Florida Owner of Home Health Care Company Sentenced to Nearly Six Years in Prison for Role in $6 Million Medicare Fraud Scheme

HCAF strongly condemns healthcare fraud and supports the removal of bad actors from the home health industry.

A co-owner of Professional Medical Home Health LLC was sentenced today to serve 70 months in prison and ordered to pay $6.2 million in restitution for her participation in a health care fraud scheme involving the now defunct home health care company .

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office, and Acting Special Agent in Charge Reginald France of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office made the announcement. U.S. District Judge Federico A. Moreno of the Southern District of Florida imposed the sentence.

According to court documents, Annarella Garcia, 44, of Hialeah, Florida, was a co-owner of Professional Medical Home Health, a Miami home health care agency that purported to provide home health and therapy services to Medicare beneficiaries. Between December 2008 and February 2014, Garcia and others engaged in a scheme to bill the Medicare Program for expensive physical therapy and home health care services that were not medically necessary or were not provided. During that time, Professional Medical Home Health was paid approximately $6.25 million by Medicare for the fraudulent claims.

Specifically, Garcia and her co-conspirators paid kickbacks and bribes to patient recruiters in return for their providing patients to Professional Medical Home Health for home health and therapy services that were not medically necessary or were not provided. In furtherance of the scheme, Garcia and her co-conspirators falsified patient documentation to make it appear that beneficiaries qualified for and received home health care services, when, in fact, many of the beneficiaries did not actually qualify for such services and did not receive such services.

Garcia pleaded guilty to conspiracy to commit health care fraud on June 25, 2014.

The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the 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 Trial Attorneys A. Brendan Stewart and Anne P. McNamara of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 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 to: www.stopmedicarefraud.gov .

Source: OIG

Owner and Administrator of Miami Home Health Companies Pleads Guilty for Role in $74 Million Health Care Fraud Scheme

HCAF strongly condemns healthcare fraud and supports the removal of bad actors from the home health industry.

A Miami resident who owned a home health care company and was the administrator of another home health care company pleaded guilty today for her participation in a $74 million Medicare fraud scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Acting Special Agent in Charge Ryan Lynch of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office made the announcement.

Elsa Ruiz, 45, pleaded guilty today before U.S. District Judge Marcia G. Cooke in the Southern District of Florida to one count of conspiracy to commit health care fraud. Her sentencing is scheduled for Oct. 8, 2014.

According to court documents, Ruiz was an owner of Professional Home Care Solutions Inc. (Professional Home Care) and an administrator of LTC Professional Consultants Inc. (LTC), Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. Ruiz and her co-conspirators operated LTC and Professional Home Care for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

Also according to court documents, Ruiz ran and oversaw the schemes operating out of LTC and Professional Home Care. Ruiz and co-conspirators paid kickbacks and bribes to patient recruiters, who provided patients to LTC and Professional Home Care , as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Ruiz and her co-conspirators used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for unnecessary home health care and therapy services.

From approximately January 2006 to June 2012, LTC and Professional Home Care submitted approximately $74 million in claims for home health care services that were not medically necessary and/or not provided, and Medicare paid approximately $45 million on those claims.

Source: OIG

Office Worker Pleads Guilty in Miami to Role in $7 Million Health Care Fraud Scheme

HCAF strongly condemns healthcare fraud and supports the removal of bad actors from the home health industry.

An office worker pleaded guilty today in connection with a health care fraud scheme involving Anna Nursing Services Corp. (Anna Nursing), a defunct home health care company.

Lizette Garcia, 37, of Miami, Florida, pleaded guilty before U.S. District Judge Joan A. Lenard in the Southern District of Florida to one count of payment of health care kickbacks. Sentencing is scheduled for August 27, 2014.

Garcia was an office worker at Anna Nursing, a Miami home health care agency that purported to provide home health and therapy services to Medicare beneficiaries. According to court documents, Anna Nursing was operated for the purpose of billing the Medicare Program for, among other things, expensive physical therapy and home health care services that were medically unnecessary and/or were not provided.

On behalf of the owners and operators of Anna Nursing, Garcia paid kickbacks and bribes to patient recruiters in return for the recruiters providing patients to Anna Nursing for home health care and therapy services that were medically unnecessary and/or were not provided. Anna Nursing then billed the Medicare program on behalf of the recruited patients, which Garcia knew was in violation of federal criminal laws.

From approximately October 2010 through approximately April 2013, Anna Nursing was paid by Medicare approximately $7 million for fraudulent claims for home health care services that were medically unnecessary and/or were not provided.

The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the 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 Trial Attorneys A. Brendan Stewart and Anne McNamara of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,900 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, has removed over 17,000 providers from the Medicare program since 2011.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: http://www.stopmedicarefraud.gov.

Ten Floridians Indicted in Medicare Home Health Fraud Scheme

HCAF strongly condemns healthcare fraud and supports the removal of bad actors from the home health industry.

Nine residents of Miami-Dade County and a resident of Hillsborough County have been indicted for their alleged participation in a $12.5 million Medicare fraud scheme.

On March 20, 2014, a federal grand jury in Miami returned a 59-count indictment charging Vicente Diaz, 39, Daniel Ocampo, 35, Elsa Capo, 71, Santiago Sepulveda, 79, Marta Curbeco, 67, Margarita Rodriguez, 72, Francisco Maysonet, 67, Pedro Peralta, 69, Amira Galan, 79, and Ana Rosa Santana, 77, for allegedly participating in a scheme to defraud Medicare by submitting false and fraudulent claims, and the payment and receipt of kickbacks in connection with a federal health care program, from approximately November 2011 to October 2013.

The allegations center on the operation of Marcialed and Sacred Health, two companies located in Miami-Dade County which were purportedly in the business of providing home health care to Medicare beneficiaries.

According to the indictment, Diaz controlled Marcialed and Sacred Health. Ocampo was for a time an officer of Sacred Health. Diaz and Ocampo offered and paid kickbacks and bribes to patient recruiters in return for referring beneficiaries to serve as patients so that Marcialed and Sacred could bill Medicare for home health services that were not medically necessary and were not provided. Curbeco, Rodriguez and Peralta solicited and accepted kickbacks and bribes in exchange for referring beneficiaries to serve as patients of Marcialed and Sacred Health. Capo, Sepulveda, Curbeco, Rodriguez, Maysonet, Peralta, Galan, and Santana are Medicare beneficiaries who solicited and accepted kickbacks in return for agreeing to serve as patients of Maricaled and Sacred Health so that the companies could bill Medicare for home health services that were not medically necessary and were not provided.

The indictment alleges that the defendants falsified, and caused to be falsified, records to document the receipt of home health services from Marcialed and Sacred Health that were not provided and were not medically necessary. Diaz and Ocampo violated Medicare rules and regulations by offering and paying kickbacks and bribes to patient recruiters in exchange for the referral of beneficiaries to Marcialed and Sacred Health. Diaz and Ocampo then caused Marcialed and Sacred Health to submit false and fraudulent claims seeking payment from Medicare for the home health services which had purportedly been provided to beneficiaries, when in truth the services had not been provided and were not medically necessary. The indictment alleges that as a result of the fraudulent claims, Diaz and Ocampo caused Medicare to pay approximately $7,809,243 to Marcialed and $4,694,834 to Sacred Health.

The indictment alleges that Diaz, Ocampo and other conspirators used the money fraudulently obtained from Medicare for their personal use and to further the fraud. The indictment seeks forfeiture of two properties and four Mercedes vehicles.

Mr. Ferrer commended the investigative efforts of U.S. Postal Inspection Service, HHS-OIG, and the FBI and was brought as part of the Medicare Fraud Strike Force. This case is being prosecuted by Assistant U.S. Attorney Eric E. Morales.

An indictment is only an accusation, and a defendant is presumed innocent unless and until proven guilty.

Medical Clinic Owner and Other Patient Recruiters Sentenced for Roles in $8 Million Health Care Fraud Scheme

HCAF strongly condemns healthcare fraud and supports the removal of bad actors from the home health industry.

Several patient recruiters, including a medical clinic owner, were sentenced today for their participation in a health care fraud scheme involving Flores Home Health Care Inc., a defunct home health care company.

Lerida Labrada, 59; Mayra Flores, 49; and German Martinez, 36, all of Miami, were sentenced by U.S. District Judge Ursula Ungaro of the Southern District of Florida to serve 37 months, 24 months, and 24 months in prison, respectively.   In addition to their prison terms, all of the defendants were sentenced to three years of supervised release and ordered to pay between $200,000 and $400,000 in restitution.

On Jan. 7, 2014, Labrada pleaded guilty to conspiracy to commit health care fraud, and Flores and Martinez pleaded guilty to conspiracy to defraud the United States and receive health care kickbacks.

According to court documents, the defendants worked as patient recruiters for the owners and operators of Flores Home Health, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries.   Labrada also owned and operated a Miami medical clinic that provided fraudulent prescriptions to patient recruiters and to the owners and operators of Flores Home Health.

The defendants would recruit patients for Flores Home Health and would solicit and receive kickbacks and bribes from the owners and operators of Flores Home Health in return for allowing the company to bill the Medicare program on behalf of the recruited Medicare patients.   These Medicare beneficiaries were billed for home health care and therapy services that were not medically necessary and/or were not provided.

From approximately October 2009 through approximately June 2012, Flores Home Health was paid approximately $8 million by Medicare for fraudulent claims for home health services.

The case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the 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 Trial Attorney A. Brendan Stewart of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion.   In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Source: OIG

Two Patient Recruiters for Miami Home Health Companies Sentenced for Roles in $48 Million Health Care Fraud Scheme

Two patient recruiters for Miami health care companies were sentenced today for their participation in a $48 million home health Medicare fraud scheme.

Elizabeth Monteagudo, 33, of Miami, was sentenced to serve 70 months in prison, followed by three years of supervised release, and ordered to pay $3.5 million in restitution jointly and severally with co-defendants.   Cristobal Gonzalez, 39, of Miami, was sentenced to serve 46 months in prison, followed by two years of supervised release, and ordered to pay $2 million in restitution jointly and severally with co-defendants.

In September 2013, Monteagudo and Gonzalez each pleaded guilty to one count of conspiring to receive health care kickbacks.  Monteagudo also pleaded guilty to receiving kickbacks in connection with a federal health care program.

According to court documents, Monteagudo and Gonzalez were patient recruiters who worked for Caring Nurse Home Health Care Corp., and Gonzalez also worked for Good Quality Home Health Care Inc. Caring Nurse and Good Quality were Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries.

According to court documents, from approximately January 2009 through approximately June 2011, Monteagudo and Gonzalez would recruit patients for Caring Nurse and/or Good Quality and would solicit and receive kickbacks and bribes from the owners and operators of Caring Nurse and/or Good Quality in return for allowing the agency to bill the Medicare program on behalf of the recruited patients.  These Medicare beneficiaries were billed for home health care and therapy services that were medically unnecessary and/or not provided.

Monteagudo also admitted to her involvement with $7 million in fraudulent billings for Starlite Home Health Agency Inc., which she owned and operated.

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 serve 108 and 51 months in prison, respectively. Their sentencings followed their December 2012 guilty pleas each to one count of conspiring to commit health care fraud charged in an October 2012 indictment.   According to that indictment, 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 actually paid approximately $33 million for these 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 1,700 defendants who collectively have falsely billed the Medicare program for more than $5.5 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 to:www.stopmedicarefraud.gov .

Orlando, Fla., Area Hospice to Pay $3 Million to Resolve Allegations That It Billed Medicare for Patients Not Terminally Ill

Hospice of the Comforter Inc. (HOTCI) has agreed to pay $3 million to resolve allegations that it violated the False Claims Act by submitting false claims to the Medicare program for hospice services provided to patients who were not eligible for the Medicare hospice benefit, the Justice Department announced today.  HOTCI is headquartered in Altamonte Springs, Fla., and provides hospice services to patients residing in Seminole, Osceola and Orange counties in Florida.

 

“This settlement is a result of the Justice Department’s continuing efforts to prevent the abuse of the taxpayer-funded Medicare hospice program, which is intended to provide comfort and care to terminally ill persons during the last six months of their lives,” said Assistant Attorney General for the Civil Division Stuart F. Delery.  “We will pursue those who seek to misuse this important benefit for their own enrichment.”

 

The government alleged that between December 2005 and December 2010, HOTCI engaged in practices that resulted in billing Medicare for patients who were not terminally ill.  Specifically, HOTCI allegedly directed its staff to admit all referred patients without regard to whether they were eligible for the Medicare hospice benefit, falsified medical records to make it appear that certain patients were eligible for the benefit when they were not, employed field nurses without hospice training, established procedures to limit physicians’ roles in assessing patients’ terminal status and delayed discharging patients when they became ineligible for the benefit. 

 

As part of this settlement, HOTCI has agreed to enter into a Corporate Integrity Agreement with the Inspector General of the Department of Health and Human Services that provides for procedures and reviews to be put in place to promptly detect and prevent future conduct similar to that which gave rise to the settlement.  In addition, HOTCI’s former Chief Executive Officer Robert Wilson has agreed to a three-year, voluntary exclusion from Medicare, Medicaid and other federal health care programs.

 

“This settlement represents a fair and appropriate resolution of this troubling matter,” said Acting U.S. Attorney for the Middle District of Florida A. Lee Bentley III.  “Hospice providers in our district should be on notice that our office will do what it takes to protect our citizens from this kind of misconduct.”

 

“Hospice care is a sacred trust from which no provider should fraudulently profit,” said Inspector General of the U.S. Department of Health and Human Services Daniel R. Levinson.  “Claiming tax dollars for people who are not terminally ill ?? and therefore ineligible for hospice care ?? cannot be tolerated.”

 

This settlement illustrates the government’s emphasis on combating health care fraud and marks another achievement for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced in May 2009 by Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius.  The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation.  One of the most powerful tools in this effort is the False Claims Act.  Since January 2009, the Justice Department has recovered a total of more than $16.7 billion through False Claims Act cases, with more than $11.9 billion of that amount recovered in cases involving fraud against federal health care programs.

 

The allegations settled today arose from a lawsuit filed by a former HOTCI employee, Douglas Stone, under the qui tam, or whistleblower, provisions of the False Claims Act.  Under the act, private citizens can bring suit on behalf of the government for false claims and share in any recovery.  Stone’s share of the recovery has not been determined.

Source: OIG

Owner Of Home Health Care Company Sentenced To 10 Years In Federal Prison For Role In Health Care Fraud Conspiracy

Defendant Also Ordered to Pay More Than $25 Million in Restitution

Cyprian Akamnonu, 64, of Cedar Hill, Texas, was sentenced this morning by U.S. District Judge Sam A. Lindsay to the statutory maximum of 10 years in federal prison and ordered to pay $25,466,779 in restitution, following his guilty plea in October 2012 to one count of conspiracy to commit health care fraud.  Today’s announcement was made by U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.

In handing down the sentence and in response to a plea for leniency, Judge Lindsay stated, “For persons out there who are inclined to commit health care fraud, a low sentence in this case would have no deterrent effect.”  Judge Lindsay also ordered that Akamnonu, who is in custody, forfeit the following property to the government:  four vehicles, 21 parcels of real estate located in Dallas, Cedar Hill and Grand Prairie, Texas and funds in several business and personal bank accounts.

According to documents filed in the case, Akamnonu and his wife/business partner/co-defendant, Patricia Akamnonu, R.N., co-owned Ultimate Care Home Health Services.  Akamnonu admits that from January 2006 through November 2011, he conspired with co-defendants Dr. Jacques Roy and others to defraud Medicare in connection with the delivery of, and payment for, health care benefits, items and services.

A trial date of January 13, 2014, is set for Akamnonu’s co-defendants, Dr. Roy, Patricia Akamnonu, Cynthia Stiger, Wilbert James Veasey, Teri Sivils and Charity Eleda.

According to documents filed in the case, at Akamnonu’s direction, his wife Patricia, and others, recruited Medicare beneficiaries to Ultimate to receive home health care services for which they did not qualify and did not need.   Akamnonu and others would approach people throughout Dallas-area neighborhoods to see if they were qualified Medicare beneficiaries, and if they were, they would attempt to sign them up for home health services.

Once a beneficiary was recruited, Akamnonu would take paperwork to Sivils and other employees of Medistat Group Associates, PA., to be signed on behalf of Dr. Roy, certifying that the Medicare beneficiary was under Dr. Roy’s care, homebound and in need of skilled nursing services, thus allowing Ultimate to bill Medicare for the skilled nursing services.  Akamnonu and Dr. Roy had an agreed-upon, fraudulent arrangement in which Ultimate provided Dr. Roy with the beneficiaries to bolster Medistat’s patient roster in exchange for Roy’s certification for skilled nursing services of any beneficiary sent to him.  In addition, Sivils signed Ultimate’s paperwork on behalf of Dr. Roy because Akamnonu paid her cash kickbacks in exchange for doing so.

At Akamnonu’s direction, nurses would perform cursory visits to the beneficiaries at their homes that bore little relationship to the skilled nursing services for which the beneficiaries had been certified.  Then, at Akamnonu’s direction, Ultimate would bill Medicare for skilled nursing services that were not necessary and were never in fact provided.

During this five-year period, more than 72% of Ultimate’s beneficiaries were certified by Dr. Roy or another Medistat physician acting at his direction.  Ultimate billed more than $40 million to Medicare for skilled nursing services for these beneficiaries and Dr. Roy, in turn, incorporated these patients into his own practice and billed more than $2.3 million for services related to them.

The case is being investigated by the FBI, the U.S. Department of Health and Human Services – Office of Inspector General (HHS-OIG) and the Texas Attorney General’s Medicaid Fraud Control Unit and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division Fraud Section and the U.S. Attorney’s Office for the Northern District of Texas.

Assistant U.S. Attorneys Michael C. Elliott, Mindy Sauter, P. J. Meitl and John DeLaGarza are in charge of the prosecution.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the HEAT Strike Force, please visit:   www.stopmedicarefraud.gov.

Source: OIG

Five More Plead Guilty in Miami to 48 and 20 Million Dollar Medicare Fraud Schemes

The owners and operators of several Miami home health care agencies as well as three patient recruiters pleaded guilty this week in connection with health care fraud schemes involving three home health care companies.

Roberto Marrero, 60, Sandra Fernandez Viera, 49, Enrique Rodriguez, 59, Elizabeth Monteagudo, 33, and Cristobal Gonzalez, 39, all of Miami, pleaded guilty before U.S. Magistrate Judges in the Southern District of Florida to conspiracy to commit health care fraud and conspiracy to receive and pay health care kickbacks. Monteagudo also pleaded guilty to receipt of kickbacks in connection with a federal health care program.

Marrero and Fernandez Viera were owners and operators of Trust Care, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. Rodriguez worked as a patient recruiter on behalf of Trust Care and Marrero and Fernandez Viera.

According to court documents, Marrero and Fernandez Viera operated Trust Care for the purpose of billing the Medicare Program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

Marrero largely controlled Trust Care and, in light of that role, oversaw the schemes operating out of the company. Fernandez Viera’s primary role, among others, involved managing and supervising personnel at Trust Care. Both Marrero and Fernandez Viera were responsible for negotiating and paying kickbacks and bribes, interacting with patient recruiters, and coordinating and overseeing the submission of fraudulent claims submitted to the Medicare program.

Marrero, Fernandez Viera and their co-conspirators paid kickbacks and bribes to patient recruiters, including Rodriguez, in return for the recruiters providing patients to Trust Care for home health and therapy services that were medically unnecessary and/or not provided. Marrero, Fernandez Viera and their co-conspirators at Trust Care also 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. Marrero, Fernandez Viera and their co-conspirators used these prescriptions, medical certifications and other documentation to fraudulently bill the Medicare program for home health care services, which Marrero and Fernandez Viera knew was in violation of federal criminal laws.

Rodriguez offered and paid kickbacks and bribes to Medicare beneficiaries in return for those beneficiaries allowing Trust Care to bill Medicare for services that were medically unnecessary and/or not provided. Rodriguez solicited and received kickbacks and bribes from the owners and operators of Trust Care, including Marrero and Fernandez Viera, in return for his patient recruiting. Rodriguez knew that in many instances the patients he recruited for Trust Care did not qualify for the services billed to Medicare.

From approximately March 2007 through at least October 2010, Trust Care submitted more than $20 million in claims for home health services. Medicare paid Trust Care more than $15 million for these fraudulent claims.

Marrero, Fernandez Viera and Rodriguez also acknowledged their involvement in similar fraudulent schemes at several other Miami health care agencies in addition to Trust Care with estimated total losses of approximately $50 million, including Global Nursing Home Health Inc., Lovable Home Health Services Corp., New Concepts In Health Inc., Ubieta Health System Inc., R&M Health Care Inc., Vital Care Home Health Services Inc., Centrum Home Health Care Inc. and A&B Health Services Inc.

At sentencing, scheduled for Nov. 12, 2013, the defendants face a maximum penalty of 10 years in prison for conspiracy to commit health care fraud and five years in prison for conspiracy to receive and pay health care kickbacks.

Monteagudo and Gonzalez were patient recruiters who worked for Caring Nurse Home Health Care Corp., and Gonzalez also worked for Good Quality Home Health Care, Inc. Caring Nurse and Good Quality were Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. 

According to court documents, from approximately January 2009 through approximately June 2011, Monteagudo and Gonzalez would recruit patients for Caring Nurse and/or Good Quality and would solicit and receive kickbacks and bribes from the owners and operators of Caring Nurse and/or Good Quality in return for allowing the agency to bill the Medicare program on behalf of the recruited patients.  These Medicare beneficiaries were billed for home health care and therapy services that were medically unnecessary and/or not provided.

Monteagudo also admitted to her involvement with $7 million in fraudulent billings for Starlite Home Health Agency Inc., which she owned and operated. 

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 serve 108 and 51 months in prison, respectively.  Their sentencings followed their December 2012 guilty pleas each to one count of conspiracy to commit health care fraud charged in an October 2012 indictment, which charged 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 actually paid approximately $33 million for these fraudulent claims. 

Both cases were investigated by the FBI and HHS-OIG and were 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.

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.

HCAF strongly condemns these individuals and supports the removal of bad actors from the home health industry.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: http://www.stopmedicarefraud.gov.

Miami Home Health Patient Recruiter and Therapy Staffing Company Owner Plead Guilty in $7 Million Health Care Fraud Scheme

A patient recruiter and a therapy staffing company owner pleaded guilty today in connection with a $7 million health care fraud scheme involving the now defunct home health care company Anna Nursing Services Corp.

Ivan Alejo, 48, and Hugo Morales, 36, pleaded guilty before U.S. District Judge Jose E. Martinez in the Southern District of Florida to one count of conspiracy to commit health care fraud.  At sentencing, scheduled for Nov. 5, 2013, Alejo and Morales each face a maximum penalty of 10 years in prison.

Alejo worked as a patient recruiter at Anna Nursing, a home health care agency in Miami Springs, Fla., that purported to provide home health and therapy services to Medicare beneficiaries but in reality billed Medicare for expensive physical therapy and home health care services that were not medically necessary and/or were not provided.  Morales owned Professionals Therapy Staffing Services Inc., which provided therapists to Anna Nursing.

Alejo and his co-conspirators negotiated and paid kickbacks and bribes to patient recruiters in return for the recruiters providing patients to Anna Nursing for home health and therapy services that were medically unnecessary and/or not provided.  He and others also 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.  Alejo and his co-conspirators would use the prescriptions, medical certifications and other documentation to fraudulently bill the Medicare program for home health care services.

Morales and others created fictitious progress notes and other patient files indicating that therapists from Professionals Therapy had provided physical or occupational therapy services to particular Medicare beneficiaries, when in many instances those services had not been provided and/or were not medically necessary.  Morales knew the falsified documents were used to support false claims for home health care services billed to Medicare by his co-conspirators at Anna Nursing.

From approximately October 2010 through approximately April 2013, Anna Nursing was paid by Medicare approximately $7 million for fraudulent claims for home health care services that were not medically necessary and/or not provided.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,500 defendants who have collectively billed the Medicare program for more than $5 billion.  In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

HCAF supports the Office of Inspector General and the Department of Justice in eliminating fraud in the home health industry. Removing these bad actors is paramount to protecting home health’s status as an upstanding player in the healthcare arena.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to:www.stopmedicarefraud.gov.