Home Health & Hospice Week

Shady physicians, a fugitive nurse, and more figure in home care fraud heat wave.

It’s been a busy summer for fraud-fighting authorities tackling home care-related crimes and violations. Check out the criminals and schemes the HHS Office of Inspector General, Department of Justice, FBI, and other officials have been busting across the nation:

In Los Angeles: Hee Jung Mun, AKA Angela Mun, RN owner of GreatCare Home Health Inc., was sentenced to nearly five years in prison for Medicare fraud. Mun pleaded guilty in 2012 and admitted that she bilked Medicare out of millions by 1) paying illegal kickbacks to doctors and individuals known as “cappers” or “marketers” for patient referrals, and to patients themselves, 2) billing Medicare for patients who were not homebound or did not qualify for home care, and 3) billing Medi-care for services provided by unlicensed individuals or not provided at all, the DOJ says in a release.

Also in the scheme, a patient recruiter was sentenced to four months in prison, an RN was sentenced to 18 months, a physician who took kickbacks was sentenced to one year, and an unlicensed worker was sentenced to 15 months. Three more GreatCare employees, including a physical therapist and an RN who is a fugitive, await sentencing.

On the civil side, in a related whistleblower lawsuit brought by one of GreatCare’s former em-ployees, two other GreatCare referring doctors, Dr. Dong Shin and Dr. Bo W. Paik, agreed to pay $217,810 and $530,000, respectively, to resolve kickback allegations. The doc sentenced to a year in prison, Dr. Whan Sil “Victoria” Kim, has also agreed to pay $1.088 million as a part of a consent judgment for her conduct, while the PT, Seonweon Kim, has agreed to pay $205,000 to resolve his civil liability related to GreatCare.

“Home health scams and the payment of il-legal kickbacks to physicians remain serious problems in the Los Angeles area,” Glenn Ferry, Special Agent in Charge of the OIG’s Los Angeles Region, said in the release. “Home health remains a top oversight priority for OIG, and we will continue to work with our law enforcement partners to aggressively investigate and prosecute anyone who engages in home health fraud.”

Also in L.A., physician Robert Glazer was indicted for Medicare fraud because he “allegedly signed prescriptions, certifications, and other medical documents for medically unnecessary home health services, hospice services, and power wheelchairs and other durable medical equipment (DME). Glazer’s co-conspirators then sold the prescriptions and certifications to DME supply companies, home health agencies, and other providers,” says the DOJ in a release. “Based on these fraudulent prescriptions and certifications, the DME supply companies, home health agencies, and other providers then allegedly submitted false and fraudulent claims to Medicare” — to the tune of about $33 million.

In Miami: Patient recruiter Euridice Bor-roto pleaded guilty to fraud and kickback charges in Miami federal court, according to the DOJ. Borroto solicited and received kickbacks and bribes from the owner and operator of HHA Nestor’s Health Ser-vices Inc. They were in return for recruiting and providing patients to Nestor HH for home care and therapy that were medically unnecessary and, in many instances, were not provided, according to a release.

Nestor HH received more than $6 million for fraudulent claims before the scheme was ex-posed, the DOJ says. Nestor’s owner Cruz Sonia Collado also pleaded guilty to related charges.

In a separate Miami case, Armando Buchil-lon, Director of Nursing for HHA Anna Nursing Services Corp., pleaded guilty to fraud charges. Buchillon and his co-conspirators regularly falsified patient documentation in order to make it appear that beneficiaries qualified for and received home health care services when they did not, and he paid kickbacks and bribes to patient recruiters, prosecutors said. Buchillon also worked as a patient recruiter for Anna and received kickbacks and bribes.

In Detroit: Physician Walayat Khan pleaded guilty to accepting kickbacks and other forms of payment in return for referring Medicare beneficiaries to Advance Home Health Care Services Inc., Perfect Home Health Care Services, and other area home health care agencies for medically unnecessary home care services, the DOJ says in a release. Dr. Khan signed false certifications and plans of care for these beneficiaries. Khan also used patient recruiters and wrote medically unnecessary controlled substance prescriptions for the recruited beneficiaries.

In Texas: Last month, federal prosecutors filed forfeiture documents against Beyamar Hos-pice Services and Beyamar Home Health Care Inc., targeting two bank accounts containing more than $60,000, reports the Brownsville Herald. Federal agents raided the agency in late February as part of a criminal investigation into Medicare fraud, but the two owners, Marisol Garza and her sister Yaneth Martinez, have not been charged in that case, the newspaper says.

Prosecutors alleged in their complaint that Beyamar Home Health employees forged a doctor’s signature, bribed doctors to sign forms for patients they never treated, sent forms for patients who were not confined to their home and submitted forms for more services than those provided, the Herald says. And prosecutors alleged that Beyamar Hospice employees transferred patients that weren’t terminal and bribed doctors to refer patients to the hospice.

In Chicago: The feds cracked down on home physician companies. They arrested the manager of Suburban Home Physicians, RN Diana Jocelyn Gumila. Suburban was doing business as Doctor At Home. Doctor At Home gets many of its patients from home health agencies, which refer patients to Doctor At Home so that a physician will certify the patient for home health, according to the DOJ. From 2013 through May 2014, more than 300 home health agencies submitted Medicare claims stating that they were ordered by just four Doctor At Home physicians to provide home health services to 4,000 patients. Those HHAs were paid more than $20 million as a result of their claims, the DOJ says in a release.

When a former Doctor At Home physician made a recording of herself telling Gumila that patients didn’t quality for home care, Gumila told her that she was an “artist” who should “paint the picture” of each patient in a way that Medicare would accept, according to the release. Doctor at Home also overbilled for care plan oversight and other physician services, the feds allege.

Authorities also indicted the two owners of home physician company Medicose Home Health Care Service Inc., John Yousefzai and Armanouhi Arzomanian. Medicose allegedly submitted more than $1.3 million in fraudulent claims to Medicare for physician services that were not actually provided, the FBI says in a release. They pled not guilty.

In Ohio: The owner of Columbus-based Janis Home Health Care, physical therapist Eric Isakov, was sentenced to 42 months in prison, followed by two years of supervised release, and ordered to pay restitution of $900,000 for defrauding the Medicare and Medicaid programs. Isakov paid kickbacks in the form of gift cards and videogame systems to people who would sign up with his company, and paid for uncovered durable medical equipment costs and emergency monitoring systems. Isakov also paid senior living centers and physician group employees for referrals, according to an FBI release.

The Ohio Occupational Therapy, Physi-cal Therapy and Athletic Trainers Board also re-voked Isakov’s PT license, the FBI adds.