Home Health & Hospice Week

Kickbacks are the focus of many recent cases.

Recent enforcement developments in home health show that physicians are increasingly being held accountable in home health fraud schemes.

In New Orleans: Four physicians have been sentenced in the high-profile Abide Home Health case. So-called “House Doctors” Henry Evans, Michael Jones, Shelton Barnes, and Gregory Molden ordered home health services for Medicare beneficiaries who had no legitimate medical necessity, a jury found after a month-long trial that ended in May, the Department of Justice says in a release.

Evans, Barnes, and Molden received sham monthly medical director or consultant fees, while Abide hired Jones’ wife, Paula Jones, and paid her an inflated salary, prosecutors proved.

Barnes was sentenced to five years in prison followed by one year of supervised release and $10.9 million in restitution; Evans to more than four years in prison, followed by one year of supervised release and $1.3 million in restitution; Molden to four years in prison followed by one year supervised release and about $626,000 in restitution; and Jones to three years in prison followed by two years of supervised release and nearly $350,000 in restitution. Paula Jones received a one-year prison sentence followed by three years of supervised release and restitution of $1.3 million. Abide’s office manager Jonathan Nora was also sentenced to more than three years in prison and $12.9 million in restitution.

In Detroit: Physician Millicent Traylor was sentenced to a whopping 11 years in prison for a scheme involving home health kickbacks. According to evidence presented at trial, from 2011 to 2016, Traylor, who was unlicensed at the time, acted as a physician for multiple companies including United Home Health Care Inc. in Ferndale. At trial, Traylor was found guilty of providing services that were not medically necessary or were not rendered, the DOJ says. Traylor and her co-conspirators falsified medical records, signed false documents, and paid and received kickbacks in exchange for referring Medicare beneficiaries to serve as patients. The trial evidence also showed that Traylor fraudulently signed the names of licensed physicians on prescriptions for opioid medications as a means of inducing patient participation in the scheme, according to the release.

Co-defendant and United owner Muhammad Qazi was sentenced to serve 3.5 years in prison back in August and co-defendant and physician Christina Kimbrough was sentenced to more than two years in prison in September. Clinic owner and co-defendant Jacklyn Price awaits sentencing.

In Florida: A 73-year-old physician has been sentenced to five months in prison followed by three years of supervised release for obstructing a Medicare audit, the DOJ says in a release. John Janick will also pay nearly $119,000 in restitution.

According to the plea agreement, Janick lied to a Medicare program integrity contractor that was auditing Janick Medical Group. Janick falsely claimed the home health agency employer of his wife, Lisa McLaren Janick, was paying rent for office space she used in his practice. McLaren Janick improperly accessed sensitive patient data to generate bogus referrals from Dr. Janick to her HHA employer. McLaren Janick pleaded guilty in a related case earlier this year (see Eli’s HCW, Vol. XXVII, No. 28) and faces sentencing Oct. 10.

In Dallas: A fourth defendant has pleaded guilty in the case against Novus Health, in which the feds allege Novus CEO Bradley Harris directed hospice nurses to speed up the death of elderly patients by administering certain drugs (see Eli’s HCW, Vol. XXVI, No. 9). Former Novus medical director Charles Leach, medical director for Novus from 2014 to 2015, admitted to his role in the $60 million scheme last month, saying he signed blank prescriptions and was aware Harris often directed the medical operations, according to press reports. But Leach’s attorney told the Dallas Morning News that Leach was “horrified to find out” that Harris was ordering the team to hasten patient deaths.

Leach, who was one of six physicians indicted in the case, faces sentencing Dec. 10. The rest of the Novus defendants who haven’t pleaded guilty face trial in January. Among those who have entered guilty pleas so far are nursing supervisor Jessica Love and operations director Melanie Murphey.

In Houston: A federal jury has found a physician and two physician clinic owners and operators guilty for their roles in a $17 million Medicare fraud scheme centering on home health patients. According to evidence presented at trial, Amex Medical Clinic owners and operators Ann Nwoko Shepherd and Yvette Nwoko sold medical orders and other documents signed by physician John Ramirez to home health agencies in and around Houston from 2011 to 2015, according to the DOJ. Ramirez falsely certified information about the patient’s medical condition and need for medical services. Co-conspirators at HHAs then used the bogus paperwork signed by Ramirez and sold by Shepherd and Nwoko to bill and receive payment from Medicare for services that were not medically necessary or not provided. Shepherd also caused Amex to bill for physician clinic services that weren’t provided.