FROM: U.S. JUSTICE DEPARTMENT
Wednesday, September 4, 2013
Two Patient Recruiters of Miami Home Health Company Plead Guilty in $48 Million Health Care Fraud Scheme
Two patient recruiters of a Miami health care company pleaded guilty late yesterday for their participation in a $48 million home health Medicare fraud scheme.
Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent in Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG) Office of Investigations Miami Office made the announcement.
Elizabeth Monteagudo, 33, and Cristobal Gonzalez, 39, both of Miami, pleaded guilty on Sept. 3, 2013, before U.S. District Judge Joan A. Lenard to one count each of conspiracy to receive health care kickbacks. Monteagudo also pleaded guilty to receipt of kickbacks in connection with a federal health care program. Both charges carry a maximum penalty of five years in prison, and sentencing for both defendants is scheduled for Dec. 2, 2013.
According to court documents, Monteagudo and Gonzalez were patient recruiters who worked for Caring Nurse Home Health Care Corp., and Gonzalez also worked for Good Quality Home Health Care, Inc. Caring Nurse and Good Quality were Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries.
According to court documents, from approximately January 2009 through approximately June 2011, Monteagudo and Gonzalez would recruit patients for Caring Nurse and/or Good Quality and would solicit and receive kickbacks and bribes from the owners and operators of Caring Nurse and/or Good Quality in return for allowing the agency to bill the Medicare program on behalf of the recruited patients. These Medicare beneficiaries were billed for home health care and therapy services that were medically unnecessary and/or not provided.
Monteagudo also admitted to her involvement with $7 million in fraudulent billings for Starlite Home Health Agency Inc., which she owned and operated.
In a related case, on Feb. 27, 2013, Rogelio Rodriguez and Raymond Aday, the owners and operators of Caring Nurse and Good Quality, were sentenced to serve 108 and 51 months in prison, respectively. Their sentencings followed their December 2012 guilty pleas each to one count of conspiracy to commit health care fraud charged in an October 2012 indictment, which charged that from approximately January 2006 through June 2011, Caring Nurse and Good Quality submitted approximately $48 million in claims for home health services that were not medically necessary and/or not provided. Medicare actually paid approximately $33 million for these fraudulent claims.
The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case is being prosecuted by Assistant Chief Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,500 defendants who collectively have falsely billed the Medicare program for more than $5 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.
Showing posts with label PATIENT RECRUITERS. Show all posts
Showing posts with label PATIENT RECRUITERS. Show all posts
Wednesday, September 11, 2013
Sunday, April 21, 2013
HOME HEALTH AGENCY OFFICE MANAGER CONVICTED FOR ROLE IN $5.8 MILLION MEDICARE FRAUD SCHEME
FROM: U.S. DEPARTMENT OF JUSTICE
Wednesday, April 17, 2013
Detroit-Area Home Health Agency Office Manager Convicted in $5.8 Million Medicare Fraud Scheme
A federal jury in Detroit today convicted the office manager of a home health agency for her participation in a $5.8 million Medicare fraud scheme, announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Robert D. Foley III, Special Agent in Charge of the FBI 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 (HHS-OIG), Office of Investigations Detroit Office.
Nabila Mahbub, 27, the office manager of All American Home Care Inc., was found guilty in U.S. District Court for the Eastern District of Michigan of one count of conspiracy to commit health care fraud.
Mahbub was charged in a superseding indictment returned March 27, 2012. Nineteen other individuals who worked at or were associated with All American were previously convicted for their roles in the fraudulent scheme; one was acquitted at trial, but was convicted at trial for a separate, but related, scheme.
According to evidence presented at trial, the defendant and her co-conspirators caused the submission of false and fraudulent claims to Medicare through All American, a home health care company located in Oak Park, Mich., that purported to provide skilled nursing and physical therapy services to Medicare beneficiaries in the greater Detroit area.
The evidence at trial showed that the defendant and her co-conspirators used patient recruiters, who paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary. The owners of All American paid physicians to sign referrals and other therapy documents necessary to bill Medicare. Physical therapists and physical therapist assistants then created fake medical records using blank, pre-signed forms obtained by the patient recruiters to make it appear as if physical therapy services were actually rendered, when, in fact, they were not.
According to evidence presented at trial, Mahbub doctored and directed the doctoring of fake patient files to facilitate the commencement and billing of home health services purportedly provided by physical therapists and physical therapist assistants working for All American. Mahbub also directed the physical therapists and physical therapist assistants who created fake therapy visit notes using blank, pre-signed forms, to make it appear that physical therapy services billed to Medicare were actually provided.
All American was paid over $5.8 million from Medicare between September 2008 and November 2009.
At sentencing, scheduled for July 25, 2013, Mahbub faces a maximum penalty of 10 years in prison.
This case is being prosecuted by Deputy Chief Gejaa T. Gobena and Trial Attorney Matthew C. Thuesen of the Criminal Division’s Fraud Section. The investigation was led by the FBI and HHS-OIG, and was brought by the Medicare Fraud Strike Force, a joint effort of the U.S. Attorney’s Office for the Eastern District of Michigan and the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
Wednesday, April 17, 2013
Detroit-Area Home Health Agency Office Manager Convicted in $5.8 Million Medicare Fraud Scheme
A federal jury in Detroit today convicted the office manager of a home health agency for her participation in a $5.8 million Medicare fraud scheme, announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Robert D. Foley III, Special Agent in Charge of the FBI 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 (HHS-OIG), Office of Investigations Detroit Office.
Nabila Mahbub, 27, the office manager of All American Home Care Inc., was found guilty in U.S. District Court for the Eastern District of Michigan of one count of conspiracy to commit health care fraud.
Mahbub was charged in a superseding indictment returned March 27, 2012. Nineteen other individuals who worked at or were associated with All American were previously convicted for their roles in the fraudulent scheme; one was acquitted at trial, but was convicted at trial for a separate, but related, scheme.
According to evidence presented at trial, the defendant and her co-conspirators caused the submission of false and fraudulent claims to Medicare through All American, a home health care company located in Oak Park, Mich., that purported to provide skilled nursing and physical therapy services to Medicare beneficiaries in the greater Detroit area.
The evidence at trial showed that the defendant and her co-conspirators used patient recruiters, who paid Medicare beneficiaries to sign blank documents for physical therapy services that were never provided and/or medically unnecessary. The owners of All American paid physicians to sign referrals and other therapy documents necessary to bill Medicare. Physical therapists and physical therapist assistants then created fake medical records using blank, pre-signed forms obtained by the patient recruiters to make it appear as if physical therapy services were actually rendered, when, in fact, they were not.
According to evidence presented at trial, Mahbub doctored and directed the doctoring of fake patient files to facilitate the commencement and billing of home health services purportedly provided by physical therapists and physical therapist assistants working for All American. Mahbub also directed the physical therapists and physical therapist assistants who created fake therapy visit notes using blank, pre-signed forms, to make it appear that physical therapy services billed to Medicare were actually provided.
All American was paid over $5.8 million from Medicare between September 2008 and November 2009.
At sentencing, scheduled for July 25, 2013, Mahbub faces a maximum penalty of 10 years in prison.
This case is being prosecuted by Deputy Chief Gejaa T. Gobena and Trial Attorney Matthew C. Thuesen of the Criminal Division’s Fraud Section. The investigation was led by the FBI and HHS-OIG, and was brought by the Medicare Fraud Strike Force, a joint effort of the U.S. Attorney’s Office for the Eastern District of Michigan and the Criminal Division’s Fraud Section.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.
Friday, January 13, 2012
OWNER OF MEDICAL EQUIPMENT COMPANY SENTENCED FOR MEDICARE FRAUD
The following excerpt is from the Department of Justice website:
“WASHINGTON – An owner and a patient recruiter for a Louisiana durable medical equipment (DME) company were sentenced today to 60 and 55 months in prison, respectively, for their roles in a $4.7 million Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS), the FBI and the Louisiana State Attorney General’s Office.
Nnanta Felix Ngari, the owner and operator of Unique Medical Solutions, and Ernest Payne, a patient recruiter for Unique, were also sentenced by U.S. District Judge James J. Brady of the Middle District of Louisiana to serve two years of supervised release following their prison terms. Ngari and Payne’s co-conspirator, Sofjan Lamid, was sentenced today by Judge Brady to three years of probation. Ngari, Payne and Lamid were also ordered to pay $2.5 million in restitution, jointly and severally with co-defendants.
On Aug. 16, 2011, after a two-week trial, a jury convicted Ngari, Payne and Lamid of one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States and to pay and receive illegal health care kickbacks.
Evidence at trial established that Ngari owned and operated Unique Medical Solution Inc., a Baton Rouge, La.-area DME supply company that specialized in the provision of power wheelchairs to Medicare beneficiaries. Beginning in late 2003, Ngari paid recruiters, including Payne, to locate and solicit prescriptions for medically unnecessary power wheelchairs, which Ngari used as a basis to submit false and fraudulent claims, on behalf of Unique, to Medicare. As part of the scheme, Payne used churches and other Baton Rouge locations to host “health fairs,” at which Medicare beneficiaries would be prescribed medically unnecessary power wheelchairs by doctors, including Lamid. Lamid and the other physicians were paid illegal kickbacks by recruiters based on the number of power wheelchair prescriptions generated at the health fairs. Payne, likewise, was paid kickbacks by Ngari based on the number of prescriptions he brought to Unique.
Between 2003 and 2009, Unique submitted approximately $4.7 million in claims to Medicare for their purported services. Medicare paid Unique approximately $2.5 million for its claims.
Today’s sentences were announced by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Donald J. Cazayoux Jr. of the Middle District of Louisiana; Mike Fields, Special Agent-in-Charge of the Dallas Region for the HHS Office of the Inspector General (HHS-OIG); David Welker, Special Agent-in-Charge of the FBI's New Orleans division; and Louisiana State Attorney General James Buddy Caldwell.
The case was prosecuted by former Assistant Chief Ben Curtis and Trial Attorney David Maria of the Criminal Division’s Fraud Section. The case was investigated by the FBI, HHS-OIG and the Medicaid Fraud Control Unit of the Louisiana State Attorney General’s Office (MFCU), and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division's Fraud Section and the U.S. Attorney’s office for the Middle District of Louisiana.
Since its inception in March 2007, the Medicare Fraud Strike Force operations in nine locations have charged more than 1,160 defendants that collectively have billed the Medicare program for more than $2.9 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.”
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