Home Health & Hospice Week

Plus: Appeals court declines to overturn sentences, restitution.

The Department of Justice isn’t done with two hospice fraud convicts.

Recap: Merida Group owner Rodney Mesquias and Administrator Henry McInnis ran a $150 million scheme in Texas in which they aggressively enrolled patients with long-term diseases who had limited mental capacity and/or resided in group homes and other facilities; falsely told patients they had six months to live and helped them prepare for death; fired employees who didn’t go along with the scheme; falsified records; and more. Mesquias and McInnis were convicted in 2019 and sentenced to a 20-year and 15-year prison sentences, respectively. Mesquias was also ordered to repay $120 million (see HCW by AAPC, Vol. XXX, Nos. 1 and 8).

Now the feds have named Mesquias and McInnis in a civil whistleblower suit covering the same ground. “The civil complaint … alleges Mesquias and McInnis conspired to violate the civil False Claims Act by submitting false and fraudulent claims to Medicare for medically unnecessary hospice and home health services,” the DOJ says in a release. “It also alleges they paid illegal kickbacks to Merida medical directors for patient referrals and created false patient medical records in support of the false and fraudulent claims,” Justice continues.

“The United States is … entitled to recover triple the damages for violations of the civil False Claims Act as well as civil monetary penalties between $11,803 and $23,607 for each false claim submitted to Medicare,” the release points out.

Meanwhile, The 5th U.S. Circuit Court of Appeals has affirmed Mesquias’ and McInnis’ health care fraud and conspiracy convictions, as well as their respective 20-year and 15-year sentences, Reuters reports. Mesquias and McInnis argued that their convictions were based on insufficient evidence, since physicians had certified that the patients were eligible for home-health or hospice care, and their sentences should be reduced based on the number of claims specifically examined in the case. The appeals court shot down both arguments.