Medicare Compliance & Reimbursement

Home care operators continue to get caught up in the feds' fraud dragnet. The Medicare Fraud Strike Force conducted a "nationwide takedown" of 91 defendants participating in alleged schemes to submit more than $295 million in bogus claims to the government, the Department of Justice says in a release.

"This coordinated takedown involved the highest amount of false Medicare billings in a single takedown in Strike Force history," says the Department of Health and Human Services in a separate release. The Strike Force is a joint effort of the DOJ, HHS Office of Inspector General, FBI, and state Medicaid Fraud Control Units. Among the alleged perpetrators are home care personnel in Miami, Houston, and Louisiana.

In Miami: Long a hotbed of Medicare fraud, U.S. Attorney for the southern District of Florida Wilfredo A. Ferrer is charging nine Miami-area defendants with fraud and kickback charges. Prosecutors allege that Prime Home Health, operated by defendants Marietha Morales and Eduardo Dominguez, submitted $22 million in false Medicare claims for services purportedly provided to 500 beneficiaries from April 2007 through April 2011. Serendipity Home Health, operated by defendants Ariel Rodriguez, Reynaldo Navarro, Melissa Rodriguez and Ysel Salado, submitted $21 million in false Medicare claims for services purportedly provided to 519 beneficiaries from April 2007 through March 2009. And Nany Home Health, operated by defendants Roberto Gonzalez, Olga Gonzalez, and Fabian Gonzalez, submitted $60 million in false Medicare claims for services purportedly provided to 1,474 beneficiaries from January 2006 through November 2009.

"The defendants paid kickbacks to patient recruiters, who referred ineligible beneficiaries to the defendants' home health companies," the U.S. Attorney's office says in a release. "The defendants obtained fraudulent prescriptions and other medical documentation ordering home health services for the beneficiaries and falsified documentation indicating that the services had been provided." The charges revolve around claims for insulin-dependent diabetic patients who did not really need or receive services, the release says.

In Houston: Jodi Leonore Latson, owner and operator of referral business Health Pro Resources, was indicted for providing beneficiary information to 100 different home health care agencies in exchange for illegal payments, according to a release from the U.S. Attorney's Office for the Southern District of Texas. Latson's company compiled the beneficiary information by data mining and cold calling benes.

In Louisiana: An indictment alleges that South Louisiana Home Health Care Inc. of Houma and New Orleans fraudulently billed $19.3 million to Medicare. Owner Louis Age and nursing director Verna Age allegedly paid illegal kickbacks to patient recruiters Milton L. Womack and Mary L. Johnson, according to The (Baton Rouge) Advocate.

RN Kathy Perio is alleged to have falsified records of patients so the agency could bill Medicare for medically unnecessary services, and Ayanna A. Alverez is alleged to have paid kickbacks to patient recruiters, the newspaper reports.

What's In A Name? Innocent providers can sometimes be affected by the fraud busts too. After the Home Care Association of Louisiana sent out an e-mail about the indictment, a similarly named agency sent this message via the trade group: "For clarification, South Louisiana Home Health is in no way affiliated with Southeast Louisiana Home Health!" said COO Jason Morris, who went on to describe the differences between the providers.