Medical Billing Fraud

February 25, 2015

A federal jury in Detroit convicted Michigan patient recruiter Reginald Smith and Michigan physical therapist Rajan Patel for their roles in a $1.6M Medicare fraud scheme.  According to the evidence, Smith worked as a patient recruiter for Angle’s Touch Home Health Care LLC where he solicited patients for foot care services at adult foster care homes and then referred them to Angle’s Touch for medically unnecessary home health care services in exchange for kickbacks.  The kickbacks were disguised as payments to Smith’s nonprofit Medicare provider People Helping People of Detroit.  Patel worked as a physical therapist at Angle’s Touch where he fabricated patient medical records to make it appear that the recruited patients qualified for and received the home health care services, when they did not.  DOJ

February 24, 2015

Angel M. Mirabal, owner of Houston-based medical equipment supplier Quick Solutions Medical Supplies Inc., pleaded guilty to a $5M scheme to defraud Medicare.  Mirabel admitted he and his co-conspirators operated Quick Solutions for the purpose of billing Medicare for medical equipment not medically necessary or not provided.  DOJ

February 18, 2015

Hospice services provider Compassionate Care Hospice Group agreed to pay $6.7M to settle charges it violated the federal and New York False Claims Acts by submitting claims to Medicare and Medicaid for hospice nursing services not actually or adequately provided.  Specifically, the government alleged CCH nurses routinely missed their required visits and then falsified nursing notes in patients’ files to make it appear as though the visits had been performed.  The charges originated in a whistleblower lawsuit filed by a former employee under the qui tam provisions of the False Claims Act.  Whistleblower Insider, NY

February 10, 2015

Iowa-based home healthcare company ResCare Iowa Inc. agreed to pay $5.63M to resolve allegations it violated the False Claims Act by submitting false home healthcare billings to the Medicare and Medicaid programs.  DOJ

February 6, 2015

A federal jury in Detroit convicted unlicensed Detroit physician Wilfred Griffith for his participation in a nearly $4.7M fraud scheme. According to evidence presented at trial, Griffith worked as an unlicensed physician at Phoenix Visiting Physicians in 2010 and 2011 where he treated Medicare beneficiaries and used prescription pads pre-signed by Dr. Dwight Smith to prescribe medicine. He also referred Medicare beneficiaries to Detroit-area home health company Cherish Home Health Services Inc. in exchange for kickbacks. Griffith used the names and signatures of Dr. Smith and two other Detroit-area physicians to certify the beneficiaries were homebound and needed home health services when they did not. DOJ

February 5, 2015

Minnesota-based medical device manufacturer ev3 Inc. (formerly known as Fox Hollow Technologies Inc.) agreed to pay $1.25M to resolve allegations it violated the False Claims Act by causing certain hospitals to submit false claims to Medicare for unnecessary inpatient admissions related to minimally-invasive atherectomy procedures for removing hardening of the arteries. According to the government, Fox Hollow sold the Silver Hawk Plaque Excision System for these procedures and advised hospitals to bill them as more expensive inpatient procedures, as opposed to less costly outpatient procedures, to artificially increase their Medicare reimbursement claims. The charges originated with a whistleblower lawsuit was filed under the qui tam provisions of the False Claims Act by former Fox Hollow sales representative Amanda Cashi. She will receive a whistleblower award of $250,000. DOJ

February 3, 2015

Ernesto Fernandez pleaded guilty and was sentenced to 10 years in prison in connection with a long-running $6.2M Medicare fraud scheme involving Miami-based home health care agency Professional Medical Home Health LLC. Fernandez was an owner and operator of Professional Home Heath and also the owner and operator of two other South Florida home health agencies where he caused patient documentation to be falsified, and planned, organized and oversaw the submission of fraudulent claims to the Medicare program. Juan Valdes also pleaded guilty to the same scheme and was sentenced to 2 years in prison. He was a patient recruiter for Professional Home Health and solicited kickbacks and bribes from the owners and operators of Professional Home Health in exchange for providing beneficiaries to allow Professional Home Health to bill Medicare for home health services that were not medically necessary or not provided. Fernandez and Valdes are the seventh and eighth defendants to be sentenced in connection with the fraudulent schemes at Professional Home Health. DOJ

January 29, 2015

Four South Florida residents were sentenced in connection with a long-running $6.2M Medicare fraud scheme involving Professional Medical Home Health LLC, a Miami home health care agency operated for the purpose of billing the Medicare program for expensive physical therapy and home health services that were not medically necessary or actually provided. Dennis Hernandez was sentenced to 120 months in prison and to pay $1,438,186; Jose Alvarez was sentenced to 120 months in prison and to pay $2,972,570; Joel San Pedro was sentenced to 97 months in prison and to pay $4,938,432; Alina Hernandez was sentenced to 24 months in prison and to pay $204,526.05. DOJ

January 26, 2015

Ramon Regueira, the owner and operator of a Miami home health care agency Nation’s Best Care Home Health Corp. was sentenced to 106 months in prison and to pay $21M for his participation in a $30M Medicare fraud scheme. Regueira admitted he and his co-conspirators operated Nation’s Best for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health care services that were not medically necessary or not provided. He further admitted he and his co-conspirators paid kickbacks and bribes to patient recruiters who provided patients to Nation’s Best, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services.DOJ

January 14, 2015

Michigan physician Paula Williamson was sentenced to 15 months in prison and to pay more than $1M in restitution for her role in a $2.1M home health care fraud scheme involving Michigan-based home health care agency AMB Healthcare Inc. According to her plea agreement, Williamson conspired with others to commit health care fraud by referring Medicare beneficiaries for home health care services that were medically unnecessary and never provided. She also falsified documents used to support the false Medicare claims. DOJ