Home Health & Hospice Week

Billing for services while traveling is a common violation.

The hunt for Medicaid home health fraud continues unabated, as evidenced by recent cases.

Allied Health Systems in Springfield, Massachusetts, and its CEO Henry Azzun submitted false and/or fraudulent claims to MassHealth and managed care organizations “for services that had not been appropriately authorized by a physician,” says state Attorney General Maura Healey in a release. Allied and Azzun settled the charges for $430,000, according to the release.

“In addition to the financial payment, the settlement also includes a requirement that Allied must operate under a three-year compliance program overseen by an independent compliance monitor,” Healey’s office adds. “That program will include updated policies and procedures, new training for staff, and yearly on-site audits conducted by the monitor.”

The settlement “is part of a larger effort by AG Healey and MassHealth to combat fraud in the home health industry,” the release says. Since 2016, Healey’s office has successfully prosecuted three home health agencies and their owners and settled civilly with 14 HHAs, “an effort which has returned more than $50 million to MassHealth,” it notes.

“The AG’s investigation into Allied began following a referral by MassHealth,” the release adds.

Other recent Medicaid fraud developments include:

In St. Louis: Barbara Martin, owner of personal care services agency Legacy Consumer Directed Services, has been sentenced to four years and nine months in prison and more than $2.6 million in restitution after pleading guilty in June to Medicaid fraud. Legacy billed the Missouri Medicaid program more than $2.5 million between May 2014 and September 2020 for care that was never provided, as Martin, her daughter Zamika Walls and another child of Martin’s were out of town on trips to Miami, Las Vegas or Atlanta, the Department of Justice says in a release. Walls, who lived in Atlanta, was listed as the agency owner because Martin and another operator, her sister Margo Taylor, were ineligible based on past convictions. Martin and Walls also submitted a fraudulent application to the Paycheck Protection Program on behalf of Legacy, lied about using the loan to pay eligible expenses, submitted fake payroll data, and eventually received a $58,295 loan, the DOJ says. After Legacy ceased operations, Martin submitted a fraudulent application seeking forgiveness of the loan. Walls has been sentenced to 15 months in prison and ordered to repay $127,491 after pleading guilty. Taylor has pleaded guilty and awaits sentencing.

Also in St. Louis: Couple Qais Meraj and Aziza Meraj have been sentenced after admitting to a Medicaid fraud scam in which they forged clients’ initials and submitted false time sheets when they were out of the country, among other misdeeds from 2019 to 2021. Qais Meraj was sentenced to two months in prison, two years of supervised release, a $5,000 fine, and was ordered to repay $45,871, the DOJ says in a release. Aziza Meraj was sentenced to three years of probation including two months of house arrest, a $5,000 fine, 200 hours of community service, and was ordered to repay $33,241. The couple has a comfortable net worth, owns a host of investment properties and a gas station and convenience store, the DOJ notes. Aziza Meraj retaliated for being reported by impersonating two clients’ daughter and canceling their Medicaid eligibility and food stamps by falsely claiming that they were leaving the country, which took several months to get restored, the DOJ adds.

In Kansas: Terri Lisa Schwager has agreed to pay the state nearly $13,000 to resolve a civil lawsuit saying she falsely claimed personal care services for her son, a Medicaid recipient. Schwager provided her confidential user information to her son, who logged into an app 91 times indicating that his mother was providing services, when she was in fact working as an emergency room nurse at those times, state Attorney General Derek Schmidt says in a release.

Also in Kansas: Seunghee Lee was sentenced to pay $3,519 in restitution to the Kansas Medicaid program, a $1,000 fine and to serve 12 months of supervised probation after she pleaded guilty to submitting false claims for personal care services for her mother-in-law after the mother-in-law was hospitalized and died. The case was part of “Operation Keeping Them Honest,” a collaboration between the AG and the HHS Office of Inspector General, AG Schmidt says in a release.

In Michigan: To reduce fraud in the state’s home health program, the state’s Medicaid Fraud Control Unit has recommended that the Michigan Department of Health and Human Services “identify and recover overpayments from providers who did not provide services to beneficiaries or provided services in violation of the State’s Medicaid policy,” according to a new report from the HHS Office of Inspector General on the Michigan MFCU. “As part of this recommendation, the Unit requested that any of the beneficiary’s family members be ineligible to receive Medicaid payment for providing any home health services to the beneficiary,” notes the OIG report. Overall, the OIG found that the Michigan MFCU “reported strong case outcomes for [fiscal years] 2018–2020, with over $47 million in combined criminal and civil recoveries,” notes the report at https://oig.hhs.gov/oei/reports/OEI-06-21-00270.pdf.