Insurance Fraud NEWS
Feds bust $21M of home-health schemes around U.S.
February 10, 2019, Washington, DC
The U.S. Department of Justice (DOJ) made nearly half a dozen announcements at the end of January regarding Medicare fraud involving home health agencies.
Among them: A Miami woman was sentenced to more than four years in prison on Jan. 17 for her role in a $4.66 million health care fraud scheme involving several Florida-based 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.
Norma Zayas, 29, pleaded guilty on Oct. 22, 2018, to one count of conspiracy to commit health care fraud. As part of her plea, Zayas admitted that from around January 2010 to January 2014, she operated Sunshine, Empire and Mildred & Marce Home Health, paying kickbacks to patient recruiters in return for the referral of Medicare beneficiaries, many of whom did not need or qualify for home health services. Zayas also admitted to paying kickbacks linked to Nursing Care PRN while the agency was placed in the name of a nominee owner.
Another Miami woman — Tania Gudin, 55 — was similarly sentenced to more than three years in prison on Jan. 3 for her role in a $1.36 million health care fraud scheme.
On Oct. 23, Gudin pleaded guilty to accepting kickbacks for recruiting and referring Medicare beneficiaries to five Miami-area businesses that claimed to provide home health care services, according to DOJ officials. Those businesses included Maya Home Health Care Corp., Floridian Home Health Care Corp., Healthylife Home Care Inc., ACM Home Health Corp. and Humanity Home Health Inc. Gudin also owned her own medical clinic, the New City Medical Center Inc., which she admittedly utilized to further the scheme by obtaining prescriptions for her recruited patients.
Federal authorities have previously told Home Health Care News that Florida is “ground zero” for health care fraud.
Outside of Miami, the owner and operator of a purported medical clinic, QC Medical Clinic, was convicted on Jan. 24 by a federal jury of participating in an $11 million Medicare fraud scheme in which fraudulent medical documents were sold to home health agencies in the Houston, Texas area. Brenda Rodriguez, 57, was convicted on one count of conspiracy to commit health care fraud and three counts of health care fraud.
Additionally, a California doctor was sentenced to more than three years in prison on Jan. 22 for his role in a Medicare kickback conspiracy involving a Los Angeles-area home health agency.
According to evidence presented at trial, from 2008 to 2016, Dr. Kanagasabai Kanakeswaran, 65, and others engaged in a conspiracy to refer Medicare patients to Star Home Health Resources in exchange for illegal kickback payments. Medicare paid about $4.1 million based on those referrals and ensuing claims, according to DOJ.
Source: Home Health Care News