Home Health & Hospice Week

Kickbacks draw investigators’ attention.

An attempt to evade fraud detection worked only so long for one Houston couple.

Husband-and-wife Felix Amos, 66 and Oluyemisi Amos, 35, have pled not guilty to charges in a $24 million Medicare fraud scheme, according to press reports. The Amoses first took over Advanced Holistic Healthcare Services Inc. in 2011 and submitted claims for home health services that were not ordered by a physician and that were not furnished, the Department of Justice says in a release. Then the defendants continued the same pattern of fraudulent billing with Access Practical Solutions, GetUpandWalk Inc., and Guarranty Home Health Agency, prosecutors say in an indictment.

“As soon as they took ownership of these companies, there was a dramatic increase in the billing for services, some of which had been performed prior to the change in ownership,” the release says. “They would allegedly bill a high volume to Medicare for a short period of time, then stop.”

Physicians and patients contacted by investigators had never heard of the Amoses or their companies, reports the Houston Chronicle. Nearly 200 Houston area residents have been indicted on health care fraud charges since 2009, the newspaper adds. Other Texas-area enforcement actions in recent weeks include:

In Dallas: A group of hospice companies have agreed to pay $12.2 million to resolve fraud charges involving paying kickbacks for patient referrals, the DOJ says in a release. Hospice Plus, Goodwin Hospice, Phoenix Hospice, and Hospice Plus were acquired by Mooresville, N.C.-based Curo Health Services in 2010 and operate in the Dallas area. Whistleblower lawsuits alleged two distinct schemes. First, from 2007 to 2012, the hospices paid kickbacks to American Physician Housecalls in exchange for patient referrals, in the form of sham loans, a free equity interest in another entity, stock dividends, and free rental space. Second, from 2007 through 2014, the hospices allegedly paid kickbacks to “medical providers, including doctors and nurses as well as hospitals and long-term care facilities,” in exchange for patient referrals. The alleged kickbacks included cash, gift cards, and other valuable items. The government has also requested to intervene in and prosecute the fraud claims against two former executives, Dr. Bryan White and Suresh Kumar, the release notes.

Also in Dallas:Afederal jury has convicted physician Noble Ezukanma on Medicare fraud charges. On the home health side, Ezukanma, coowner of US Physician Home Visits, falsely certified patients for home care. “More than 97 percent of USPHV Medicare patients received home health care, whether they needed it or not,” the DOJ says in a release. On the physician practice side, “USPHV submitted billing primarily under Dr. Ezukanma’s Medicare provider number, regardless of who actually performed the service,” the release says. “They billed at an alarming rate, generally billing for only the most comprehensive physician exam, and always adding a prolonged service code.”

Ezukanma and another USPHV doc certified 94 percent of the Medicare beneficiaries receiving home health services from A Good Homehealth, and 65 percent from Essence Home Health. Four codefendants in the case have pled guilty and are awaiting sentencing, while USPHV billing supervisor Lita Dejesus has pled guilty and was sentenced to 24 months in prison and ordered to pay $4.2 million in restitution, the DOJ says.

In South Texas: Three of five Rio Grande Valley residents charged with accepting illegal kickback payments for home health agency patient referrals have been convicted, reports KRGV News.

Brenda de la Cruz, Francisco Rangel, Sonia Garcia, Aurora de la Garza, and Luis Manuel Garza were charged, the DOJ notes in a release. De la Cruz, Garcia, and Manuel Garza were convicted after admitting to the fraud and face sentencing in July, the news station reports.