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Home Health and Hospice

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Catch of the Week: Bayada Home Health Care Settles Kickback Allegations for $17 Million in Case Demonstrating that Kickbacks Come in Many Forms

Posted  09/17/21
business person stamping a paper
Last week, Bayada Home Health Care, Inc., a national home health company with more than $1.5 billion in reported revenues and offices in twenty-two states, agreed to pay the United States $17 million to settle allegations that it violated the federal Anti-Kickback Statute (AKS).  The AKS prohibits paying illegal remuneration in any form to induce business or referrals paid for with federal health care dollars, and...

September 8, 2021

Bayada Home Health Care, Inc. and related entities agreed to pay $17 million to resolve allegations of paying unlawful kickbacks that were initiated by a whistleblower action under the False Claims Act.  The government alleged that Bayada purchased two home health care agencies from a company that owned retirement communities in order to induce referrals from the seller to Bayada.  The whistleblower, David Freedman, was the director of strategic growth for Bayada; he will receive more than $3 million as a whistleblower reward.  DOJ; USAO NJ

May 19, 2021

Latisha Harron of North Carolina has been sentenced to over 14 years in prison and ordered to pay over $13 million in restitution after pleading guilty to charges of defrauding the North Carolina Medicaid Program, aggravated identity theft, and money laundering.  Together with husband Timothy Harron, the defendant scoured obituaries for recently deceased Medicaid recipients and billed Medicaid for up to a year of home health services that were allegedly provided to the deceased by her company, Agape Healthcare Services, Inc.  By concealing the fact that both Harrons were previously convicted felons, the defendant was able to obtain millions in reimbursements, which she then laundered into expenses such as business properties, a private jet, clothing and jewelry, and gym equipment.  NC AG

May 4, 2021

Alberto Orian Gonzalez-Delgado was sentenced to 210 months in prison after pleading guilty to conspiracy to commit health care fraud and wire fraud.  He is the last of eight individuals to be sentenced for a money laundering scheme in Florida and Michigan involving the use of nominee owners to fraudulently purchase home health agencies and then bill Medicare for services that were never provided to Medicare beneficiaries.  The defendants caused the payment of approximately $53 million in fraudulent claims.  DOJ

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
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