Home Health & Hospice Week

Watchdog agency profiles Texas, Florida cases.

The feds continue to paint home care with a broad fraud brush, as evidenced by the OIG’s latest Semiannual Report to Congress.

“Home- and community-based services, including home health care and hospice services, can be particularly susceptible to fraud and abuse,” the HHS Office of Inspector General says in the newly released report. “OIG, along with our law enforcement partners, focuses specific attention on investigating suspected fraud committed by these providers and in assessing and recommending safeguards to protect taxpayers and beneficiaries.”

Here are cases the OIG lists as examples of its “specific attention” on home health:

In Florida: A home health agency co-owner was sentenced to six years and eight months in prison after pleading guilty to a Medicare fraud scheme. From 2006 to 2012, Sila Luis and her codefendants paid patient recruiters kickbacks and bribes in exchange for patient referrals to Silas’ two home health agencies to receive services that were not medically necessary, not provided, or both, the OIG notes. Two additional defendants were previously sentenced to a combined 11 years and eight months in prison and ordered to pay a portion of Silas’ $45 million in restitution, as well as an additional $27 million in restitution. Silas was indicted back in 2012 (see Eli’s HCW, Vol. XXI, No. 12).

In Texas: An RN who owned and operated two Houston HHAs was sentenced to 10 years in prison and $17.1 million in restitution after pleading guilty to a Medicare fraud scheme. From 2009 to 2016, Eric Ugorji and his co-defendants recruited patients to receive services from Deligent Health Services Inc. and Preferred Health Services Inc. that were not medically necessary, not provided, or both, the OIG says. Ugorji also paid kickbacks to physicians who would falsely certify that the Medicare beneficiaries were under their care and confined to the home when they were not.

Also in Florida: A Medicare Fraud Strike Force case resulted in jail time for co-defendants in a home care fraud case. Antonio E. Alfonso-Ramos, Dayan Vina Guerra, Jose Ruiz-Dean, Jose Carlos Gonzalez, and Rosa Marbella Patino-Gonzalez, from about 2010 through 2015, paid kickbacks and bribes to patient recruiters in exchange for the referrals of Medicare beneficiaries to serve as patients at the home health agencies, which then billed Medicare for services that were not medically necessary, not provided, or both, the OIG says. The defendants also paid kickbacks and bribes for home health prescriptions and plans of care. Three defendants involved in the scheme were sentenced to a combined 13 years and nine months in prison and ordered to pay $34.2 million in restitution.

Also in Texas: Houston group home owner Patricia Ann Thomas was sentenced to six months in prison after pleading guilty to receiving kickbacks in exchange for referring her group home residents for home health services, the OIG says.

The OIG also reviewed its report issued earlier this year about how HHAs can game the survey roster process (see Eli’s HCW, Vol. XXVII, No. 11).

Note: The report is at https://oig.hhs.gov/reports-and-publications/archives/semiannual/2018/sar-spring-2018.pdf.