Home Health & Hospice Week

Physician CPO features in Texas fraud case.

Increasingly, the feds are not letting physicians or their associates off the hook when it comes to home care fraud.

Case in point: In Miami, Isabel Medina, owner of medical clinic Merfi, drew a nine-year prison sentence after pleading guilty to a $20 million Medicare fraud scheme over the holidays. Medina provided fraudulent home health and therapy prescriptions and other medical documentation to the owners and operators of Flores Home Health Care Inc. and other home health agencies, as well as to patient recruiters, in return for kickbacks and bribes, the Department of Justice says in a release. Flores and the other HHAs then billed Medicare for services that were not provided or weren’t medically necessary.

Medina was also sentenced to three years probation and $8.4 million in restitution.

Relatedly, three of the Flores patient re-cruiters drew two- to three-year prison sentences in the scheme. Lerida Labrada, Mayra Flores, and German Martinez must pay between $200,000 and $400,000 restitution as well, the DOJ says.

Another case: In Dallas, physician Nicolas Alfonso Padron was sentenced to 4 years, nine months in prison and $9.5 million in restitution after pleading guilty last September to Medicare fraud. Padron was medical director for A Medical House Calls, also known as A+ Medical House Calls and ANM Physician House Calls, the DOJ says in a release. A Medical’s “primary purpose was to certify and re-certify Medicare beneficiaries for home health services, regardless of the true condition of the patient,” according to the release. The practice would bill for bogus care plan oversight claims, prosecutors charge.

Co-owners Lawrence Dale St. John and his son, Jeffrey Dale St. John, conspired together to bill Medicare for CPO by Dr. Padron “for numerous beneficiaries when Dr. Padron was out of town, including dates when he was out of the country and on a cruise,” the release says. The St. Johns were convicted at trial last September.