilla, Ben Gaines, physician Ransome Etindi and Lita Dejesus pled guilty in the case. Codefendant physician Noble Ezukanma has pled not guilty and is set to go to trial in January.

Parcon owned USPHV, which provided home visits and home care certifications, and managed its operations, the DOJ says. She also bought A Good Homehealth from Gaines and formed Essence with Padilla, but they concealed her ownership from Medicare.

“Once USPHV established a new patient and Ezukanma, Etindi or others conducted a home visit, USPHV, at the direction of Ezukanma, Parcon and Dejesus submitted billings for fraudulent claims for services not rendered,” the DOJ says. USPHV upcoded claims or submitted claims “as if Etindi provided the services, regardless of who actually did perform the services.”

“Ezukanma and Etindi signed Medicare Form 485s certifying the Medicare beneficiaries for home health services even if the beneficiary was ineligible to receive the benefits,” the DOJ says.

“They also signed and certified Form 485s regardless of the homebound status of the patient and often without any knowledge of the patient or the patient's medical condition.” The bogus certifications resulted in $40 million in fraudulent Medicare home health payments.