Home Health & Hospice Week

HEAT cities see more home care fraud.

Fraud-fighting activities in home care fraud hot spots continue, as evidenced by newly announced guilty pleas, convictions, and sentences.

Case #1: Co-owners of seven Miami-area home health agencies, Mildrey Gonzalez and Milka Alfaro, have pleaded guilty to paying bribes and kickbacks to physicians, patient recruiters, and others for home care referrals and, in docs’ case, prescriptions for the services, the Department of Justice says in a release. Sometimes the care furnished to the patients wasn’t medically necessary, the government adds. Gonzalez and Alfaro also concealed their role as owners in their agencies, Inar Home Care Service Corp., MAHome Health Inc., Golden Home Health Care Inc., Nova Home Health Care Inc., Finetech Home Health Inc., Homestead Home Health Care and Metro Dade Home Health Inc. Sentencing for the $20 million scheme is scheduled for May.

Case #2: An eleventh person has been sentenced in the case against Miami-area HHAs Mercy Home Care Inc. and D&D&D Home Health Care Inc. — and the sentence is a whopper. Raciel Leon, who was a manager at Mercy and a billing staffer at D&D&D, was convicted in December after a twoweek trial, the DOJ notes in a release. The evidence showed that Leon and his co-conspirators used the companies to submit false claims to Medicare for services that weren’t medically necessary, not actually provided, for patients that were procured with illegal kickbacks to doctors and patient recruiters, and for beneficiaries who were admitted to Mercy and DDD only as a result of forged prescriptions and falsified medical documentation; backdated claims for services supposedly rendered years prior; and claims for beneficiaries who were coached to say they needed services, when in fact they were not homebound. Leon also destroyed evidence, including a kickback ledger, prosecutors said. A federal judge has sentenced Leon to ten-and-a-half years in prison.

Case #3: A Detroit-area physician has pleaded guilty to accepting kickbacks for home care prescriptions, among a number of other misdeeds, the DOJ says in a release. Aaron Goldfein had two physicians who lost their licenses work for him at Tri-City Medical Center in Livonia, the feds say. The docs would perform home visits and prescribe drugs including controlled substances under Goldfein’s name. They would also bill for home health services that weren’t medically necessary or that weren’t provided at all.

Case #4: A federal jury in Houston has found a physician imposter guilty of Medicare fraud. According to evidence presented at trial, Rex Duruji posed as a physician to induce Medicare beneficiaries to sign up for fraudulent home care services with Koby Home Health. The services were not actually provided and Duruji paid illegal cash kickbacks to the beneficiaries, the prosecutors said. Sentencing is scheduled for May, the DOJ says in a release.