Home Health & Hospice Week

Patient recruiters feature prominently in busted fraud schemes.

Miami is holding up its reputation as the nation’s hottest spot for home care fraud. These fraud actions have been announced in the area over the last few months:

• The case against Professional Home Health is racking up guilty pleas and prison sentences. Co-owner Ernesto Fernandez has received a 10-year prison sentence and was ordered to pay $2.1 million in restitution and to forfeit $9.1 million in a Medicare fraud case, the Department of Justice says in a re-lease. Fernandez admitted he caused patient documentation to be falsified, and planned, organized and oversaw the submission of fraudulent claims to the Medicare program, as well as receiving kickbacks as a patient recruiter for the agency.

Patient recruiter Juan Valdes received a two-year prison sentence and was ordered to pay about $200,000 in restitution. Valdes admitted to receiving kickbacks.

Three other co-owners and operators and a patient recruiter also admitted to billing for home health services that were medically unnecessary or not provided. Dennis Hernandez, Jose Alvarez, Joel San Pedro, and Alina Hernandez received stiff prison sentences ranging up to 10 years each for fraudulent behavior at Professional, the DOJ notes in a separate release. They also were ordered to pay millions in restitution. They acted as patient recruiters for the HHA and received kickbacks as well.

Two other HHA individuals were sentenced in the case last year (see Eli’s HCW, Vol. XXIII, No. 31).

• Felix Gonzalez, owner of AA Advanced Care Inc., faces sentencing in March after pleading guilty to Medicare fraud. Gonzalez and his co-conspirators billed Medicare for home care services that were not medically necessary or that weren’t provided at all, the Department of Justice says in a release. He also admitted to paying kickbacks for patient referrals and related paperwork. Medicare paid about $22 million in such bogus claims.

• Orelvis Olivera, owner and operator of Acclaim Home Healthcare Inc., faces sentencing in April after pleading guilty to Medicare fraud. Olivera admitted to billing Medicare for home care services that were not medically necessary or that weren’t provided at all, and to paying kickbacks for patient referrals and related paperwork. Medicare paid about $5.7 million for the false claims.

• Alexander Lara, owner and operator of Longcare Home Health, has pled guilty to paying kickbacks and bribes to patient recruiters, Medicare beneficiaries, and doctors’ offices and clinics, the DOJ says. Medicare paid about $13.7 million in resulting false claims from 2009 to 2014.