Home-health cons gouge insurance, abuse patients
Fraud of the Month: December 2016
Much-lauded “Entrepreneur of the Year” tries to steel $16 million
Business owner Martha Lima was the queen bee of Miami’s home healthcare industry.
The elderly entrepreneur ran a lucrative homecare firm. She was a model success story — a Cuban immigrant who fled Castro’s dictatorship and built a prosperous life from scratch.
Lima’s firm provided skilled nursing, physical therapy and other care to frail, homebound seniors who couldn’t fend for themselves. She made a fortune off their misfortune. Years of glittering success peaked when she was named national “Entrepreneur of the Year” by the Latin Chamber of Commerce of the U.S. — the largest Hispanic business organization in Florida.
Lima now has a new title: convicted insurance felon.
She feasted off of taxpayers, trying to soak Medicare for $16 million in false home-treatment claims through her agency, Continuous Home Care Services.
Corruption in home healthcare such as Lima’s is a large and profitable industry. Medicare made $1 billion in improper payments to providers nationally in fiscal 2015.
Gouging is so common in South Florida’s home healthcare industry that Medicare imposed a cap on billing for home-bound patients with diabetes and other chronic ailments. The clampdown has saved Medicare hundreds of millions of dollars.
Forged patient care plans
Taxpayer money poured into Lima’s bank accounts. She bribed dishonest doctors to refer patients to her agency. The doctors signed off on fake care plans that lied the seniors needed homecare because they were too infirm to visit a doctor’s office.
“Corruption in home healthcare such as Lima’s is a large and profitable industry. Medicare made $1 billion in improper payments to providers nationally in fiscal 2015.”She had squadrons of hired patient recruiters to bring in seniors off the streets. The bribe money was laundered through her charity, Bridge of Love and Hope.
Lima stood no chance at trial. She’s 82-year-old and pleaded guilty instead of facing a virtual life sentence if she’d fought the charges and lost. As it stands, she still could be salted away for five years in federal prison when sentenced in late January 2017.
Teen dies of neglect
Home healthcare scams also can turn deadly.
Makayla Norman was a beautiful 14-year-old girl battling cerebral palsy. Bed-ridden and unable to speak or move, she weighed just 28 pounds when she died.
Her caretaker nurse was Mollie Parsons. She starved, abused and ignored the helpless Dayton, Ohio teen. Parsons amassed false Medicaid claims for home care while traipsing through department stores on shopping jaunts.
Insurance money paid Parsons to care for Makayla six days per week, eight hours a day. She showed up a few times per month.
Makayla was covered in filth, lice and open sores when investigators found her body. Her diaper wasn’t changed. Norman's sentence — 10 years in state prison.
Used bogus paperwork
Florence and Michael D. Bikundi stood at the center of a breathtaking $80-million carving of Medicaid, the government health insurer for low-income people.
The couple soaked taxpayers through their Washington, D.C.-area home-health agency. Year after year, they billed Medicaid for substandard home services that short-shrifted vulnerable Medicaid patients.
Florence lied her way into the business. She already was permanently booted from Medicaid because of an earlier fraud conviction. So she just changed her name and used bogus paperwork to be re-admitted as Global HealthCare.
Family members all fed at the Medicaid trough as phony and unqualified caregivers.
Forged time sheets, patient files and employment files all flooded into Medicaid, and money flooded back. The Bikundis amassed growing payments as they perfected their craft each year, with Medicaid dutifully handing over the money based on their doctored claims.
Stolen money financed a newly built home for the Bikundis. They also bought a $140,000 Land Rover, $120,000 Porsche, $75,000 Mercedes Benz, $70,000 Cadillac and $36,000 BMW.
Florence was handed 10 years in federal prison and Michael seven years.
These homecare scammers abused taxpayers and patients with substandard, phony and even deadly service. They’ll learn the meaning full home service during lengthy stays in cozy prison cells.