Home Health & Hospice Week

Fraud Strike Forces turn up the HEAT.

The Dallas trial of the largest Medicare home health scam in history might have been grabbing most of the headlines lately, but federal authorities have been busy with fraud enforcement activities in other areas as well.

Check out the latest enforcement actions from cities with Medicare Fraud Strike Forces, which are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT).

Fraud Hot Spot: Chicago

Case #1: Echoing the Dr. Jacques Roy case, many referrals from a small group of doctors threw up red flags for HEAT investigators in a case involving Suburban Home Physicians, doing business as Doctor At Home. From 2013 through May 2014, more than 300 home health agencies submitted Medicare claims ordered by just four Doctor At Home physicians to provide home health services to 4,000 patients. Those HHAs were paid more than $20 million as a result of their claims, the DOJ said in a 2014 release.

Now a federal jury has convicted RN and Suburban office manager Diana Jocelyn Gumila on fraud charges, the DOJ says in a new release. Among other misdeeds such as upcoding, Gumila ordered physicians to falsify documentation to make patients appear homebound.

Two other defendants have pled guilty in the case, the DOJ notes: physician Alan Newman, who admitted to falsely certifying patients for home care, and nurse James Ademiju, who admitted to paying for referrals and billing for unnecessary services.

Case #2: Marketer Jenette George of Ttenej Senior Referral Agency was found guilty of taking kickbacks in a bench trial, the DOJ says in a release. George received about $500 per patient for referrals to Chicago-area HHAs. George is the eleventh defendant to be convicted in the kickback and fraud schemes at Rosner Home Healthcare Inc. The prior convictions include three of the company’s owners and two physicians.

Fraud Hot Spot: Detroit

Case #1: Five defendants pleaded guilty last month to Medicare fraud — home health agency and hospice owners Muhammad Tariq, Shahid Tahir, and Manawar Javed, as well as physicians Waseem Alam and Hatem Ataya, according to a Department of Justice release.

Tariq, Tahir and Javed paid kickbacks and bribes to Alam, Ataya and other docs for referrals to A Plus Hospice and Palliative Care, At Home Hospice, At Home Network Inc., and other HHAs and hospices they owned, they admitted. Then the agencies would bill for medically unnecessary services or services that were never provided.

Alam would bribe patients into accepting home health and hospice services with illegal drug prescriptions, the DOJ adds.

Case #2: Naseem Minhas, owner of Tri-County Home Care Services Inc., has pled guilty to his part in a $4 million Medicare fraud scheme. Licensed physical therapist Minhas admitted to paying physicians and recruiters for referrals and false documentation, and creating his own bogus records, according to the DOJ.

Case #3: Mohammad Rafiq, owner of Perfect Home Health Care, has received nearly five years in prison and restitution of $3.5 million after pleading guilty to Medicare fraud, the DOJ says.

Rafiq paid physicians and recruiters for referrals and false documentation, and directed recruiters and Perfect employees to pay cash kickbacks to patients.

Fraud Hot Spot: Texas

A Houston federal jury has convicted physician Warren Dailey on fraud and kickback charges.

In a three-day trial, prosecutors showed that Dailey certified ineligible patients for home care in exchange for a flat monthly fee from an HHA, the DOJ says in a release. Dailey faces up to 10 years in prison upon sentencing in June.

Home care providers long have complained that they were targeted for fraud investigations when referring physicians got off scot free. Now the feds may be swinging in the other direction. Dailey “is 69, 30 years in practice and received $9,200 over two years,” Tom Boyd with Simione Healthcare Consultants in Rohnert Park, Calif., tells Eli. “Is the government overzealous or sending a message?”

Fraud Hot Spot: Miami

A federal jury has convicted home health patient recruiter Carlos Rodriguez Nerey on fraud and kickback charges, the DOJ says in a release. Nerey claimed to work at staffing company Sweet Life Staffing Inc., but was in fact a patient recruiter for D&D&D Home Health Inc. and Mercy Home Care Inc., the feds say. Nerey created a shell company to accept kickbacks from Mercy and D&D&D and received about $250,000, evidence at trial showed.

Fraud Hot Spot: New Orleans

Last month a New Orleans federal jury convicted Christian Home Health Care Inc. Owner Elaine Davis and Dr. Pramela Ganji of Medicare fraud in a seven-year, $35 million scheme, the DOJ says in a release. Prosecutors showed at trial that Davis paid employees to recruit new patients, then Ganji furnished bogus certifications for the patients whom she often had never seen. Dr. Godwin Ogbuokiri was acquitted of all charges in the case.