Posts Tagged ‘Medicare Fraud Strike Force’

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

August 29, 2014

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

September 10, 2013

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

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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…)

Miami HHA Patient Recruiter Sentenced to 37 Months $20 Million Fraud Scheme

May 7, 2013

A patient recruiter for a Miami health care company was sentenced today to serve 37 months in prison for his participation in a $20 million Medicare fraud scheme. Manuel Lozano, 65, was sentenced to serve two years of supervised release and ordered to pay $1,851,000 in restitution, jointly and severally with co-conspirators.

In February 2013, Lozano pleaded guilty to one count of conspiracy to receive health care kickbacks. According to court documents, Lozano was a patient recruiter who worked for Serendipity Home Health, a Miami home health care agency that purported to provide home health and therapy services to Medicare beneficiaries. (more…)

Two Patient Recruiters of Miami HHA Plead Guilty in $20 Million Medicare Fraud Scheme

February 7, 2013

Two patient recruiters for a Miami home health care company have pleaded guilty for their participation in a $20 million home health Medicare fraud scheme. Manuel Lozano, 65, and Vladimir Jimenez, 43, pleaded guilty to one count each of conspiracy to receive health care kickbacks.

According to the court documents, both Lozano and Jimenez were patient recruiters who worked for Serendipity Home Health, a Miami home health care agency that claimed to provide home health and therapy services to Medicare beneficiaries. (more…)

Owners of Two Miami Home Care Agencies Plead Guilty in $48 Million Fraud Scheme

December 20, 2012

The owners and operators of two Miami health care agencies pleaded guilty today for their participation in a $48 million home health Medicare fraud scheme. Rogelio Rodriguez, 43, and Raymond Aday, 48, each pleaded guilty to one count of conspiracy to commit health care fraud.

According to court documents, Rodriguez was the owner of both Caring Nurse Home Health Corp. and Good Quality Home Health Inc., and Aday was a manager at Caring Nurse and owner of Good Quality. (more…)

Owner of Miami HHA Sentenced to 10 Years in Prison for $42 Million Fraud Scheme

October 16, 2012
The owner and operator of a Miami health care agency was sentenced this week to 120 months in prison for his participation in a $42 million home health Medicare fraud scheme.

Eulises Escalona, 44, of Monroe County, Fla., was sentenced to prison and ordered to pay $26.5 million in restitution. (more…)

Medicare Fraud Strike Force Charges 91 Individuals for $430 Million in False Billing

October 4, 2012

Indictments Include $230 Million in Home Health Fraud; Miami Agency Charged for Fraudulently Billing Medicare $74 Million

By publishing announcements about home health fraud, HCAF demonstrates its commitment to honest providers throughout the state by shining a spotlight on the dishonest providers, eager to provide hope and validation to the good and send a message to the bad actors that their days are numbered.

Medicare Fraud Strike Force operations in seven cities have led to charges against 91 individuals – including doctors, nurses and other licensed medical professionals – for their alleged participation in Medicare fraud schemes involving approximately $429.2 million in false billing, Attorney General Eric Holder and Health and Human Services (HHS) Secretary Kathleen Sebelius announced today.

“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal health care programs to steal billions in taxpayer dollars for personal gain,” said Attorney General Holder. “Such activities not only siphon precious taxpayer resources, drive up health care costs, and jeopardize the strength of the Medicare program – they also disproportionately victimize the most vulnerable members of society, including elderly, disabled and impoverished Americans.” (more…)

Owner of Miami Home Health Company Pleads Guilty in $60 Million Health Care Fraud Scheme

August 15, 2012

The owner of a Miami health care agency pleaded guilty this week for his participation in a $60 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services.

Rodolfo Nieto Jr., 40, of Miami, pleaded guilty before U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida to one count of conspiracy to defraud the United States and to receive health care kickbacks. (more…)

Miami Home Health Agency Owner Pleads Guilty in $42 Million Medicare Fraud Scheme

August 3, 2012

The owner and operator of a Miami health care agency pleaded guilty yesterday for his participation in a $42 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services.

Eulises Escalona, 43, pleaded guilty before U.S. District Judge Joan A. Lenard to one count of conspiracy to commit health care fraud. In addition, as part of his plea agreement, Escalona agreed to forfeit to the government two residential properties and cash proceeds of the fraud contained in several bank accounts.  (more…)