Home Health & Hospice Week

Plus: Agency owners aren’t the only convicts in Medicare fraud cases.

One of Indiana’s largest home care providers has sought relief from a survey citation of immediate jeopardy by filing multiple lawsuits.

Based on Indiana State Department of Health surveys conducted last fall, Medicare terminated Carmel-based Nightingale Home Healthcare Inc. in December. Surveyors claimed that Nightingale put at least two patients in immediate jeopardy by failing to furnish visits and failing to perform blood draws, among other things, according to the Indiana Business Journal.

But Nightingale filed bankruptcy on Dec. 10 in order to fight the termination. “The findings are misleading and, in some cases, outright false,” said an attorney for Nightingale, Mike Grubbs with Indianapolis law firm Barnes & Thornburg.

The bankruptcy judge ordered Medicare to keep paying Nightingale during its appeal, rejecting a government argument that he had no jurisdiction in the case, the Journal says. A bankruptcy court has set a final hearing on the preliminary injunction for April 27, according to the Current newspaper in Carmel. Nightingale is also pursuing an Administrative Law Judge appeal and is fighting to gets its survey finding reversed, the Journal says.

Plus: Nightingale CEO Dev Brar has filed suit against the state, saying the surveys and their results were part of a campaign of retaliation by health department officials after he complained about “racially tinged” remarks allegedly left on his voicemail from a health department employee, the Journal reports. Brar is Indian-American. “Surveyors … made statements to Nightingale that ‘we are going to shut you down’ before the survey was even completed,” states the lawsuit, which was filed in U.S. District Court in Indianapolis, according to the Journal.

Nightingale serves about 900 patients and has annual revenues of nearly $15 million. Medicare and Medicaid account for nearly 98 percent of the agency’s business, says the newspaper. In other fraud and abuse cases:

In Philadelphia: It’s not just the owners of shady HHAs who get hit with fraud convictions. For example, a federal jury has convicted director of professional services and RN Patricia McGill for her involvement in the Home Care Hospice fraud case, the Department of Justice says in a release.

According to prosecutors, when HCH found out it was being audited in 2007, McGill helped the hospice director in reviewing patient charts, sanctioning false documentation by the nursing staff, and authorizing the alteration of charts. McGill also helped initiate a mass discharge of 128 patients when the hospice exceeded its cap in 2007, prosecutors alleged. Then in spring 2008, HCH brought about 20 percent of the discharged patients back on service. McGill is scheduled for sentencing May 24.

In 2014, HCH owner Matthew Kolodesh was convicted and ordered to serve 14.5 years in prison, plus to repay $16.2 million in restitution to Medicare and $16.2 million in a forfeiture money judgment (see Eli’s HCW, Vol. XXIII, No. 20). Coowner Alex Pugman pleaded guilty in the case and got a much lighter two-year prison sentence, due to being “without a doubt the most exceptional co-operator I have worked with,” according to a federal prosecutor quoted by the Philadelphia Daily News in 2014. Pugman’s wife, Svetlana Ganetsky, HCH development executive, pleaded guilty to obstructing a federal audit and was sentenced in 2014 to a year in prison. HCH Medical Director Eugene Goldman was sentenced to more than four years in prison in the case in 2013.

In Pittsburgh: At press time, former Horizons Hospice COO Mary Ann Stewart planned to plead guilty to Medicare fraud in federal court March 4, reported the Pittsburgh Post-Gazette newspaper. In an indictment last year, authorities alleged Stewart ran a scheme in which she caused Horizons staff to place non-qualifying patients into hospice care that were not appropriate, and then recertified the patients for continued hospice care. Stewart also allegedly made false statements before a grand jury. Former Horizons medical director Oliver Herndon was expected to testify against Stewart at trial, the newspaper notes. Herndon pleaded guilty in 2014 to falsely certifying patients for hospice care (see Eli’s HCW, Vol. XXIII, No. 39) and was sentenced to nearly three years in prison last July.

In Miami: Physician Henry Lora has pleaded guilty to receiving kickbacks in exchange for writing bogus home care prescriptions and falsifying patient records to make it appear they qualified for home care, according to the DOJ. Lora was the medical director of Merfi Corp., whose owner Isabel Medina drew a nine-year prison sentence after pleading guilty to a $20 million Medicare fraud scheme involving Flores Home Health (see Eli’s HCW, Vol. XXIII, No. 12).