Home Health & Hospice Week

Kickbacks and sham medical directorships feature in egregious case.

You don’t have to be an owner or CEO to get a prison sentence for Medicare fraud, judging by the latest development in the high-profile Merida Group case in South Texas.

Recap: At a November 2019 trial, “witnesses testified that from 2009 to 2018, the vast majority of hospice and home health patients at the Merida Group did not qualify for services. Rather, physicians were bribed with illegal kickbacks, under the pretense of medical directorships, to falsely certify unqualified patients for services,” the Department of Justice says in a release. “Employees were instructed to falsify medical records, making non-terminal patients appear to be terminally ill and declining” in the $150 million fraud scheme.

Merida personnel “recruited patients at hospitals and other medical practices by touting that the Merida Group offered ‘hospice that you don’t have to die to use,’ pursuant to the Merida Group’s corporate marketing strategy,” the DOJ says.

Two defendants in the case, owner Rodney Mesquias and CEO Henry McInnis, went to trial, were convicted of fraud and other charges, and received stiff prison sentences of 20 and 15 years, respectively (see HCW by AAPC, Vol. XXI, Nos. 1 and 8).

In contrast, operations manager Jose Garza pleaded guilty, admitting to “participating in the scheme, facilitating kickback payments to physicians, and directing employees to falsify medical records,” the DOJ says. Now Garza has gotten off with a much lighter 27-month prison sentence and order to pay a whopping $4.7 million in restitution.

The fourth co-conspirator in the case, physician and former Rio Bravo mayor Francisco Pena, died in November 2020.

Other recent fraud case developments include:

In California: A home health and hospice agency owner has pled guilty to fraud and kickback charges. Liana Karapetyan, co-owner of ANG Health Care Inc., Excel Home Healthcare Inc., and Excel Hospice Inc. in the Sacramento area, admitted she paid and directed others to pay kickbacks to multiple individuals for beneficiary referrals, including employees of skilled nursing facilities and a hospital, and their spouses. Karapetyan is scheduled for sentencing on Aug. 26, the DOJ says in a release. The recipients of the kickbacks have also pled guilty in the case and await sentencing.

In Florida: The owner of a home and community-based service provider in Quincy has been arrested on charges of more than $50,000 in Medicaid fraud, Florida Attorney General Ashley Moody says in a release. Golden Angels Professional Services owner Quantara Clarke billed Medicaid in excess of time limits, billed for unauthorized services to patients who were in a hospital or incarcerated, overstated the time spent with patients, and treated patients in a group when billing Medicaid for one-on-one services. Plus, “several victims allege that Clarke and her employees intimidated them,” according to the release.

In North Carolina: Las Vegas resident Timothy Mark Harron has pled guilty to “conspiring with his wife, Latisha Harron, to carry out a massive fraud upon the North Carolina Medicaid Program … by billing the government for fictitious home health services” through their Medicaid agency, Agape Healthcare Systems Inc., in Roanoke Rapids, the DOJ says in a release. “Harron further admitted to working with his wife to launder the proceeds of the fraud into, among other things, a private jet, luxury jewelry and clothing, and properties in … North Carolina.” The two former felons fraudulently billed “the program for millions in just the few years in which [Timothy Mark Harron] participated in the scheme,” the DOJ notes. Latisha Harron previously pled guilty in the case (see HCW by AAPC, Vol. XXIX, No. 45).