Insurance Fraud NEWS
Michigan home-health firm bills for people not homebound
November 08, 2018, Detroit, MI
The owner of a Michigan home health agency was sentenced to 84 months in prison today for her role in a scheme involving approximately $1.6 million in fraudulent Medicare claims for home health services that were procured through the payment of kickbacks, and that were medically unnecessary and not provided.
Assistant Attorney General Brian A. Benczowski of the Justice Department’s Criminal Division, U.S. Attorney Matthew J. Schneider of the Eastern District of Michigan, Special Agent in Charge Timothy R. Slater of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Chicago Regional Office made the announcement.
Editha Manzano, 70, of Troy, Michigan, was sentenced by U.S. District Judge Gershwin A. Drain of the Eastern District of Michigan. Judge Drain also ordered Manzano to pay $1,593,804.35 in restitution, jointly and severally with her co-conspirators, and to forfeit $758,407.07. On Dec. 4, 2017, Manzano was convicted after a two-week trial on all counts that were charged in the indictment -- one count of conspiracy to commit health care and wire fraud, one count of conspiracy to pay and receive kickbacks in connection with Medicare beneficiaries, and one count of health care fraud.
According to evidence presented at trial, from 2013 to 2016, Manzano masterminded a scheme to defraud Medicare of approximately $1.6 million by submitting false and fraudulent claims for home health care services in connection with Anointed Care Services (Anointed), a Detroit-area home health care agency. Medicare requires that physical therapy and skilled nursing services in the home be provided only to Medicare beneficiaries who are homebound and need the services. The evidence showed that Manzano paid illegal kickbacks in exchange for recruited beneficiaries’ signatures on blank home health documents. The evidence further showed that Manzano conspired with physicians to admit beneficiaries for home health care with Anointed when they did not qualify for such services. Manzano and her co-conspirators then billed Medicare for home health services that were never provided, the evidence showed. To make it appear that the services were medically necessary and actually provided, Manzano and her co-conspirators fabricated and falsified medical records, the evidence showed.
The evidence further showed that Manzano conspired with physicians to provide medically unnecessary opioids to beneficiaries who signed up for home health care with Anointed. Some of these beneficiaries sold the opioids to drug dealers to be resold on the street; others traded the opioids to drug dealers in exchange for crack cocaine.
Manzano was charged along with Liberty Jaramillo, 68, also of Troy; Roberto Quizon, M.D., 72, of Bloomfield Hills, Michigan; Juan Yrorita, R.N., 64, of Sterling Heights, Michigan, and Victoria Gallardo-Navarra, M.D., 75, also of Bloomfield Hills, in an indictment returned on Sept. 1, 2016. Jaramillo and Quizon pleaded guilty prior to trial and were sentenced to serve 36 months and 18 months in prison, respectively. Gallardo-Navarra was acquitted, and Yrorita pleaded guilty on the fifth day of trial and was sentenced to serve 36 months in prison.
The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan. Trial Attorneys Jacob Foster and Rebecca Yuan of the Fraud Section prosecuted the case.
The Criminal Division’s Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.
Source: United States Department of Justice