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Home Health and Hospice

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May 4, 2021

After being convicted of running a $11 million healthcare fraud scheme, Brenda Rodriguez, the owner and operator of Texas-based QC Medical Clinic, has been ordered to spend 25 years in prison, followed by 3 years of supervised release.  As shown by evidence presented at trial, Rodriguez’s scheme involved paying doctors to approve Medicare beneficiaries for home health services, selling the approvals to various home health providers, and causing the providers to bill Medicare for services that were medically unnecessary, never provided, and/or arose from illegal inducements.  USAO SDTX

Catch of the Week: Final Merida Hospice Fraudster Sentenced in $150 Million Scheme

Posted  04/23/21
Hands in handcuffs behind back of white man in business suit
Jose Garza, the former operations manager of Merida Group, a Texas-based hospice, and home health chain, just landed a 27-month prison sentence for his role in a $150 million hospice fraud scheme. Garza is the latest to receive a sentence in connection with the decade-long Merida Group scheme, which saw people with long-term illnesses falsely told they would die soon, while executives at the company pocketed millions...

Disturbing New Evidence Suggests Fraud Underlies Five-Star Ratings for Some Nursing Homes

Posted  03/19/21
By Jessica T. Moore
Nurse helping elder man walking in rehab facility
Twelve years after the implementation of the nursing-home star-ratings system, a disturbing New York Times exposé and a lawsuit by California against Brookdale Senior Living reveals how the ratings are manipulated to the detriment of families in their time of crisis.  The NYT’s investigation and California’s allegations in combination paint the troubling picture of profits tied to higher star ratings, and...

DOJ Previews False Claims Act Enforcement Priorities for 2021

Posted  03/5/21
Department of Justice Seal on the United States Flag
The False Claims Act is the federal government's primary enforcement tool to combat fraud against the public.  Every year the government recovers billions of dollars under the statute, primarily with the help of whistleblowers.  Under the so-called qui tam provisions of the act, whistleblowers are authorized to act as private attorneys general and bring lawsuits on behalf of the government and recover a portion of...

February 19, 2021

Antonio Olivera, a hospice administrator in Southern California, has been sentenced to 2.5 years in prison and ordered to pay nearly $2.2 million in restitution for his role in a multimillion dollar fraud scheme that ran from 2011 to 2018.  Together with three co-conspirators, Olivera paid illegal kickbacks to patient recruiters for referrals of Medicare beneficiaries to the hospice, Mhiramarc Management LLC.  When Mhiramarc staffers realized the referrals did not qualify for hospice, Olivera overruled them and caused the referrals to be put on hospice, ultimately causing Medicare to pay over $17 million in false claims.  DOJ

February 3, 2021

The former CEO of Texas hospice and home health chain the Merida Group, Henry McInnis, has been sentenced to 15 years in prison following his conviction for healthcare fraud and alleged charges.  McInnis and his co-conspirator Rondey Mesquias, who was previously sentenced to 20 years in prison, submitted over $150 million in fraudulent Medicare bills between 2009 and 2018 by falsifying medical records and telling thousands of patients with long-term incurable diseases they had less than six months to live in order to enroll the patients in hospice programs for which they were otherwise unqualified.  In addition, McInnis directed Merida’s practice of paying physicians bogus “medical director” fees in exchange for those doctors falsely certifying unqualified patients for hospice and home health, as well as paying improper kickbacks to patient recruiters.  DOJ

January 19, 2021

Texas-based Allstate Hospice LLC and Verge Home Care LLC and their founders, Onder Ari and Sedat Necipoglu, have paid over $1.8 million to resolve allegations of submitting claims to Medicare that were tainted by improper inducements.  In violation of the Physician Self-Referral Law and False Claims Act, the defendants allegedly set up monthly payments to referring physicians through sham medical directorship agreements, sold interests to five referring physicians in order to provide them with substantial quarterly dividends, and provided other referring physicians with free tickets and travel.  USAO SDTX

Top Ten Healthcare Fraud Recoveries of 2020

Posted  01/5/21
Healthcare Fraud
Consistent with the trend in prior years, the bulk of the Justice Department’s fraud and false claims recoveries in 2019 stemmed from healthcare fraud matters, and with the Biden administration eyeing a bigger role for the federal government in our healthcare system, this trend is likely to accelerate. Most of the funds recovered arose from cases originated by whistleblowers under the qui tam provisions of the False...

December 16, 2020

Texas resident Rodney Mesquias, the former owner and officer of hospice services provider Merida Group, was sentenced to 20 years in prison following his conviction on fraud charges.  According to the evidence at trial, Mesquias falsely told thousands of individuals and their families that they had less than six months to live, so that he could enroll them in hospice programs, denying them from accessing curative care.  Mesquias also paid kickbacks to physicians for referring patients with long-term diseases such as Alzheimers and dementia.  Over  nearly ten years, Mesquias’ scheme resulted in the submission of $150 million in false and fraudulent claims for medically unnecessary services.  DOJ
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