Home Health & Hospice Week

Catch up on recent enforcement actions.

The last few weeks have brought a slew of home care-related settlements, convictions and guilty pleas, making it harder than ever for legit providers to secure their good reputations and defend their reimbursement from law- and policymakers looking to make budget cuts.

Take a look at the biggest offenders:

In Arizona. Hospice of Arizona, related entity American Hospice Management, and their parent corporation, American Hospice Manage-ment Holdings, have agreed to settle False Claims Act allegations for $12 million. AHMH also will enter into a corporate integrity agreement with the HHS Office of Inspector General.

The charges were brought in a whistleblower suit by former employee Ellen Momeyer, who will receive $1.8 million as part of the settlement, the DOJ says.

 “The government alleged that Hospice of Arizona and its related entities, engaged in certain practices that resulted in the admission of ineligible patients or inflated bills,” the DOJ says. The practices included “pressuring staff to find more patients eligible for Medicare, adopting procedures that delayed and discouraged staff from discharging patients from hospice when they were no longer appropriate for such services, and not implementing an adequate compliance program that might have addressed these problems.”

In Miami. For once, the government has gone after the Medicare beneficiaries involved in home care fraud. A federal jury found defendants Rene Suarez-Basanta and Marta Gonzalez guilty of soliciting kickbacks. The benes received payments from conspirators at Safe Home Health Care Inc. to pretend to be patients. Nine defendants have been convicted of paying and receiving health care kickbacks in the investigation, the Department of Justice says in a release.

Also in Miami, patient recruiter Vladimir Jimenez was sentenced to 36 months in prison for accepting kickbacks from Serendipity Home Health. Serendipity paid Jimenez for using patient info to bill for medically unnecessary services that often weren’t provided, the DOJ notes in a release.

Last June, Serendipity owners Ariel Rodri-guez and Reynaldo Navarro were sentenced to six years in prison for their roles in the $20 million scheme, the DOJ adds.

In Louisiana. A New Orleans HHA owner and his former wife, the agency’s director of nursing, were convicted of fraud and kickback charges in federal court. South Louisiana Home Health Care Inc. owner Louis Age hired and paid physicians to sign referrals and certifications for home health services that were not medically necessary. DON Verna Age falsified and directed others to falsify certification evaluations and other forms to make it appear that the home health services were medically necessary, the DOJ says in a release.

Ayanna Age Alverez, who has pled guilty in this case, testified that she was trained by her father and stepmother to pay recruiters kickbacks to recruit beneficiaries, to falsify patient files and to pay doctors kickbacks for their signatures on home health certifications, Justice says.

In New Jersey. Visiting Physicians of South Jersey owner Dr. Lori Reaves has pled guilty to Medicare fraud. Reaves lied about how much face-to-face time she spent on home visits with patients, the FBI says in a release.

Reaves was the highest-billing home care provider among the more than 24,000 doctors in New Jersey from 2008 through October 2011, the FBI points out. Reaves billed a CPT™ code indicating she spent 60 to 150 minutes with homebound patients, when in fact she spent far less time.

In Detroit. RN Beverly Cooper pled guil-ty to fabricating nursing notes and signing notes for unlicensed individuals while working at Reliance Home Care, First Choice Home Health Care Services Inc., and Accessible Home Care Inc. The documents supported visits that weren’t medically necessary or weren’t provided at all.

When the HHAs were visited by state surveyors, Cooper helped them stage bogus visits with fake patients, the DOJ says in a release. Cooper faces up to 10 years in prison at sentencing in July.