Home Health & Hospice Week

Miami dominates the home care fraud market.

While you were busy delivering gifts and covering shifts during the holidays, the feds continued their crackdown on fraudsters in the home care industry. Home care cases include:

In Miami: Home health patient recruiters Marianela Martinez, Omar Hernandez, and Celia Santovenia pleaded guilty in federal court to conspiracy to receive health care kickbacks, the De-partment of Justice says in a release. From 2006 through 2011, the defendants would recruit patients for Caring Nurse Home Health Care Corp. and Good Quality Home Health Care Inc., soliciting and receiving kickbacks and bribes from the agencies’ owners and operators in return for allowing them to bill Medicare on behalf of the recruited patients. These HHAs billed for home care and therapy services that were medically unnecessary and/or not provided, the DOJ says in the release.

Two other patient recruiters for the agencies already pleaded guilty in the case. They received stiff prison sentences — five years and 10 months for Elizabeth Monteagudo and three years and 10 months for Cristobal Gonzalez. The recruiters also must repay $3.5 million and $2 million, respectively, the DOJ says in a separate release.

Miami Case #2: In another case, two home health agency owners received 10-year prison sentences for paying kickbacks and bribes. Yiral Car-dona and Susan Chi, owners of Vista Home Health Services Inc., were convicted of illegally obtaining Medicare patients from 2009 to 2012 by paying bribes and kickbacks of at least $141,000 to patient recruiters. They then billed for services that weren’t medically necessary or were not provided, the DOJ says in another release. The owners also must repay $733,000, the court ordered.

Miami Case #3: A patient recruiter and therapy staffing company owner were sentenced to lengthy prison sentences in relation to yet another Miami HHA. Anna Nursing Services Corp. patient recruiter Ivan Alejo pleaded guilty to negotiating kickbacks and bribes for other patient recruiters and doctor’s office staff for patients and for bogus prescriptions, the DOJ says in a release. Professionals Therapy Staffing Services Inc. owner Hugo Mor-ales created and directed the creation of fictitious progress notes and other patient files indicating that therapists from his company had provided physical or occupational therapy to Anna Nursing patients, when in many instances those services had not been provided and/or were not medically necessary, the DOJ says. Medicare paid Anna Nursing about $7 million for false claims from 2010 to 2013.

Miami Case #4: Isabel Medina, owner of medical clinic Merfi, provided fraudulent home health and therapy prescriptions and other medical documentation to the owners and operators of Flores Home Health Care Inc. and other home health agencies, as well as to patient recruiters, in return for kickbacks and bribes, the DOJ says in a release. Flores and the other HHAs then billed Medicare for services that were not provided or weren’t medically necessary. Medina pleaded guilty to fraud in the case and awaits sentencing in March.

In Texas: Debra Jean Velasquez and Syl-via Salinas Ramirez, working for MRNG Inc. do-ing business as Caring Touch Home Health in Cor-pus Christi, submitted false claims to the Texas Medicaid program for home care services that were never rendered, says the DOJ. The women falsified time sheets, then created phony payroll records which they sent to Caring Touch’s payroll staff, the DOJ says. They then obtained the payroll checks generated from the false time records, forged the signatures of the former Caring Touch employees, and cashed the checks and divided the money among themselves. They must repay $155,000 and were handed prison sentences of more than four and three years, respectively.

In New York: L. Woerner, Inc., which does business as Home Care of Rochester, has settled a case charging that it billed for more than 6,500 hours of services provided by 23 uncertified home health aides and aides who falsely inflated the hours they worked, says the state’s Attorney General Eric T. Schneiderman in a release. Under the agreement, HCR will refund $2.5 million plus interest to the Medicaid program. A Medicaid Fraud Control Unit investigation also uncovered that HCR submitted more than $2.2 million in non-allowable costs, including country club dues for HCR executives, marketing and advertising costs, company vehicles, and interest expense on business loans that was not offset by investment income.