Home Health & Hospice Week

A federal judge has overturned a fraud conviction in a case that was high-profile enough to land in the HHS Office of Inspector General's Semiannual Report to Congress.

The fifth circuit court of appeals reversed a decision in a March 2016 Medicare fraud case where Christian Home Health Care Inc. owner Elaine Davis and physician Pramela Ganji were convicted of paying employees to recruit new patients (Davis) and furnishing bogus certifications for the patients whom she often had never seen (Ganji) (see Eli's HCW, Vol. XXV, No. 16). Davis was sentenced to eight years in prison while Ganji was sentenced to six years, and they were ordered to pay a combined $9 million in restitution.

On Jan. 30, the court cited "insufficient evidence" to show that the women had "knowingly executed a scheme to defraud Medicare," reports The Times-Picayune newspaper. Further, it said Medicare guidelines don't prohibit treating physicians who are not primary care docs from beginning the certification process and therefore Ganji could not be held "liable for fraudulence as a result of activity that is legal," the paper says. The feds also "based the fraud case against Davis completely on the actions of Ganji. There was not sufficient evidence to show an agreement to commit health care fraud, and the government did not otherwise attempt to show that Davis individually committed the fraud," according to the report.

Ganji has been serving time at a prison camp since March, her attorney told The Times-Picayune.