Home Health & Hospice Week

Fraud & Abuse:

Home Care Features In Recent Fraud Takedown

Ill gotten gains go to buy luxury cars.

The reimbursement your agency earns may go to pay hardworking staff instead of buying a Lamborghini, but that may not matter when lawmakers are making budget decisions with stories of home care fraud rattling around in their memories.

The government’s Medicare Fraud Strike Force coordinated the "sixth national Medicare fraud takedown in Strike Force history" May 14, according to a press release from the Department of Justice. The takedown resulted in charges against 89 individuals — including doctors, nurses and other licensed medical professionals — for fraud schemes involving $223 million in false billings. About 400 law enforcement agents from the FBI, HHS Office of Inspector General, multiple Medicaid Fraud Control Units and other state and local law enforcement agencies participated in the takedown, the Justice Department says.

In one Miami case, three defendants were charged for participating in a $20 million fraud scheme involving ironically named home health agency Trust Care Health Services. The defendants bribed Medicare beneficiaries for their Medicare information, which was used to bill for home health services that were not rendered or that were not medically necessary, court documents allege. The lead defendant spent much of the money from the scheme, and purchased multiple luxury vehicles, including two Lamborghinis, a Ferrari and a Bentley, according to court documents.

In New Orleans, five individuals — including two physicians — were charged for participating in a $51 million home care fraud scheme. The defendants allegedly recruited beneficiaries, offering cash and other incentives in exchange for their Medicare information, which was used to bill medically unnecessary home health services.

In Houston, brother-and-sister defendants used patient recruiters to obtain Medicare beneficiary information that they then used to bill for $8.1 million in home care services that were not medically necessary nor provided, according to prosecutors.

In Detroit, home care fraudsters were part of a $49 million fraud ring that also included psycho-therapy and infusion therapy services, the DOJ says.

Authorities also announced these cases unrelated to the takedown:

• In Detroit, Moonlite Home Care Inc. co-owner Rehan Khan received a 60-month prison sentence after pleading guilty to a $14 million Medicare fraud scheme. Khan paid doctors to refer patients for home care services that were not medically necessary and/or never rendered, prosecutors allege.

Khan also worked as a physical therapy assistant for several HHAs in the Detroit area — Physicians Choice Home Health Care and First Care Home Health Care. Khan paid and directed the payment of kickbacks to benes for Physicians Choice, First Care, and Moonlite. The Medicare beneficiaries sometimes pre-signed forms and visit sheets that were later falsified to indicate they had received home care services that they had never received. Other times, the Medicare beneficiaries’ signatures were forged on the forms and visit sheets.

Khan allegedly paid clinicians to create fictitious patient files to document home care services purportedly provided by Moonlite that were never rendered. Khan also signed fictitious patient files purporting to have given PT services at all three home health care agencies that were in fact never rendered. Khan was responsible for about $1.8 million in false claims, the DOJ says.

• In Corpus Christi, Texas, Sylvia Salinas Ramirez and Debra Jean Velasquez are charged with submitting false bills to Medicaid and managed care organizations Evercare of Texas and Superior Health Plan Inc. for home health services that had not been provided, says the Federal Bureau of Investigation in a release. The defendants worked for Caring Touch Home Health. Ramirez and Velasquez allegedly created fraudulent time sheets for current and former Caring Touch employees for home health services that were not provided and created false payroll records they sent to the agency’s staff. Then the women obtained the payroll checks, forged the signatures of the payees, cashed the checks, and divided the money among themselves.

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