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September 27, 2018

Millicent Traylor, M.D., of Detroit, Michigan was sentenced to over 11 years in prison today for her part in a health care scheme against Medicare from 2011 to 2016. Traylor and her co-conspirators defrauded Medicare of an estimated $8.9 million during that period. They submitted fraudulent claims for home health care services and other services which were not provided or not medically necessary. At times, the physician services which were provided were provided by Dr. Traylor, though she was unlicensed during that period. Furthermore, evidence presented during the four-day trial showed that Traylor forged the signature of licensed physicians on prescriptions for opioid medications, oxycodone for instance, as a way to encourage patient participation in the scheme. Traylor’s three co-conspirators will also serve time in prison.  DOJ  

Tagged in: Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Lack of Medical Necessity, Medical Billing Fraud, Medicare,

September 25, 2018

Six individuals in the New Orleans area - four physicians, a medical biller, and a medical office manager - were sentenced after having been found guilty of conspiracy to commit health care fraud and to pay and receive unlawful kickbacks.   The defendants fraudulently billed Medicare for medically unnecessary home health services for patients who were not homebound and had no legitimate medical need for the services, creating false and fraudulent home health orders.   USAO E.D. La.

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

September 19, 2018

A physician and two clinic operators were convicted after trial for charges arising from a $17 million Medicare fraud scheme.  The doctor, John Ramirez, provided medical orders falsely certifying the need for home-health services, which the other defendants then sold to to home-health agencies in the Houston, Texas area.  These agencies then used the false and fraudulent paperwork signed by Ramirez to submit false claims to Medicare for medical services that were not medically necessary or not provided.  DOJ

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

August 10, 2018

An Illinois personal assistant, Betsy Gutowski, has pleaded guilty to filing fraudulent Medicaid reimbursement claims for work purportedly performed for a client under the Home Services Program, which is designed to keep clients out of nursing homes and in their own homes. At the time of the fraud, which spanned the year 2012, the client was in fact hospitalized or living in a nursing home, yet Gutowski billed for and received payments totaling $4,036.73. She now faces a possible maximum sentence of 10 years in prison and a $250,000 fine. USAO SDIL

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

July 31, 2018

Compassionate Home Care Services, Inc., its owner Carol Anders, and her son Ryan Santiago will pay a $3 million judgment for violating the federal and North Carolina False Claims Acts by filing reimbursement claims for services not rendered or rendered by unlicensed aides and family members. Anders and Santiago were also found to have falsified documents to conceal evidence of fraud upon being investigated by the government. USAO EDNC

Tagged in: FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medical Billing Fraud,

July 16, 2018

Healthquest, Inc. and its owners have settled FCA allegations for $1.5M. According to the government, the home health care company, paid kickbacks to marketers to induce patient referrals. The company has also entered into a 5 year corporate integrity arrangement. The allegations were first brought by a whistleblower, a former marketer, who will receive $300K. USAO Southern District of Florida

Tagged in: Anti-Kickback and Stark, FCA Federal, Healthcare Fraud, Home Health and Hospice, Whistleblower Case, Whistleblower Rewards,

July 2, 2018

Virginia in-home healthcare provider Hope In-Home Care, LLC, will pay $3.3 million to resolve allegations that it fraudulently billed Medicaid for a series of false statements and billing related to the provision of personal care services.  Specifically, the USAO and Virginia Attorney General alleged that Hope In-Home Care billed for services that it did not perform and for services provided by uncertified personal care aides, and it falsified records to conceal these frauds.  USAO EDVA

Tagged in: Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medical Billing Fraud,

June 25, 2018

Caris Healthcare, L.P. agreed to pay $8.5 million to settle a False Claims Act lawsuit regarding improper billing for ineligible hospice patients. Caris was accused of admitting patients into hospice care that did not have medical records supporting a terminal diagnosis. Caris also allegedly recertified previous false submissions for payment related to hospice care. The case was filed in the United States District Court for the Eastern District of Tennessee by qui tam whistleblower Barbara Hinkle, a registered nurse who previously worked for Caris. As a result of the settlement, Hinkle will receive $1,402,500 as a relator’s share. DOJ

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

June 22, 2018

Dr. Kelly Robinett and Kingsley Nwanguma were each convicted of multiple counts of conspiracy to commit health care fraud and health care fraud. Joy Ogwuegbu was also convicted of four counts of health care fraud. The conviction were related to a scheme by the three to overbill Medicare for medically unnecessary home health services that in many cases were not provided. The scheme billed Medicare $11.3 million for home health care services pursuant to certifications signed by Robinett and approximately $1 million related to medically unnecessary home health services. Sentencing has not yet been scheduled. DOJ

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

June 25, 2018

New York announced registered nurse Collins Anyanwu-Mueller has been sentenced to a year in prison for stealing over $390,000 from Medicaid. A MFCU investigation uncovered that Anyanwu-Mueller submitted false Medicaid claims for private duty nursing services that he never provided to two severely disabled Medicaid recipients. Both Medicaid recipients required around-the-clock care. Prior to sentencing, Anyanwu-Mueller paid the State of New York $25,000 and has agreed to pay the remaining $367,954 in restitution owed. NY

Tagged in: FCA State, Home Health and Hospice, Medicaid, Medical Billing Fraud,

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