Archive

July 23, 2014

Elsa Ruiz, the owner and administrator of the Miami-based home health care agencies Professional Home Care Solutions and LTC Professional Consultants, pleaded guilty for her participation in a $74M Medicare fraud scheme. According to court documents, Ruiz and her co-conspirators operated the two companies for the purpose of billing Medicare for expensive physical therapy and home health care services that were either never provided or not medically necessary. DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud,

July 10, 2014

Four patient recruiters pleaded guilty in connection with a $20M health care fraud scheme involving the now defunct Miami-based home health care agency Trust Care Health Services. The defendants recruited patients for Trust Care and solicited and received kickbacks and bribes from the owners and operators of Trust Care in return for allowing the agency to bill the Medicare program on behalf of the recruited Medicare patients for home health care and therapy services that were not medically necessary and/or not provided. DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice,

June 23, 2014

Cruz Sonia Collado, the owner and operator of Nestor’s Health Services, a now-defunct Miami home health care agency, pleaded guilty to a $6.5M million health care fraud scheme. According to the government, Collado and her co-conspirators operated Nestor for the purpose of billing Medicare for expensive physical therapy and home health care services that were not medically necessary or never provided. As part of the scheme, Collado allegedly also paid kickbacks and bribes to patient recruiters, in return for those recruiters providing patients to Nestor for these unnecessary or phantom home health care and therapy services. DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud,

June 18, 2014

Lizette Garcia, a former office worker at Anna Nursing Services Corp., a now defunct Miami home health care company, pleaded guilty in connection with a $7M health care fraud scheme under which Anna Nursing paid kickbacks and bribes to patient recruiters in return for providing patients to Anna Nursing for home health care and therapy services that were medically unnecessary or never provided. DOJ

Tagged in: Healthcare Fraud, Home Health and Hospice,

May 22, 2014

Zahir Yousafzai, the co-owner or operator of four Detroit-area home health agencies involved in a $13.8M Medicare fraud scheme was sentenced to serve 72 months in prison and pay $4.1M in restitution. According to court records, Yousafzai and his co-conspirators paid and directed the payment of various medical professionals, including doctors, nurses, physical therapists and physical therapist assistants, to create fictitious patient files to document purported home health services that were never provided. The healthcare companies involved included First Care Home Health Care, Moonlite Home Care, Physicians Choice Home Health Care and Quantum Home Care. DOJ

Tagged in: Home Health and Hospice, Medical Billing Fraud,

May 14, 2014

Richard Shannon, a patient recruiter for All American and Patient Choice, two home health care companies that provide skilled nursing and physical therapy services to Medicare beneficiaries in the greater Detroit area, was sentenced to 86 months in prison for his role in a $14.5M Medicare fraud scheme. The evidence showed that Shannon paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary. Shannon recruited destitute beneficiaries from housing projects and soup kitchens in the Detroit area, obtaining their patient information in exchange for cash and promises of prescription narcotics prescribed by co-conspirator physicians. DOJ

Tagged in: Home Health and Hospice, Lack of Medical Necessity, Medical Billing Fraud, SNF,

April 30, 2014

A federal jury in Detroit convicted a physical therapist, physical therapy assistant and unlicensed doctor for their participation in a $15M Medicare fraud scheme at Detroit area companies Physicians Choice Home Health Care, Quantum Home Care, First Care Home Health Care, Moonlite Home Care and Phoenix Visiting Physicians. According to evidence presented at trial, these companies operated a fraudulent scheme to bill Medicare for home health care services that were never provided and paid kickbacks to recruiters who in turn paid Medicare beneficiaries cash and promised them access to narcotic prescriptions. DOJ

Tagged in: Home Health and Hospice, Improper Medical Personnel,

November 5, 2013

Hospice of the Comforter agreed to pay $3M 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 allegations were first raised in aqui tam lawsuit filed under the whistleblower provisions of the False Claims Act. DOJ

Tagged in: FCA Federal, Home Health and Hospice, Whistleblower Case,

August 24, 2015

The New York Attorney General announced a $6 million dollar settlement with Empire State Home Care Services, Inc. (Empire), a home care agency operating out of Brooklyn, NY. The settlement resolves claims that Empire improperly reported its home health aide hours as well as administrative and general expenses on cost reports filed between 2002 and 2005. These cost reports were used to set the reimbursement rates that Empire received from the state for the years 2004 through 2007 and resulted in over $3 million in reimbursements to which Empire was not entitled. NY

Tagged in: Government Investigation, Home Health and Hospice,

July 29, 2015

New York Attorney General Eric T. Schneiderman announced the sentencing of the executive director of a company for stealing funds from the Nursing Home Transition and Diversion program, a Medicaid-funded program that provides senior citizens and those suffering from physical disabilities an alternative to institutional living through the use of Medicaid funds for renovations to the homes of the elderly and disabled (wheelchair ramps, grab bars, etc.). Defendant plead guilty to grand larceny, based on the submission of bids and cost reports, which falsely stated the actual costs of the projects, significantly inflating the actual costs or including services which were never provided. NY

Tagged in: Home Health and Hospice, Medicaid,

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