Home Health & Hospice Week

The feds continue to put away Medicare home care fraudsters.

In Michigan: Former HHA owner Babu-bhai Rathod, who was also a physical therapist who had lost his license, has received a four-year jail term following a fraud conviction for a kickback scheme involving Lakeshore Home Health Care Inc., and other medical and therapy pratices. Rathod directed a scheme to pay physicians and other practitioners for referrals to the HHA and practices, according to a related civil lawsuit, the Department of Justice says in a release. "The illegal payments were made in cash and checks disguised as bonuses, mileage reimbursements, and payments under sham contracts for medical director and consulting services that were never performed," the DOJ says.

"Rathod was able to own and operate this network of affiliated health care companies, and direct these kickback and upcoding schemes, despite the fact that in 2003, Rathod pleaded one of his physical therapy companies guilty to a felony charge of falsifying medical records and subsequently lost his physical therapy license as the result of an assault conviction involving a patient," the Justice Department adds.

As part of the False Claims Act suit settlement, Rathod agreed to a 20-year exclusion from federal healthcare programs and $950,000 in restitution, the DOJ says.

In Miami: Two former HHA owners, husband and wife Miguel Jimenez and Marina San-chez Pajon, pled guilty to an $8 million Medicare fraud scheme in which Flores Home Health billed for services never furnished. Jimenez and Pajon negotiated and paid kickbacks and bribes, interacted with patient recruiters, and coordinated and oversaw the submission of fraudulent claims, the DOJ claims. They paid recruiters for referrals and paid kickbacks and bribes to co-conspirators in doctors’ offices and clinics in exchange for home health and therapy prescriptions, medical certifications, and other documentation.