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Healthcare Fraud

This archive displays posts tagged as relevant to healthcare fraud.

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December 17, 2014

Mark Morad and Dr. Divini Luccioni, both of Louisiana, pleaded guilty to their role in a $56M Medicare fraud scheme. According to court documents, Morad directed the scheme through multiple New Orleans-area companies he owned, including Interlink Health Care Services Inc.,Memorial Home Health Inc., Lakeland Health Care Services Inc., Lexmark Health Care LLC, and Med Rite Pharmacy Inc. Morad paid kickbacks to recruiters who canvassed New Orleans neighborhoods for Medicare beneficiary numbers, which Morad then used to bill Medicare for services that were not medically necessary or not provided. Dr. Luccioni admitted that he signed home health referrals and wrote DME prescriptions that were used to support these fraudulent billings. DOJ

December 2, 2014

Luis Duluc, a Florida owner and operator of multiple physical therapy rehabilitation facilities, was sentenced to serve 11 years in prison for his role in organizing a $28.3M Medicare fraud scheme involving physical and occupational therapy services. Duluc was chairman and president of a Delaware holding company known as Ulysses Acquisitions Inc. which was used to purchase comprehensive outpatient rehabilitation facilities and outpatient physical therapy providers, including West Coast Rehab Inc. in Fort Myers, Florida; Rehab Dynamics Inc. in Venice, Florida;Polk Rehabilitation Inc. in Lake Wales, Florida; and Renew Therapy Centerof Port St. Lucie LLC in Port St. Lucie, Florida. Duluc admitted that he and his co-conspirators paid kickbacks to obtain, and stole, the personal identifying information of Medicare beneficiaries and used this information to create and submit false claims to Medicare through the clinics owned by Ulysses Acquisitions. DOJ

November 13, 2014

Ramon Regueira, owner of Miami home health care company Nation’s Best Care Home Health Corp., pleaded guilty for his role in a $30M home health Medicare fraud scheme. Regueira admitted that he and his co-conspirators operated Nation’s Best for the purpose of billing the Medicare program for expensive physical therapy and home health care services not medically necessary or provided. Specifically, Regueira admitted he and his co-conspirators paid kickbacks and bribes to patient recruiters who provided patients to Nation’s Best, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services. From January 2007 through November 2012, Nation’s Best submitted approximately $35M in false claims and Medicare paid approximately $21M for these fraudulent claims. DOJ

October 22, 2014

Tayyab Aziz, founder of three Detroit-area home health agencies Prestige Home Health Services Inc., Royal Home Health Care Inc., and Platinum Home Health Services Inc. pleaded guilty for his role in a $22M home health care fraud scheme. Specifically, Aziz admitted he and his co-conspirators submitted fraudulent claims to Medicare for services that were medically unnecessary or never performed. They also submitted claims for services purportedly provided to Medicare beneficiaries who were recruited through illegal kickbacks paid to the patients and recruiters. DOJ

October 20, 2014

A federal jury in Houston convicted Earnest Gibson III, the president of Riverside General Hospital, his son, and two others for their participation in a $158M Medicare fraud scheme involving false claims for mental health treatment. Ten defendants have now been convicted in connection with the Riverside fraud scheme. DOJ

October 10, 2014

Extendicare Health Services Inc., an operator of a chain of skilled nursing facilities, and its subsidiary Progressive Step Corporation (ProStep), agreed to pay $38 million that Extendicare billed Medicare and Medicaid for materially substandard nursing services that were so deficient they were effectively worthless and billed Medicare for medically unreasonable and unnecessary rehabilitation therapy services. It is the largest failure of care settlement with a chain-wide skilled nursing facility in the Justice Department’s history. The government’s charges originated from two whistleblower lawsuits filed by Tracy Lovvron and Donald Gallick under the qui tam provisions of the False Claim Act. They will receive whistleblower awards of more than $1.8 million and $250,000, respectively. DOJ

October 8, 2014

Usman Butt, a former owner and manager of two Detroit-area home health care agencies, Home Health Services Inc. and Royal Home Health Care Inc., pleaded guilty for his role in a $22 million Medicare fraud conspiracy. Specifically, Butt admitted that beginning in 2008 and continuing through January 2013, he conspired with others to bill Medicare for home health care services that were not actually rendered, not medically necessary, and procured through paying illegal kickbacks. He also admitted that he fabricated patient files to give the false appearance that the services were medically necessary and actually provided. DOJ

September 26, 2014

Detroit-area physician Dr. Vicha Janviriya pleaded guilty for making fraudulent referrals for home health care in a $1.3 million Medicare fraud scheme. He admitted that he falsified medical documentation which would be used to support false claims to Medicare for services that were never rendered or not medically necessary, or where the Medicare beneficiary referrals were obtained through the payment of kickbacks. DOJ

September 18, 2014

Three patient recruiters were sentenced to prison for their participation in a $20 million health care fraud scheme involving defunct home health care company Trust Care Health Services. Estrella Perez was sentenced to 37 months and ordered to pay $1.2 million; Solchys Perez was sentenced to 30 months and ordered to pay $746,000; and Abigail Aguila was sentenced to 30 months and ordered to pay $491,000. According to court documents, Estrella Perez, Solchys Perez, and Aguila recruited patients for Trust Care, a Miami home health care agency, in exchange for kickbacks paid in cash or by check to the defendants or their shell companies. In turn, Trust Care billed the Medicare program for home health care and therapy services that were not medically necessary or were not provided. DOJ

September 15, 2014

Episcopal Ministries to the Aging, a Maryland not-for-profit corporation that owns skilled nursing facilities, agreed to pay $1.3 million for submitting false claims to Medicare for unreasonable or unnecessary rehabilitation therapy purportedly provided by RehabCare Group East Inc., a subsidiary of Kindred Healthcare Inc. DOJ
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