Home Health & Hospice Week

'Uncooperative and obstructive' behavior amps up fine levels.

Kickbacks were a defining feature in multiple recent fraud cases centering on Medicare and Medicaid home health services. Take a look at cases spanning the U.S.:

In Detroit: Editha Manzano, owner of Anointed Care Services, has been convicted on Medicare fraud charges after a seven-day trial, the Department of Justice says. Evidence presented at trial showed Manzano paid illegal kickbacks for patients to sign up for home care with Anointed and that she "conspired with physicians" to admit ineligible patients. "To make it appear that these patients did qualify, Manzano and her co-conspirators falsified medical records and signed false documents purporting to show that patients admitted to Anointed's home health program satisfied Medicare's requirements for admission," the DOJ says in a release.

One physician, Dr. Roberto Quizon, pleaded guilty in June in the case and is awaiting sentencing. Another, Dr. Victoria Gallardo-Navarra, was acquitted after trial, the DOJ says. Two other codefendants also pleaded guilty and are awaiting sentencing - RN Juan Yrorita and Liberty Jaramillo.

In California: Elaine Lat, former chief operating officer of Star Home Health in La Verne, has been sentenced to 30 months in federal prison and ordered to pay $41,930 in restitution to Medicare for her role in a scheme to pay kickbacks for patient referrals, according to press reports. Lat pleaded guilty in May, admitting to paying at least $1.26 million in kickbacks to physicians, marketers, and other referral sources from May 2008 through May 2016.

Five other defendants have been charged in relation to the scheme: Lat's parents - Errol Lat and Thelma Lat; marketer Corinne Chavez; physician Dr. Kain Kumar; and physician Dr. Kanagasabai Kanakeswaran. Errol and Thelma Lat pleaded guilty in May to kickback charges and are scheduled to be sentenced next March. Kumar and Kanakeswaran have pleaded not guilty and are scheduled to go on trial separately next year.

In Chicago: The government has intervened in a whistleblower lawsuit against Gateway Health Systems Inc. and its owners Ajibola Ayeni and Joy Turner-Ayeni, as well as Ayeni's physician home visit practice Docs at the Door, the DOJ says in a release. Gateway and the Ayenis billed for home health services that weren't medically necessary because the patients weren't homebound, and Docs at the Door certified those patients as homebound falsely, the feds allege. The agency and owners created false documentation to support the homebound status. Ayeni also faces separate criminal charges for upcoding Docs at the Door services.

In addition, the Ayenis attempted to conceal multiple properties from the government after learning of the investigation, the qui tam suit originally filed in 2013 says.

In Washington, D.C.: A D.C. Medicaid home care agency has been ordered to pay the government nearly $2 million in damages due to the agency's and its owner's stonewalling, the DOJ says.

In 2008, the District of Columbia's Department of Health Care Finance discovered irregularities in Dynamic Visions Inc.'s records during a routine audit, and the FBI and HHS Office of Inspector General investigated, including executing search warrants at Dynamic's offices and the residence of owner Isaiah Bongam, says the DOJ. Patient files contained no plans of care; unsigned POCs; and POCs with forged signatures.

The federal court held that Bongam failed to provide many of Dynamic's financial records, withdrew large sums of money out of Dynamic's business accounts after the government search, and moved the funds to his own personal accounts, or to the accounts of his two other businesses that had no substantive connection to Dynamic.

"In its decision to treble the initial $489,744 damages awarded to the United States under the False Claims Act, and to further impose an additional $11,000 civil penalty for each and every one of the 47 invoices at issue submitted by Dynamic Visions, Judge Kollar-Kotelly found that Dynamic Visions' uncooperative and obstructive conduct during the investigation and the proceeding before the Court justified the trebling of damages and the imposition of the maximum civil penalty possible under the statute," the DOJ notes.