Home Health & Hospice Week

Physician kickbacks included in charges.

The nation’s Medicare fraud hot spots have produced a new crop of fraudsters using home care to perpetrate their schemes — making life harder for legitimate home care providers.

Medicare Fraud Strike Force teams in six cities orchestrated a takedown resulting in charges against 90 individuals, including 16 doctors and 11 nurses and other medical professionals, for their alleged participation in Medicare fraud schemes in-volving $260 million in false claims, the Depart-ment of Justice says in a release. Home care fraud featured in four of the six locations.

“The defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and often never provided,” DOJ notes in the release. “In many cases, court documents allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent bills to Medicare for services that were medically unnecessary or never performed.”

For example, in Houston five physicians were charged with conspiring to bill Medicare for medically unnecessary home health services, the DOJ continues. According to court documents, the defendant doctors were paid by two co-conspirators to sign off on home care services that were not necessary and often never provided.

And in Los Angeles, a doctor was charged for causing almost $24 million in losses to Medicare through his own fraudulent billing and referrals for durable medical equipment and home health services that were not medically necessary and frequently not provided.

In Detroit, seven defendants were charged for their roles in fraud schemes involving $30 million in false claims for medically unnecessary services, including home health services, psychotherapy and infusion therapy, the DOJ says.

Since 2007, Strike Force operations in nine locations have charged almost 1,900 defendants who collectively have falsely billed the Medicare program for almost $6 billion, the release points out. And CMS and the HHS Office of Inspector Gene-ral have suspended enrollments of high-risk pro-viders in five Strike force locations and have removed more than 17,000 providers from the Medicare program since 2011.

Sham Medical Director Fees Cost Hospice

The Strike Forces’ seventh national takedown wasn’t the only fraud enforcement activity taking place this week. The feds also announced:

• In Mississippi: You may want to have legal counsel look over your medical director ar-rangements. Harper’s Hospice Care Inc. in Merid-ian agreed to pay $150,000 for allegedly violating the CMP Law provisions on physician self-referrals and kickbacks, the OIG says on its website. Harper’s Hospice paid remuneration to a physician in the form of medical directorship fees. The OIG contends that Harper’s Hospice paid the remuneration to the physician in exchange for the physician referring patients for hospice services and pre-signing blank forms for patients treated by the hospice.

• In Pennsylvania: Don’t forget to check and recheck your employees against the OIG exclusion list. After it self-disclosed conduct to the OIG, Immediate Homecare Inc. in Bensalem agreed to pay $78,160 for allegedly violating the CMP Law. Immediate employed an individual that it knew or should have known was excluded from participation in Federal health care programs, the OIG alleges on its website.

• In Washington, D.C.: Aide Adoshia L. Flythe pled guilty to selling packages of counterfeit aide certification documentation, charging two individuals $350 apiece for a counterfeit “Home Health Care Aide” certificate from the University of the District of Columbia and a counterfeit “Health Certificate for Staff” that contained the forged name and signature of at least one doctor, the FBI says in a release.

Flythe was one of 24 people — including operators of home care agencies and nurse staffing agencies, office workers, and personal care aides — arrested in late February 2014, following investigations into fraudulent billing practices in the Medicaid home health care industry. The investigations uncovered numerous, separate schemes involving fraud, kickbacks, and false billings, the FBI says in the release. She is the first defendant to plead guilty in the various schemes.

• In Texas: A federal jury has convicted physician Joseph Megwa and HHA manager and nurse Ebolose Eghobor of Medicare fraud, the DOJ says in a release. According to prosecutors, from 2006 to 2011, PTM Healthcare Services Inc. re-cruited Medicare beneficiaries so that PTM could bill Medicare for unnecessary home health services. Eghobor and others then prepared fraudulent medical records that made it appear that the beneficiaries needed the services. In exchange for cash, Megwa, who owned and operated Raphem Medical Prac-tice, falsely certified that the beneficiaries needed home health.

Megwa was also convicted of submitting false claims to Medicare for home visits or house calls that he never actually made, the release adds.