Home Health & Hospice Week

Plus: Investigation of physician practice leads to HHA’s door.

While the OIG congratulates itself on its 2014 fraud-fighting successes, it continues to plow ahead with current cases. Take a look at recent enforcement actions announced by the HHS Office of Inspector General and other authorities:

In New Orleans: Just because you aren’t the big dog doesn’t mean you’ll escape prosecution for Medicare fraud. A Louisiana U.S. Attorney has indicted 20 people in a home health agency fraud scheme, from certifying physicians down to administrative workers. According to an indictment, Abide Home Care Services owner Lisa Crinnel and daughter/chief administrative officer Wilneisha Jakes hired “House doctors” to falsely sign home health orders in exchange for sham medical director or consulting fees. For one doctor, Abide hired his wife and paid her inflated salary amounts, prosecutors charge. Abide RNs and LPNs then completed false assessments with fake diagnoses and generated sham documentation to support nonexistent medical necessity, they add.

Crinnel and some of the RNs also face char-ges of defrauding BP by falsely claiming lost wages due to the Deepwater Horizon oil spill in the Gulf.

Prosecutors are calling for forfeiture of property including real estate, bank and life insurance accounts, and jewelry purchased with the proceeds of the health care fraud.

In Chicago: RN James Ademiju, owner of HHAs Adonis Inc. and BestMed-Care Services Ltd., is charged with billing for medically unnecessary HHA services and paying kickbacks for referrals. Adonis and BestMed-Care allegedly paid hundreds of dollars per patient to obtain many patients from a marketing company which claimed to offer “free” nursing services to Medicare beneficiaries. 

According to the affidavit, Adonis and Best Med-Care referred many patients to physicians at Suburban Home Physicians, even when patients had primary care physicians they continued to see. Physicians at Suburban then certified the patients for skilled nursing services, even when patients did not qualify for them. The case arose from the investigation of Suburban, which did business as Doctor At Home.

The agencies “billed Medicare for long periods in part by periodically discharging patients, claiming the patients no longer needed services, and then re-admitting the same patients a short time later without telling the patients that they had been discharged or re-admitted,” the Department of Justice says in a release. “In some instances, a patient was discharged from one agency and then admitted at the other agency in less than a week, and sometimes even on the same day.”

Detroit #1: A physician has pled guilty to furnishing home care referrals in exchange for cash kickbacks. Kutub Mesiwala referred patients to Advance Home Health Care Services Inc. and other home health care agencies, resulting in nearly $900,000 in fraudulent Medicare payments to those HHAs, the DOJ says in a release. Advance’s owner pled guilty to Medicare fraud this summer and awaits sentencing.

Detriot #2: A federal jury convicted patient recruiter Reginald Smith of taking kickbacks from Angle’s Touch Home Health Care in exchange for patient referrals. Smith recruited patients in adult foster care homes, the DOJ says. The kickbacks were disguised as payments to Smith’s nonprofit Medicare provider, People Helping People of Detroit.

The jury also convicted Angle’s Touch physical therapist Rajan Patel of recruiting patients from an adult daycare center, then fabricating patient medical records to make it appear that the recruited patients qualified for and received home health services, when they did not.

Detroit #3: HHA owner Mohammed Sdiq pled guilty to paying kickbacks to patient re-cruiters to obtain the information of Medicare beneficiaries, which he then used to bill Medicare for services that were not medically necessary or were not provided, the DOJ says in another release. Sadiq further admitted that he created fake patient files for a Medicare audit to make it appear as though services were provided and medically necessary.

In Miami: Dr. Daniel Ronchetta, Chiro-practic Physician Assistant John Crowe, and patient recruiter Frank Barrios are charged with allegedly defrauding Medicaid and Medicare by paying and receiving kickbacks and bribes in return for creating and providing false and fraudulent home health prescriptions and plans of care to patient recruiters, the DOJ says.