Home Health & Hospice Week

A federal jury has found two home health fraudsters guilty in a complicated $93 million fraud scheme.

Florida residents Karel Felipe and Tamara Quicutis conspired with others to submit false claims to Medicare for three home health agencies in Michigan, the Department of Justice says in a release. Their co-conspirators recruited individuals from Cuba to sign Medicare enrollment documents and appear as the HHA owners to conceal the identities of Felipe, Quicutis, and others.

“Felipe, Quicutis, and their co-conspirators used these home health companies to submit claims for services that were not rendered using lists of stolen patient identities,” the DOJ says. “Felipe, Quicutis, and their co-conspirators used hundreds of shell companies and bank accounts to launder the Medicare fraud proceeds and convert the proceeds into cash at Miami-area ATMs and check cashing stores.”

During Felipe and Quicutis’ trial, co-defendant Jesus Trujillo pleaded guilty to fraud and money laundering charges, the DOJ adds. “Trujillo oversaw a group of people that recruited nominee owners for home health agencies and shell companies and converted Medicare fraud proceeds into cash,” according to the release.

Trujillo faces sentencing in December and Felipe and Quicutis in January.

Husband And Wife Nabbed For Fraud

In Texas, two former HHA owners in their 70s have been sentenced to years in prison for their home health fraud scheme, the DOJ says. Vincent Nwabeke and Victoria Nwabeke owned Houston-area Vital Ambulatory Healthcare Inc. from 2012 to 2018.

Victoria admitted to paying kickbacks to marketers and patients for referrals; bribing physicians to authorize medically unnecessary home health services; and submitting $8 million in fraudulent claims, according to the Justice Department. A judge has ordered her to pay $8.5 million to Medicare and to serve four years in prison followed by three years of supervised release.

As Vital’s CFO, Vincent admitted to filing a fraudulent cost report attempting to disguise the kickback payments his wife made as legitimate business expenses, the DOJ says. He has been sentenced to a year in prison and ordered to pay nearly $1.1 million in restitution.

Other recent fraud cases include:

In Michigan: A federal jury has convicted an HHA owner on fraud, money laundering, and related charges, the DOJ says in a release. Yogesh Pancholi, owner Shring Home Care Inc. in Livonia, purchased Shring using the names, signatures, and personal identifying information of others to conceal his ownership. In a two-month period, Pancholi and his co-conspirators billed and were paid nearly $2.8 million by Medicare for services that were never provided. Pancholi then transferred these funds through shell corporations into his accounts in India. “After being indicted, and on the eve of trial, Pancholi, using a pseudonym, wrote false and malicious emails to various federal government agencies alleging a government witness had committed various crimes and should not be allowed to remain in the United States in an attempt to keep the witness from testifying,” the DOJ adds. Pancholi is scheduled for sentencing in January.

In Texas: A key player in the $150 million Merida Health Care Group hospice fraud case has been sentenced to 50 months in prison and to repay $9 million, the DOJ says in a release. Physician Jesus Virlar-Cadena pleaded guilty in 2019 to certifying unqualified patients for hospice in exchange for bogus medical director payments. He also received luxury trips, bottle service at exclusive nightclubs and other perks, the DOJ says. The scheme involved telling patients with limited mental capacity they were dying when they were not. The Texas Medical Board has suspended his medical license. Virlar-Cadena’s four coconspirators were found guilty at trial in 2019, with Rodney Mesquias and Henry McInnis later sentenced to 20 and 15 years in prison, respectively (see more case details in HHHW by AAPC, Vol. XXVII, No. 39-40). v