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Home Health and Hospice

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Page 7 of 24

May 8, 2019

A South Florida woman who received kickbacks in exchange for patient referrals has been sentenced to over 7 years in prison. In exchange for at least $710,000, Yamilet Diaz allegedly referred Medicare beneficiaries to five home health agencies, aiding the agencies in unlawfully receiving over $1.6 million in reimbursements from Medicare that were tainted by the kickbacks. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medicare,

April 30, 2019

Home healthcare company Avenue Homecare Services, Inc, of Dracut, Massachusetts, will pay $8.3 million to resolve allegations that between 2013 and 2016 it defrauded the state's Medicaid program, MassHealth, by submitting false bills for unauthorized services not supported by a valid plan of care from a physician.  In some cases, Avenue submitted bills for home healthcare services for patients who were hospitalized at the time of the alleged services.  The settlement also requires the company to implement a compliance program to continue as a MassHealth provider.  MassAG

Tagged in: FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

April 30, 2019

Home healthcare company Amigos Homecare, LLC, of Lawrence, Massachusetts, will pay $2.13 million to resolve allegations that between 2014 and 2018 it defrauded the state's Medicaid program, MassHealth, by submitting false bills for unauthorized services not supported by a valid plan of care from a physician.  In some cases, Amigos submitted bills for home healthcare services for patients who were hospitalized at the time of the alleged services.  The settlement also requires the company to implement a compliance program to continue as a MassHealth provider.  MassAG

Tagged in: FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

April 18, 2019

Two former business partners behind three hospice and home healthcare agencies in the Las Vegas area have been sentenced for their roles in a $7.1 million Medicare fraud scheme.  Camilo Primero and Aurora Beltran—the owners of Advent Hospice, Angel Eye Hospice, and Vision Home Health Care—had been previously convicted of defrauding California’s insurance system in connection with another business, the Beltran House for disabled adults, and Primero had been excluded from participating in federal healthcare programs.  To get around the exclusion, the two filed false enrollment forms to Medicare, then submitted false claims for unqualified beneficiaries.  Each has been sentenced to three years of supervised release and ordered to pay $2,492,627.  USAO NV

Tagged in: Healthcare Fraud, Home Health and Hospice, Medicare,

April 4, 2019

Evelyn Mokwuah, a former administrator for Houston, Texas-based Beechwood Home Health and Criseven Health Management Corporation, was sentenced to ten years in prison for her role in the submission of approximately $20 million in false claims to Medicare.  According to the evidence at trial,  Mokwuah falsely certified and billed for patients who were not homebound or did not qualify for home health services; falsified patient records to show that patients were homebound when they were not; paid patient recruiters; and, paid doctors to certify false plans of care for Medicare beneficiaries.  DOJ

Tagged in: Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Lack of Medical Necessity,

March 26, 2019

Accurate Home Care, LLC, a Minnesota-based home health provider has agreed to pay $726,957.59 after voluntarily self-disclosing its violations of the False Claims Act in duplicated bills sent to both Medicaid and private insurers. Accurate had also admitted to fraudulently retaining payments from Medicaid even when Medicaid wasn't the primary insurer. USAO MN

Tagged in: FCA Federal, Healthcare Fraud, Home Health and Hospice, Medicaid, Medical Billing Fraud,

February 28, 2019

A former employee within the Wayne County Adult Services division of the Michigan Department of Health and Human Services has been charged with defrauding the state's Medicaid program. As an Independent Living Services Specialist, Eliza Yulonda Ijames was responsible for approving Medicaid beneficiaries for home health services. In violation of anti-kickback rules, however, she used her position to refer clients to agencies with which she had an improper financial relationship. AG MI

Tagged in: Anti-Kickback and Stark, Healthcare Fraud, Home Health and Hospice, Medicaid,

February 27, 2019

Tennessee-based skilled nursing facility chain Vanguard Healthcare LLC, along with former executives William Orand and Mark Miller, have agreed to pay upward of $18 million to resolve False Claims allegations of billing Medicare and Medicaid for worthless and "grossly substandard nursing home services." According to press releases, five facilities in the Vanguard network allegedly submitted false claims for reimbursement, despite a litany of failures, including forging nurse and physician signatures, using unnecessary physical restraints on residents, failing to prevent pressure ulcers, failing to provide wound care as ordered, failing to provide standard infection control, failing to administer medications as prescribed, and failing to meet basic nutrition and hygiene requirements. The case is considered the largest case of fraud involving worthless services in state history. DOJ; USAO MDTN

Tagged in: Certifications, FCA Federal, FCA State, Healthcare Fraud, Home Health and Hospice, Medicaid, Medicare, Misrepresentations, SNF,

February 1, 2019

Ali Jama, co-owner of Alpha Star Health Care Inc., was sentenced to 18 months in prison for health care fraud and tax fraud schemes against Medicare and Medicaid. Jama billed the government for services performed by unqualified individuals with criminal backgrounds who were prohibited from providing direct care. Jama also billed for services provided by untrained home health aides and provided false documents and false records for his taxes to reduce his company’s tax liability from approximately $680,000 to $81,000. Jama has been ordered to forfeit $300,000 and pay $392,000 in restitution to Medicaid. He must also pay the IRS $311,000 in restitution. DOJ

Tagged in: Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Improper Medical Personnel, Medicaid, Medicare, Tax Fraud,

January 28, 2019

Norma Zayas, of Miami, was sentenced to 51 months in prison for her role in a $4.66 million health care fraud scheme involving several Miami-area home health agencies, including Sunshine Home Health Services Inc., Empire Home Health Agency Inc., Mildred & Marce Home Health Care Services Inc., and Nursing Care PRN Inc., which purported to provide home health services to Medicare patients. Zayas must also pay $4,658,241.00 in restitution and forfeit $186,650.50. Zayas admitted that from approximately January 2010 through approximately January 2014, she operated Sunshine, Empire, and Mildred & Marce Home Health and paid kickbacks to patient recruiters in return for the referral of Medicare beneficiaries, many of whom did not need or qualify for home health services. She also paid kickbacks to patient recruiters who referred Medicare beneficiaries to Nursing Care PRN. As a result of false and fraudulent claims submitted as part of this conspiracy, Medicare made payments of nearly $4.66 million. DOJ

Tagged in: Anti-Kickback and Stark, Criminal Proceedings, Healthcare Fraud, Home Health and Hospice, Medicare,

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