Posts Tagged ‘Department of Justice’

Five Miami Residents Arrested for Alleged Roles in $48 Million Home Health Care Fraud Scheme

September 27, 2013

Five Miami residents have been charged for their alleged roles in a $48 million home health Medicare fraud scheme.

On Sept. 24, 2013, a federal grand jury in Miami returned an 11-count indictment charging Marianela Martinez, 45; Mireya Amechazurra, 49; Lissett Jo-Moure, 55; Omar Hernandez, 48; and Celia Santovenia, 49, each with one count of conspiracy to receive health care kickbacks and two counts of receiving kickbacks in connection with a Federal health care program.  Each charge carries a maximum penalty of five years in prison upon conviction.

According to the indictment, the defendants participated in a scheme involving Caring Nurse Home Health Care Corp. (Caring Nurse) and Good Quality Home Health Inc. (Good Quality), Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries.  The defendants allegedly referred Medicare beneficiaries to Caring Nurse and/or Good Quality in exchange for kickbacks, knowing that Caring Nurse and/or Good Quality would in turn bill Medicare for home health services purportedly rendered for the recruited Medicare beneficiaries.

An indictment is a formal accusation of criminal conduct, not evidence.  A defendant is presumed innocent unless and until convicted.

In a related case, on Feb. 27, 2013, Rogelio Rodriguez and Raymond Aday, the owners and operators of Caring Nurse and Good Quality, were sentenced to 108 and 51 months in prison, respectively.  The sentencings followed their December 2012 guilty pleas to one count each of conspiracy to commit health care fraud charged in an October 2012 indictment, which alleged that from approximately January 2006 through June 2011, Caring Nurse and Good Quality submitted approximately $48 million in claims for home health services that were not medically necessary and/or not provided.  Medicare paid approximately $33 million for those fraudulent claims.

The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.  This case is being prosecuted by Assistant Chief Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.

Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,500 defendants who collectively have falsely billed the Medicare program for more than $5 billion.  In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go

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Sun-Sentinel: Get Disabled Children Out of Nursing Homes

July 29, 2013

South Florida Sun-Sentinel Editorial

If Pearl Buck was right, and “the test of a civilization is the way that it cares for its helpless members,” Florida got a failing grade this week.

The U.S. Justice Department filed suit Monday against the state, accusing it of violating the federal Americans with Disabilities Act by failing to do enough to keep children with disabilities in Florida from being sent for care to nursing homes for the elderly. The department’s lawsuit called it “deliberate indifference to the suffering” of those children.

The head of the Florida Agency for Health Care Administration, Liz Dudek, called the lawsuit “disruptive” and accused Washington of wanting to take over the state’s Medicaid and disability programs. Seriously?

The Justice Department says it spent six months investigating the plight of disabled kids in Florida nursing homes before calling on the state last September to do more to give their families the option of care at home or in community-based settings. The department filed suit after concluding that it couldn’t count on the state to comply voluntarily. (more…)

Feds Sue Florida for Keeping Kids in Nursing Homes

July 22, 2013

The Associated Press reported today that the U.S. Justice Department is suing Florida, saying the state is unnecessarily keeping hundreds of disabled children in nursing homes.

According to the lawsuit filed Monday, federal officials visited six nursing homes throughout the state and identified about 200 children who didn’t need to be there and could receive care at home. (more…)

U.S. Intervenes in False Claims Act Lawsuit Against Fla. Home Health Care Company and Its Owner

July 22, 2013

The government has intervened in a whistleblower lawsuit against A Plus Home Health Care, Inc., a home health care company in Fort Lauderdale, Fla., and its owner, Tracy Nemerofsky, the Justice Department announced today. The government alleges that A Plus offered referring physicians’ spouses sham marketing positions with the company to induce the physicians to refer Medicare patients for home health care services. (more…)

Medicare Fraud Strike Force Charges 89 Individuals for $223M in False Billing

May 15, 2013

medicare fraudAttorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius announced today that a nationwide takedown by Medicare Fraud Strike Force operations in eight cities has resulted in charges against 89 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billings. Florida accounted for 34 of the arrests made.

This coordinated takedown was the sixth national Medicare fraud takedown in Strike Force history. In total, almost 600 individuals have been charged in connection with schemes involving almost $2 billion in fraudulent billings in these national takedown operations alone. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative announced in May 2009 between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country. (more…)

HHS Proposal Would Increase Rewards to Seniors for Reporting Fraud

April 24, 2013

Health and Human Services Secretary Kathleen Sebelius today announced a proposed rule that would increase rewards paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the successful recovery of funds to as high as $9.9 million. In addition, a new funding opportunity released this month supports the expansion of Senior Medicare Patrol (SMP) activities to educate Medicare beneficiaries on how to prevent, detect and report Medicare fraud, waste and abuse. (more…)

Detroit Home Health Manager Convicted of Fraud

April 18, 2013

The manager of a home health agency in the Detroit area was convicted this week of bilking Medicare of $5.8 million by recruiting patients to fill out forms suggesting they had received services that were never performed, the Department of Justice announced. Nabila Mahbub, 27, the manager of All American Home Care Inc., was found guilty in a Michigan federal court, the twentieth employee or associate of All American convicted in connection with a fraud scheme.

“According to evidence presented at trial, Mahbub doctored and directed the doctoring of fake patient files to facilitate the commencement and billing of home health services purportedly provided by physical therapists and physical therapist assistants working for All American,” according to the DOJ announcement.

Miami Patient Recruiter in Medicare Fraud Scheme Sentenced to 3 Years

April 2, 2013

A patient recruiter for a Miami home health company was sentenced to three years in prison for a scheme in which he billed Medicare for unnecessary services in exchange for kickbacks, the Department of Justice announced Monday. The recruiter, Vladimir Jiminez, will also pay $950,000 in restitution, along with the other co-defendants in the case, which centered on a company called Serendipity. “From approximately January 2006 through March 2009, Serendipity submitted approximately $20 million in claims for home health services that were not medically necessary and/or not provided. Medicare actually paid approximately $14 million for these fraudulent claims.” (more…)

Feds Announce Record-Breaking Recoveries From Efforts to Combat Health Care Fraud

February 12, 2013

healthcare_fraud_imageWASHINGTON – Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius yesterday released a new report showing that for every dollar spent on health care-related fraud and abuse investigations in the last three years, the government recovered $7.90. This is the highest three-year average return on investment in the 16-year history of the Health Care Fraud and Abuse Program.

The government’s health care fraud prevention and enforcement efforts recovered a record $4.2 billion in taxpayer dollars in Fiscal Year (FY) 2012, up from nearly $4.1 billion in FY 2011, from individuals and companies who attempted to defraud federal health programs serving seniors and taxpayers or who sought payments to which they were not entitled. Over the last four years, the administration’s enforcement efforts have recovered $14.9 billion, up from $6.7 billion over the prior four-year period. Since 1997, the HCFAC Program has returned more than $23 billion to the Medicare Trust Funds. (more…)

AHCA Tries to Reassure Parents on Private Duty Nursing Care

February 7, 2013

By Mark Sherman, LRP Publications

Since September, Florida officials have been taking various steps in response to charges by the Justice Department that they are violating the ADA by letting certain children with disabilities live in nursing homes when they could be living at home.

The charges, In re: United States’ Investigation of the State of Florida’s Service System for Children with Disabilities Who Have Medically Complex Conditions, 112 LRP 44774 (DOJ 09/04/12), mirror the allegations in a federal class action lawsuit, T.H. et al. v. Dudek et al. (more…)