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Home Health and Hospice

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February 19, 2020

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, 2020

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

December 10, 2020

Teresita Lumanas Alquero, the former owner of Providence Home Health and Providence Hospice, agreed to pay $1.05 million to resolve False Claims Act claims first made in an action brought by a whistleblower that she paid improper kickbacks to the medical director of Providence.  The payments exceeded fair market value and were intended to induce the doctor to refer Medicare patients to Providence.  USAO SDTX

December 2, 2020

The owner and operator of Atlanta-based Elite Homecare has been sentenced to over five years in prison and ordered to pay $999,999 in restitution for defrauding Medicaid of nearly $1 million.  As a provider under the Georgia Pediatric Program (GAPP)—an in-home nursing program for Medicaid-eligible children with severe physical and cognitive disabilities—Diandra Bankhead allegedly submitted thousands of claims for services that were fraudulent in a myriad of ways.  Some of the claims falsely represented that employees provided more than 24 hours of services in a given day to multiple children simultaneously (including to children whose families had not retained Elite, and by RNs who did not know their credentials were being used), while other claims contained fraudulent credentialing information and fraudulent supporting documentation, or were upcoded to induce higher payments from Medicaid.  Additionally, Bankhead allegedly “sold” information about twenty of Elite’s former clients to another Atlanta-based home health provider in exchange for a percentage of the reimbursements from Medicaid.  USAO NDGA

October 16, 2020

Massachusetts home health agency Altranais Home Care, LLC and its owners, Constant Ogutt and Shakira Lubega, will pay $3.1 million to resolved claims that they submitted false claims to the state’s Medicaid program, MassHealth.  According to the state, the defendants billed for services for which they did not have a physician-authorized plan of care.  Mass

Top Takeaways from Former DOJ Civil Chief Jody Hunt on the Current State of False Claims Act Enforcement

Posted  08/28/20
department of justice website
Law360 recently interviewed former DOJ Civil Chief Jody Hunt on what he sees as the key issues surrounding False Claims Act enforcement these days.  Here are the top takeaways:
    • COVID-relief fraud will be a DOJ priority. No surprise there given the billions of dollars the federal government is pouring into the economy to alleviate some of the financial strain the pandemic is wreaking on healthcare providers...
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