Fraud claims involve SNFs, home healthcare and DME providers

Several recent multimillion dollar Medicare fraud case convictions and settlements relate to the actions or alleged actions of home healthcare agencies, skilled nursing facilities and durable medical equipment companies and their employees.

In the latest news, four patient recruiters of Miami home healthcare agency Caring Nurse Home Health Care Corp. have pleaded guilty for their roles in a $48 million home health Medicare fraud scheme, one year after the company owners and operators pleaded guilty.

  • Emilio Amador was sentenced Dec. 4 to serve 108 months in prison after pleading guilty to one count of conspiring to receive healthcare kickbacks and two counts of receiving healthcare kickbacks. His sentence also includes serving three years of supervised release and, with his co-defendants, paying $24 million in restitution.
  • Marianela Martinez, Omar Hernandez and Celia Santovenia pleaded guilty Dec. 3 to one count each of conspiracy to receive health care kickbacks. Santovenia also worked for Good Quality Home Health Care Inc. Sentencing has been scheduled for Feb. 11.

The companies purported to provide home health and therapy services to Medicare beneficiaries. From about January 2006 through June 2011, according to the Department of Justice, the defendants recruited patients for Caring Nurse and/or Good Quality, and then solicited and received kickbacks and bribes from the owners and operators in return for allowing the companies to bill the Medicare program on behalf of the recruited patients. The Medicare beneficiaries were billed for home healthcare and therapy services that were medically unnecessary and/or not provided.

Amador also pleaded guilty to his involvement in $30 million in fraudulent billings for Nation’s Best Care Home Health Corp., a company he owned, operated and was president of.

The owners and operators of Caring Nurse and Good Quality pleaded guilty in December 2012 to one count each of conspiracy to commit healthcare fraud. In February, Rogelio Rodriguez and Raymond Aday were sentenced to serve 108 and 51 months in prison, respectively.


In other justice department news:

  • Patrick Adebowale Sogbein, Adebola Adefunke Adebimpe and Eduardo Abad of San Francisco were convicted Dec. 4 of conspiracy to commit healthcare fraud and healthcare fraud. Sogbein and Abad also were convicted of conspiracy to pay and receive kickbacks involving the Medicare program. The convictions relate to the submission of more than $3.2 million in fraudulent claims to Medicare for power wheelchairs and power wheelchair accessories based on bogus prescriptions for Medicare beneficiaries who had been identified by Abad and other recruiters. Co-defendants Edna Calaustro and Mele Saavedra, both of San Francisco, had previously pleaded guilty to conspiracy to commit healthcare fraud, conspiracy to receive kickbacks involving the Medicare program, and healthcare fraud.
  • Emeka Daniel Orji of Richmond, Texas, was sentenced Nov. 25 to 48 months in federal prison and ordered to pay $1.5 million in restitution to the Medicare program following his July 29 guilty plea to charges of conspiracy to commit and committing healthcare fraud. Orji said he opened the durable medical equipment (DME) company Spectrum Foundation Inc., obtained a Medicare provider number and worked with Aghaegbuna “Ike” Odelugo and, through Spectrum, submitted approximately $4.4 million in false claims to Medicare and received payments totaling approximately $1.5 million. Most items billed to Medicare and Medicaid, including “artho kits,” power wheelchairs, lymphedema pumps or lumbar braces, either were not delivered at all, not medically necessary, not prescribed by a physician or upcoded from what was actually delivered, Orji said. Odelugo pleaded guilty and was sentenced last year to 72 months in prison.
  • Francisco Enrique Chavez of Miami, the former president and owner of a defunct DME clinic, World Class Medical Clinic Corp., pleaded guilty Nov. 21 for his role in an $11 million Medicare fraud scheme to receive payments for DME that was not prescribed by a physician or medically necessary. He faces a maximum penalty of 10 years in prison when he is sentenced Feb. 11.
  • The Ensign Group Inc., a skilled nursing provider based in Mission Viejo, Calif., that operates nursing homes in the western United States, agreed in November to pay $48 million to resolve allegations that, between 1999 and 2011, it knowingly submitted to Medicare false claims for medically unnecessary physical, occupational and speech therapy services at six facilities. The government also alleged that Ensign billed for inflated amounts of therapy it had not provided and that certain patients were kept in the facilities for periods of time exceeding what was medically necessary for the treatment of their conditions. In addition to paying the settlement amount, Ensign also agreed that all of its SNFs would be bound by the terms of a corporate integrity agreement with the U.S. Department of Health and Human Services Office of Inspector General. The claims settled by the agreement are allegations only; no determination of liability was made.
  • Mehran Javidan, the owner of a Detroit-area home healthcare agency, was sentenced Nov. 7 to serve 65 months in prison for her leading role in a $2.2 million Medicare fraud scheme. In addition to her prison term, Javidan was sentenced to serve three years of supervised release and was ordered to pay $2.2 million in restitution, with her two co-defendants. She was found guilty in April of one count of conspiracy to commit healthcare fraud, one count of healthcare fraud, two counts of making false statements related to healthcare matters and one count of conspiracy to solicit or pay healthcare kickbacks in exchange for referrals of patients to home healthcare company Acure Home Care Inc. One co-defendant, physical therapist Vishnu Meda, was convicted in April of one count of conspiracy to commit healthcare fraud, two counts of healthcare fraud and two counts of making false statements relating to healthcare matters. The other co-defendent remains a fugitive.

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