Home Health & Hospice Week

The doctor charged in a Boston-area home health fraud scheme has pled guilty to Medi-care fraud. Dr. Spencer Wilking was employed in 2011 and 2012 as a medical director by MJG Man-agement Company, d/b/a At Home VNA, a home health agency located in Waltham, Mass.

Wilking signed certifications and recertifications to provide AHVNA home health services to hundreds of Medicare beneficiaries who did not qualify under Medicare, the Department of Justice alleges in a release. Wilking certified hundreds of patients after reviewing AHVNA paperwork on them or talking with clinical staff, instead of having a face-to-face encounter as required and reviewing their records. "Had Wilking reviewed the patient files, he would have discovered that many of the files contained information demonstrating that many of the patients were not homebound because, for example, they worked, took vacations, and spent substantial time outside the home," DOJ says in the release.

Medicare paid Wilking about $30,000 for these patients’ certs and recerts, and AHVNA paid him about $42,000 to be its medical director.

Last fall, the DOJ charged AHVNA owner Michael Galatis and clinical director Janice Troisi with billing Medicare for home care services that weren’t medically necessary or furnished (see Eli’s HCW, Vol. XXII, No. 34). Galatis and Troisi trained VNA nurses to recruit seniors through wellness clinics held at senior residential facilities, prosecutors said. Then the nurses fudged documentation to make the patients appear homebound and eligible for services. The VNA’s paid medical director signed certifications for the ineligible patients, authorities allege. Galatis and Troisi also discouraged nurses from discharging patients and retaliated against nurses who recommended discharge.

VNA nurses complained that the patients didn’t want services and weren’t home when they visited. Often, the patients’ primary care physicians would direct the VNA to terminate services when the docs found out, but the VNA disregarded the directions, the DOJ says.

Galatis and Troisi have pleaded not guilty to the charges, the DOJ says in the release. Wilking will face sentencing in May.