Healthcare Fraud
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June 27, 2014
Euridice Borroto, a patient recruiter for a Miami home health care agency pleaded guilty today in connection with a health care fraud scheme involving defunct home health care company Nestor’s Health Services Inc. The owner and operator of Nestor pleaded guilty to charges related to the scheme earlier this month. According to court documents, Borroto solicited and received kickbacks and bribes from Nestor in return for recruiting and providing patients to Nestor for home health care and therapy services that were medically unnecessary or never provided. Borroto acknowledged her involvement in similar fraudulent schemes at other Miami health care agencies. DOJJune 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. DOJJune 20, 2014
Valnita Turner and Valdie Jackson, respective owners of the home health agencies Houston Compassionate Care and Jackson Home Healthcare, were sentenced for their roles in a $3M Medicare fraud scheme relating to the purchase of stolen patient information used to submit fraudulent claims to Medicare. Turner and Jackson also were charged with billing Medicare for medically unnecessary home health services never ordered by a doctor. Turner was sentenced to serve 151 months in prison and pay $3M in restitution. Jackson was sentenced to serve 12 months in prison and pay $1.5M in restitution. DOJJune 19, 2014
Michael Mendoza, president of patient recruiting firm Network Resource Consultant Inc., pleaded guilty for his role in a $205M Medicare fraud scheme. According to court documents, Mendoza made an agreement with Lawrence Duran, owner of American Therapeutic Corporation, a now defunct partial hospitalization program located in Miami, under which Mendoza would refer residents living in assisted living facilities to ATC for medically unnecessary services in exchange for illegal kickbacks. Duran previously pleaded guilty and was sentenced to serve 50 years in prison for his role in orchestrating the fraud scheme. DOJJune 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. DOJMay 22, 2014
An owner and operator of community mental health centers in Baton Rouge as well as a patient recruiter for a related facility in Houston were convicted for their roles in a $258M Medicare fraud scheme involving three facilities that filed fraudulent claims for psychiatric services that were unnecessary or never actually provided. The ongoing investigation into these three community mental health centers — Shifa Community Mental Health Center, Serenity Center and Shifa Community Mental Health Center — has so far resulted in the convictions of 17 employees of these facilities, including therapists, marketers, administrators, owners and the medical director. DOJTop-10 Prison Sentences For Medicare Fraud In 2015
Posted 01/5/16
By the C|C Whistleblower Lawyer Team
Here is our look-back at the top-10 prison sentences for Medicare fraud in 2015.
10. SYLVIA WALTER-EZE -- The former owner of medical equipment supply company Ezcor Medical Supply was sentenced to 97 months (and to pay roughly $2 million in restitution) for billing more than $3.5 million to Medicare and Medi-Cal for products not medically necessary and paying illegal...
December 18, 2015
Thirty-two hospitals in 15 states agreed to pay more than $28 million to settle charges they violated the False Claims Act by submitting false claims to Medicare for minimally-invasive kyphoplasty procedures used to treat certain spinal fractures often arising from osteoporosis. According to the government, the settling hospitals billed Medicare for these procedures on a more costly inpatient basis when they should have been billed on a less costly outpatient basis. The government has now reached settlements with more than 130 hospitals totaling approximately $105 million to resolve allegations of overcharging Medicare for kyphoplasty procedures. The 15 current settling hospitals include: The Cleveland Clinic (Ohio); Citrus Memorial Health System (Florida); Cullman Regional Medical Center (Alabama); Martin Memorial Medical Center (Florida); MultiCare Tacoma General Hospital (Washington); Norwalk Hospital (Connecticut); Princeton Community Hospital Association (West Virginia); Sacred Heart Medical Center (Washington); Sarasota Memorial Hospital (Florida); Spartanburg Regional Health Services District Inc. (South Carolina); St. Cloud Hospital (Minnesota); Tampa General Hospital (Florida); 5 hospitals affiliated with Community Health Systems Inc. (Tennessee); 5 hospitals affiliated with Tenet Health Care Corporation (Texas); 5 hospitals formerly owned and operated by Health Management Associates (Florida); 3 hospitals affiliated with BayCare Health System (Florida); and 2 hospitals affiliated with Banner Health (Arizona). In addition, the government previously settled with Medtronic Spine LLC, the corporate successor to Kyphon Inc., for $75 million to settle allegations the company caused false claims to be submitted to Medicare by counseling hospital providers to perform kyphoplasty procedures as inpatient rather than outpatient procedures. All but 3 of the current settlements originated in a whistleblower lawsuit filed by Craig Patrick, a former Kyphon reimbursement manager, and Charles Bates, a former Kyphon sales manager for Kyphon. They will receive a whistleblower award of roughly $4.75 million from the proceeds of the government’s recovery. DOJShould Britain’s National Health Service (NHS) Be Doing More to Counter Fraud?
Posted 10/1/15
By Richard Pike and Yulia Tosheva
As mentioned in one of our Whistleblower Insider daily updates, the accountants PKF Littlejohn got a lot of press coverage in the UK this week for a report suggesting that the NHS may be losing as much as £5.74 billion per year to fraud. Such a big number obviously provokes a reaction but what can we really conclude about fraud in the NHS and the measures taken to address...