Home Health and Hospice

November 12, 2014

Home healthcare agency CareAll Management LLC agreed to pay $25M to settle charges it violated the False Claims Act by submitting false and upcoded home healthcare billings to Medicare and Medicaid. According to the government, between 2006 and 2013, CareAll overstated the severity of patients’ conditions to increase billings and billed for services that were not medically necessary and rendered to patients who were not homebound. The current allegations first arose in a whistleblower lawsuit filed by Toney Gonzales under the qui tam provisions of the False Claims Act.  Gonzales will receive a whistleblower award in an undisclosed amount.  Whistleblower Insider

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 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

October 1, 2014

A federal jury in Detroit convicted Felicar Williams, the operator of Haven Adult Day Care Center LLC, and Abdul Malik Al-Jumail and his daughter Jamella Al-Jumail, owners of a network of home health care companies, for their participation in a $29 million Medicare fraud scheme. According to evidence presented at trial, at Williams’s direction, Haven billed Medicare for sophisticated mental health services purportedly provided by other, unlicensed staff members. And the Jumails’ companies — including ABC Home Care Inc., Associates in Home Care Inc., Accessible Home Care Inc., Swift Home Care LLC, and Be Well Home Care LLC — billed Medicare for home health services that were not needed or not provided. Abdul Malik Al-Jumail also paid kickbacks to Williams to obtain billing information about patients at Haven. He then used the information to bill Medicare for home health care services that were never 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 17, 2014

Fort Lauderdale based home health care company A Plus Home Health Care, and its owners Tracy and Stephen Nemerofsky, agreed to pay $1.65 million to settle charges A Plus violated the False Claims Act by paying spouses of referring physicians for sham marketing positions to induce patient referrals. According to the government, the company allegedly hired at least seven spouses and one boyfriend of physicians to perform marketing duties but required them to do little if any real work. Their salaries instead were allegedly for the purpose of inducing and rewarding the physicians’ referrals of Medicare patients to A Plus. Whistleblower Insider

September 8, 2014

Cruz Sonia Collado, the owner and operator of now defunct home health care company Nestor’s Health Services was sentenced to 75 months in prison and ordered to pay $6.5 million in restitution for her participation in a $6.5 million Medicare fraud scheme under which she paid kickbacks and bribes to patient recruiters in return for their providing patients to Nestor’s for home health care and therapy services that were medically unnecessary and, in many instances, not provided. DOJ

August 26, 2014

Annarella Garcia, a co-owner of Professional Medical Home Health LLC, a Miami home health agency, was sentenced to 70 months in prison and ordered to pay $6.2 million in restitution for her participation in a health care fraud scheme involving the now defunct home health care company. According to the government, Garcia and others engaged in a scheme to bill Medicare for expensive physical therapy and home health care services that were not medically necessary or were not provided. DOJ

August 20, 2014

Muhammad Aamir, owner of the three Michigan home health agencies Prestige Home Health Services, Platinum Home Health Services, and Empirical Home Health Care, pleaded guilty for his role in a $22 million home health care fraud scheme. Specifically, Aamir and his co-conspirators billed Medicare for home health care services that were not actually rendered, not medically necessary, and procured through paying illegal kickbacks. DOJ