Kentucky-based Nurses’ Registry and Home Health Corp. recently filed for Chapter 11 bankruptcy, and alleges Medicare owes the company $1 million in payments for health care services it provided. 

Medicare officials suspended payments to Nurses’ Registry earlier this year after suing the company over alleged kickbacks and improper billing, court documents show. The case drew attention in part because Nurses’ Registry was a prominent corporate sponsor of University of Kentucky athletics, and the alleged kickbacks included exchanging Wildcats basketball tickets for referrals, The Wall Street Journal reported.

Other kickbacks allegedly involved doctors being given tickets to a Journey concert and bottles of tequila, and there was an email exchange in which a doctor and the home health company discussed how many referrals would be needed for Kentucky Derby tickets, according to the WSJ.

Nurses’ Registry, founded and incorporated in 1984, providers home health care services in central Kentucky including skilled nursing, physical therapy, occupational therapy, nursing assistant and other services.The company serves more than 1,300 patients, court records show.

On an annual basis, Medicare receivables represent approximately 65% of the company’s revenues, according to court documents. Medicare receivables average approximately $1.3 million per month.

Since Medicare payments were suspended, Nurses Registry’ has been unable to fully pay its ongoing operating expenses, the company says in the filing. 

“Without immediate delivery of the outstanding Medicare Receivables and payment of future Medicare Receivables, the Debtor [Nurses’ Registry] will have no choice but to cease operations and discharge its patients and employees,” the company says in the suit. “Disruption to patient care will cause immediate and irreparable harm to patients, and ceasing operations abruptly will greatly minimize the going concern value of the Debtor for the benefit of all of its constituencies.” 

The Centers for Medicare & Medicaid Services (CMS) provided a notice to the company regarding suspending payments on May 6, 2015. 

The suspension of Medicare payments was based on, but not limited to, “interviews of staff and patients which corroborated the allegation that patients who are receiving or have received services from Nurses’ Registry are not appropriate for home health services,” CMS said in the notice.

It is not clear whether the company intends to use Chapter 11 protection to reorganize, close or sell, according to the WSJ.

Written by Cassandra Dowell

Soliciting kickbacks for home care referrals is enough to land any physician in jail or a hefty fine, but this was far from the most serious offense in the case of one Detroit-area doctor who could spend 175 years in prison for defrauding Medicare.

Farid Fata, M.D., 49, of Oakland Township, Mich., faced the statutory maximum sentence as his federal sentencing proceedings began Monday before presiding U.S. District Judge Paul D. Borman of the Eastern District of Michigan. 

Last September, Fata pleaded guilty for his role in a health care fraud scheme that submitted approximately $225 million in claims to Medicare over six years for providing medically unnecessary chemotherapy to patients. He was indicted in August 2013.

At the time of his plea, Fata pleaded guilty to 13 counts of health care fraud, one count of conspiracy to pay or receive kickbacks and two counts of money laundering. 

A hematologist-oncologist, Fata owned and operated a cancer treatment clinic, Michigan Hematology Oncology, P.C. (MHO), which had locations in Rochester Hills, Clarkston, Bloomfield Hills, Lapeer, Sterling Heights, Troy and Oak Park, Mich. He also owned a diagnostic testing facility in Rochester Hills called United Diagnostics. 

In his plea, Fata admitted to prescribing and administering aggressive chemotherapy, cancer treatments, intravenous iron and other infusion therapies to patients who did not need them.  

As a result, Fata was able to submit approximately $225 million in claims to Medicare between August 2007 and July 2013, of which approximately $109 million was for chemotherapy and other cancer treatments, according to court documents, which also indicate that Medicare paid over $91 million to Fata, of which over $48 million was for chemotherapy and other cancer treatments. 

Fata also admitted to soliciting kickbacks from Guardian Angel Hospice and Guardian Angel Home Health Care in exchange for his referral of patients to those facilities. 

Additionally, Fata further admitted to using the proceeds of the scheme at his medical practice to promote additional health care fraud at United Diagnostics, where he administered unnecessary and expensive Positron Emission Therapy scans, for which he billed a private insurer.

It is estimated that more than 500 people suffered from Fata’s crimes, with about 150 alleged victims having filed impact statements with the court, according to The Wall Street Journal.

A criminal complaint charged against Fata at the time of his August 2013 indictment alleged that in one instance, a male patient fell down and hit his head when he came to MHO. 

“Dr. Fata insisted that the patient receive his chemotherapy before he could be taken to the emergency room,” the Department of Justice (DOJ) said in a statement. “MHO administered the chemotherapy, after which the patient was taken to the emergency room. The patient later died from his head injury.”

In another instance cited in the complaint, a patient came to MHO with “extremely low” sodium levels. 

“Dr. Fata again directed that the patient first receive chemotherapy before being taken to the emergency room,” the DOJ stated. “MHO administered the chemotherapy and the patient was taken to the emergency room and hospitalized.”

In a May 28 memorandum, federal prosecutors asked for the maximum sentence of 175 years in prison, however, Fata’s defense attorneys are asking that the sentence not exceed 25 years.

Written by Jason Oliva

The U.S. Department of Labor has sued an Orlando-based home health care agency for allegedly misclassifying certain employees as “independent contractors” and paying them a flat hourly rate, regardless of the number of hours they worked, according to a suit filed in the Middle District of Florida. 

Since at least March 13, 2012, Caring First, Inc., along with its owner and president Ivanah V. Thomas, and vice president Timothy Thompson,  have misclassified employees, including their licensed practical nurses and registered nurses, as independent contractors — many of whom regularly worked more than 40 hours a week, the court document states. 

The defendants also allegedly failed to make, keep and preserve adequate and accurate records of the employees and of the wages, hours and other conditions and practices of employment maintained by them. 

In the suit, Secretary of Labor Thomas E. Perez is seeking back wages for a period of three years prior to Tuesday’s court filing, plus any time that passes pursuant to agreement by the parties, and an additional equal amount as liquidated damages to the employees. 

Written by Emily Study

A federal undercover operation has led to the arrest of a Chicago-based home health care company’s CEO accused of fraudulently billing Medicare for up to $1.2 million.

Henry Smilie, CEO of Home Physician Services LLC, was charged with Medicare fraud in a federal complaint unsealed following his arrest Thursday, according to the U.S. Attorney’s Office of the Northern District of Illinois. A federal affidavit filed with the complaint claims the company received $1.2 million in payments from Medicare between February 2012 and July 2014 for in-home treatment, when the patients in fact were not confined to their homes and therefore not eligible to receive such services.

As part of the investigation, an undercover confidential source posed as a 71-year-old Medicare recipient. Home Physician Services certified him as homebound, despite him not being confined to his home, according to the affidavit. Visits from doctors were secretly recorded and unveiled that the source frequently walked outside his home, visited friends and grandchildren and expressed his love for gardening, but the company continued to declare him homebound in billing submissions to Medicare in order to receive maximum payouts.

Smilie, 54, of Lake Zurich, reported to Medicare that his contracted physicians had conducted services for patients that weren’t actually administered, according to the affidavit. The document also said a former employee told federal agents that Smilie encouraged him to falsify records to meet the criteria to receive Medicare payments, and that Smilie used a rubber stamp of physicians’ signatures to create orders for treatment.

Home Physician Services hires doctors to perform house calls and oversee treatment plans for elderly and homebound patients, with bill-collecting rights granted to and payments distributed by the company. Home Physician Services has offices in Chicago and the city’s northern suburb of Schaumburg.

Representatives with Home Physician Services could not be reached Monday for comment to Home Health Care News regarding the allegations.

If convicted, Smilie faces up to 10 years in prison, mandatory restitution, and a maximum fine of $250,000.

Written by Kourtney Liepelt

A series of whistleblower cases over how Medicare Advantage plans utilize in-home health assessments to set their payment rates has raised concerns over poor government oversight.

Filed in 2014 and unsealed by the federal court in Dallas in June, the case against CenseoHealth LLC is one of several such suits filed in the past five years, and only the second whistleblower case to target Medicare Advantage in-home assessments, the Center for Public Integrity reported this week.

As an alternative to standard Medicare, which pays physicians for services administered, Medicare Advantage plans receive a set monthly payment for each patient based on a risk score, getting higher rates for the sickly and less for those in good health, the CPI article stated. The number of beneficiaries has ballooned to 17 million people, according to the CPI.

The most recent lawsuit was filed by a former employee of the Dallas-based firm CenseoHealth LLC, a company that conducts home visits to provide patients’ health information to health plans for use to bill Medicare. The suit alleges the company contracted with thousands of doctors to evaluate elderly patients’ health on behalf of Medicare Advantage plans, and then some of these doctors exaggerated or altered their patient assessments to inflate their risk scores so that the plan could receive more money from Medicare.

Meanwhile, federal officials grapple with preventing health plans from overcharging Medicare by tens of billions of dollars every year as home visits escalate, according to a 2014 Center for Public Integrity investigation. And in 2013, when federal officials stepped forward to voice their concerns about home visits inaccurately raising risk scores and wasting tax dollars, they received backlash from the industry and therefore backed off a proposal to limit the home health visits, according to the investigation. In fact, a bill passed by the House in June seems to block government officials from stopping these types of home health evaluations.

CenseoHealth had no comment on the latest lawsuit, according to the CPI report, and the Centers for Medicare & Medicaid Services issued a prepared statement touting the value of home exams.

Written by Kourtney Liepelt

A husband and wife in charge of a Chicago-based home health care business and nurses employed by the company are among those who have been accused in a more than $6 million fraud scheme, according to a federal indictment unsealed late last week.

Estrellita and Miguel Duquilla, the owners of HCN Home Healthcare Inc., were charged with bribing employees and marketers to refer Medicare beneficiaries to the company and having employees change nursing reports and patient files to falsely reflect beneficiaries’ need for in-home treatment from 2008 to 2012, according to the U.S. Attorney’s Office of the Northern District of Illinois. In doing so, the indictment claims Medicare overpaid HCN by more than $6 million.

The Duquillas, of Des Plaines, were each charged with conspiracy to pay and receive healthcare kickbacks, one count of conspiracy to commit health care fraud and 10 counts of Medicare fraud. Also charged in the scheme were four HCN employees and an outside marketers.

Many of the elderly and disabled referred to HCN were ineligible for home health services, according to the indictment, and in many cases didn’t need or receive the care. The indictment states that in still other cases, employees and marketers paid cash to patients in exchange for permission to use their information for paperwork submitted to Medicare.

Estrellita Duquilla, 58, was additionally charged with five counts of paying kickbacks to induce referrals of Medicare beneficiaries. Miguel Duquilla, 60, was charged with two counts of the same crime. In total, four nurses were charged with various counts of kickback conspiracy, Medicare and health care fraud and soliciting health care and Medicare kickbacks.

Representatives with HCN could not be reached Monday for comment regarding the allegations.

The indictment comes amid a federal investigation, which included the execution of a search warrant at the HCN office. Federal officials say the investigation is ongoing.

The Medicare fraud and health care fraud conspiracy counts carry a maximum 10-year prison sentence and a $250,000 fine. The kickback and kickback conspiracy charges are punishable by up to five years in prison and a $250,000 fine.

Written by Kourtney Liepelt

The founder of a Texas-based home health care company, Three Angels Home Health Inc., is in U.S. Marshal custody after being charged with Medicare fraud. Grace Munthali, also known as “Ms. Grace,” was sentenced to five years in prison on Sept. 22 after pleading guilty to her role as the ringleader in a scheme to defraud Medicare for home care services that were never needed nor received.

Twelve other individuals were indicted on 18 counts by a federal grand jury on Sept. 16 for acting as recruiters to collect Medicare and physician information from patients who were not eligible for services or did not need them, according to a release from the U.S. Attorney’s Office.

Between August 2013 and November 2014, the group allegedly defrauded Medicare of $2.5 million for home health services to 250 Medicare patients.

Recruiters for Three Angels paid Medicare patients between $100 and $200 for their information throughout East Texas, U.S. Department of Health and Human Services agents allege. The case is also being investigated by the Texas Attorney General’s Medicare Fraud Control Unit. In most cases, patients did not receive home care from Three Angels. Recruiters were allegedly paid up to $500 for each Medicare beneficiary they signed up for Three Angels home care services.

Munthali’s illegal Medicare ring has been under scrutiny by agents since 2012, after one employee told agents “Ms. Grace” paid him between $300 and $400 for each Medicare patient he signed up in the Lufkin and Nacogdoches areas in Texas, plus an additional $50 to $100 for patient visits.

The twelve individuals indicted were named by investigators as Lizzy Swirls, 33, of Cuney, Texas; Katrina Watts, 38, of Lufkin, Texas; Pandra Wade, 55, of Lufkin, Texas; Victoria Sterns, 40, of Lufkin Texas; Tammy Washington, 51, of Nacogdoches, Texas; Nichelle Fofana, 51, of Nacogdoches, Texas; Yulanda Nash a.k.a. “Sugar Mama,” 44, of Nacogdoches, Texas; Ronald Russell a.k.a. “Petey,” 51, of San Augustine, Texas; Sheneki McCollister, 30, of Center, Texas; Meoshe Goodwin, 42, of Tenaha, Texas; Latosha Gray a.k.a. “Tasha,” 26, of Jacksonville, Texas; and Marcus Chukwu, Jr., 52, of Sugarland, Texas.

The defendants face up to five years in federal prison if convicted for conspiracy to commit health care fraud and up to five years for each of the payments of illegal remuneration charges.

Written by Amy Baxter

Guardian Hospice of Georgia LLC, Guardian Home Care Holdings Inc. and AccentCare Inc—collectively known as Guardian, a for-profit company that provides hospice services in Atlanta, Georgia—agreed to pay $3 million following allegations that it submitted false claims to Medicare for hospice patients who were not terminally ill.

The Justice Department announced the settlement resolves allegations filed by whistleblowers Rose Betts and Jennifer Williams, former Guardian employees. 

“Hospice care is only medically appropriate—and reimbursed by Medicare—for terminally ill patients who are in the last months of their lives,” said Derrick Jackson, special agent in charge with the U.S. Department of Health and Human Services-Office of Inspector General (HHS-OIG). “We will continue to vigorously investigate health care companies that put their own profits above their duty to give appropriate medical care to their patients and bill Medicare only for legitimate health care services.”

Hospice providers may only bill Medicare for hospice services for patients who elect for treatment during the last few months of their lives as a result of a terminal illness. Guardian allegedly falsified documents and billed Medicare between Dec. 1 2009 and March 31, 2012, for patients Guardian knew were not terminally ill, the authorities alleged.

“Medicare payments to hospices are increasing every year,” U.S. Attorney John Horn of the North District of Georgia said in a statement. “In order to preserve Medicare funds for services patients truly need, we will continue to pursue hospice providers who abuse the Medicare hospice benefit by billing Medicare for the care of patients who are not terminally ill.”

As a result of their efforts to reveal the fraud, Betts and Williams will each receive $510,000, according to the Justice Department.

“The Medicare hospice benefit is intended to provide comfort and care to patients nearing the end of life,” Principal Deputy Assistant Attorney General Benjamin C. Mizer said in a prepared statement. “We will continue to aggressively pursue companies that abuse the Medicare hospice benefit to improperly inflate their profits.”

Guardian does not admit any wrongdoing in the settlement and the claims reflect allegations only.

Written by Amy Baxter

An elaborate $30 million Medicare fraud indictment has resulted in a Louisiana home health company owner and three former home health workers pleading guilty to health care fraud-related charges, the Justice Department announced. The case has grabbed media attention not only for the high dollar amount but for claims of racial bias and a scam related to the Deep Water Horizon oil spill.

Lisa Crinel, former owner and operator of Abide Home Care Services Inc., was indicted last March as part of a sweeping charge that involved 20 individuals.

As operator, Crinel was charged with Medicare fraud for allegedly hiring “house doctors” to sign home health orders for Medicare beneficiaries who did not need home care. The house doctors reportedly falsely signed home health orders—regardless of a beneficiary’s diagnoses, homebound status or needs—in return for monthly payments that were fraudulently characterized as medical consultant or director fees.

Following the indictment, Crinel, who is also the 2004 Zulu Queen, repeatedly attempted to have all evidence seized in a 2014 raid thrown out, alleging that federal authorities acted with racial bias when they seized the more than $1 million in property a year before she was indicted. She alleged that prosecutors seized the property in an effort to cripple her financially and would not have acted in the same way against a white defendant in a similar case. Crinel also said in a civil lawsuit that she had a romantic relationship with the husband of a federal judge who signed the search warrant for the FBI in the investigation in 2014, Louisiana news outlet WDSU News reported.

Crinel’s daughter, Wilneisha Harrison Jakes, who was serving as chief administrative officer for Abide, was also deeply involved with the scam and indicted. The company was also accused of hiring marketers to increase referrals, which are typically driven by health care professionals. Authorities allege that the company and defendants were involved in more than $30 million in Medicare fraud.

Crinel pled guilty to two counts of conspiracy to commit health care fraud and conspiracy to pay and receive illegal kickbacks. As a result, Crinel, 52, faces a maximum prison term of 10 years, a $250,000 fine and 3 years of supervised release following imprisonment. Her sentencing is scheduled for Jan. 13, 2016. She owes restitution in the amount of $16,088,222 jointly with several co-defendants.

Crinel and Abide were also accused of falsely applying for wage relief in the aftermath of the oil spill in the Gulf of Mexico caused by BP’s Deepwater Horizon oil rig. According to authorities, the home care company pocketed more than $37,000 in reimbursements from BP.

Threasa Adderley, 64, pled guilty to Count 2 of the Indictment for conspiracy to pay and receive illegal kickbacks. Adderley was a physician with Abide who acted as a medical consultant and received more than $48,000 of Medicare funds for medically unneccessary home health billing, court documents show.

Rhonda Maberry, 48, pled guilty to conspiracy to commit health care fraud. Mayberry worked as an Advanced Practice Registered Nurse with Abide and received payments totaling approximately $272,982.61 from Medicare between January 2006 and December 2012 for medically unnecessary home health.

Adderley and Maberry face a maximum term of 5 years imprisonment, a fine of $250,000, a supervised release term of up to 3 years and restitution.

Seila Mathieu, 46, pled guilty to aiding and abetting the theft of Government money of property and faces a maximum term of 1 year imprisonment, a fine of $100,000, a term of supervised release up to one year and restitution. Matheiu worked as a RN for Abide and received approximately $48,800 for performing false and fraudulent home health certifications that were largely medically unnecessary.

Twenty individuals were indicted conspiracy to commit health care fraud, conspiracy to defraud the United States and to receive and pay health care kickbacks, and the prosecutors warned that the case has not concluded for other individuals involved.

“Today’s guilty pleas are further evidence of our commitment to fighting health care fraud in our region,” U.S. Attorney Kenneth Polite said in a prepared statement. “Those engaged in similar criminality should take note: our investigation in this case, and other related matters, is on-going.”

Written by Amy Baxter

A Miami physician was indicted as part of a $20 million Medicare fraud conspiracy that already has found one home health operator sentenced to prison.

Henry Lora, 51, was charged with two counts of fraud on allegations that the part owner and operator of a Miami-area clinic wrote prescriptions for home health care and other services for Medicare beneficiaries that were not medically necessary in exchange for kickbacks and bribes.

Lora’s partner of the now-defunct clinic Merfi Corporation, Isabel Medina, already pleaded guilty to conspiracy to commit health care fraud and was sentenced to nine years in prison in March 2014. Medina admitted her part with her co-conspirators to defraud Medicare in losses exceeding $20 million.

Prosecutors allege that Merfi employed physicians, physician assistans and other medical professionals and falsified patient records to make it appear patients were qualified for the services billed to Medicare.

Three others from Miami pled guilty in January 2014 for taking part in the scam: Lerida Labrada, 59; Mayra Flores, 49; and German Martinez.

The indictment is part of a national sweep to collect Medicare losses. The Medicare Fraud Strike Force has charged over 2,300 defendants representing more than $7 billion in Medicare billing since its inception in 2007.

Written by Amy Baxter

When a home health care worker’s criminal record was expunged by a New York district judge earlier this year, the decision thrust the issue of employment discrimination based on past criminal convictions into the spotlight. For an industry that anticipates a shortage of caregivers in the future, the ruling was a boost for a growing movement to reduce or eliminate criminal background checks that bar employment.

The New York Times editorial board recently took to the opinion pages to voice support for the decision in the case, which concluded in May. The woman, named only as Jane Doe in court records, filed an application to have her record expunged after being unable to keep a job in home health care. Her past conviction of fraud—though not relevant to health care—has led to her firing at least “half a dozen times” over the past decade, court records show. Her record was expunged by the same judge who sentenced her in 2002, though no federal laws allow for expungement, the NY Times reported.

The ruling marks a changing attitude about criminal convictions in the United States. Several states and U.S. cities have adopted “Ban the Box” legislation over the past few years in an effort to increase fair chances for people with criminal convictions to be hired. This type of legislation bans the “box” where applicants are asked to answer if they have ever been convicted of a felony. While some of these laws do not prohibit employers from conducting a criminal background search later in the hiring process, the initiative aims to help an employer consider a job candidate’s qualifications without the stigma of a conviction.

There are nearly 70 million people in the U.S. living with a criminal conviction, or nearly one in four adults, who are subject to thousands of laws that can prevent employment and prohibit many other rights, according to the NY Times. The restrictions and consequences can follow Americans throughout their entire lives, even after completing sentences for non-violent, minor crimes.

The woman was involved in an insurance fraud case from 2001, where she netted just $2,500 for faking an injury following a staged car accident. She was sentenced to five years of probation, 10 months of home detention and ordered to pay restitution in the amount of $46,701 by U.S. District Court Judge John Gleeson in March 2002.

Gleeson granted her request after finding that her criminal record was preventing her from keeping a job as a home health worker.

“There is no justification for continuing to impose this disability on her,” Judge Gleeson wrote. “I sentenced her to five years of probation supervision, not to a lifetime of unemployment.”

The court documents also cited a letter from Attorney General Eric Holder to the State Governors that noted how past criminal convictions “impose additional burdens on people who have served their sentences without increasing public safety in essential ways.”

“Simply put, the public safety is better served when people with criminal convictions are able to participate as productive members of society by working and paying taxes,” Judge Gleeson wrote in his ruling.

Written by Amy Baxter

Allegations of stolen health records and their use to solicit customers to a new business are the basis of a seemingly ‘he-said-she-said’ lawsuit filed last week by home care agency Angels in Your Home.

The suit, filed against former Angels employees and All American Home Care, seeks damages for actions ranging from breaches of fiduciary duties to unfair competition. More specifically, the lawsuit aims to block All American from using any protected information allegedly taken from Angels; contacting current or potential Angels clients; and engaging in “further acts of unfair competition,” the Democrat & Chronicle reported.

Central to the allegations is the Consumer Direct Personal Assistance Program (CDPAP), which allows people to hire their own care providers as an alternative to skilled nursing facilities. These home care services are reimbursed by Medicaid, and both agencies are authorized by New York to provide nursing, personal care, housekeeping and other health and social services to clients.

The lawsuit came after advocacy group Center for Disability Rights disclosed that its clients had reported a possible breach of personal data. It names former Angels CEO Marco Altieri, along with seven other past employees: Jean Pierre Garvey, former human resources manager; Jaidy Rosario-Delgado, former human resources worker; Daniela Rosario-Delgado, Sean O’Brien and Molly Slifer, former employees and support specialists of the CDPAP; Elisa Heckathorn, former employee and director of CDPAP; and Beyri Payamps-Delgado, former finance coordinator. Glidedowan LLC, doing business as All American, is also named in the suit.

“There is no truth to any of these allegations whatsoever,” Michael Smith, attorney for Altieri and All American, told the Democrat & Chronicle. “Nothing happened as alleged. No one stole, copied, misappropriated, did anything with any patient files and everyone that left, left voluntarily and with their hands in their pockets. Nobody stole a thing.”

Smith argued that Angels’ goal with the lawsuit is to disrupt its competition. Attorneys for Angels didn’t immediately respond to the newspaper’s requests for comment on the case.

On Oct. 13, Altieri submitted his immediate resignation via email, according to the complaint. He and the other workers named in the lawsuit are now employed with All American.

The lawsuit goes on to allege the removal of physical files and the coping of all employee files. It also claims that defendants used personal and confidential information in these files to drive business from Angels to All American. Records show that since Oct. 1, nine Angels customers have requested to have their records transferred to All American.

Written by Kourtney Liepelt

U.S. District Court Judge Karon Bowdre ordered a new trial Monday in a False Claims Act case asserting that a hospice provider fraudulently billed Medicare for patients—and the fault for the new trial is her own, the judge stated.

The case is seeking to determine whether AseraCare, a subsidiary of Plano, Texas-based Golden Living, admitted Medicare beneficiaries who were ineligible for end-of-life care in order to rake in more money.

The first phase of the trial — which had been divided into two phases — ended on Oct. 19. The jury determined that AseraCare, which operates approximately 60 hospices in 19 states, had fraudulently billed for 104 of 121 patients.

When granting AseraCare’s request for a new trial, the Alabama federal judge said she had given the jury “incomplete” instructions prior to their deliberations in the first phase of the trial, AL.com reported. The second phase of the trial was originally scheduled to start on Oct. 26.

Bowdre said she did not include essential statements of the False Claims Act law in her jury instructions, such as the notion that claims are not false under that law when reasonable people can disagree on whether the hospice care was properly billed to the government, AL.com reported.

During the second phase of the trial, the jury was expected to hear claims that AseraCare pressured doctors and nurses to sign patients up and keep them in Medicare-funded hospice care.

Bowdre said the new trial, with a new jury, would start sometime after Jan. 1, 2016, AL.com reported.

AseraCare attorneys had asked Bowdre for a new trial after she said she realized she had committed “major reversible error” in the jury instructions, according to a motion filed Oct. 26 by U.S. Department of Justice (DOJ) attorneys.

The filing was a motion for reconsideration of the order to grant a new trial. In the document, the DOJ says Bowdre’s jury instructions “were correct as a matter of law.”

The judge granted AseraCare’s motion on the basis that she had failed to provide the jury with a “sufficient legal standard for evaluating the case,” the filing said.

“It would be grossly inefficient and unprecedented at this stage to empanel a second jury and force the taxpayers to bear the expense of a second twelve-week trial in phase one, especially because there is a great risk that the court will commit reversible error in the second trial by instructing the jury in the manner that it now contends is required,” the DOJ said in its motion.

DOJ attorneys also said a reversible error in a second trial would likely lead to a remand for a third trial.

If a jury ultimately finds against AseraCare, the hospice agency could have to pay more than $200 million, including fines and additional penalties — the biggest False Claims Act penalty ever involving a hospice provider.

Written by Mary Kate Nelson

The CEO of Chicago-based Mobile Doctors has pleaded guilty to bilking Medicare out of nearly $2 million for in-home treatments deemed lengthier than they actually were, Healthcare Finance News reported.

In his plea agreement, Dike Ajiri said he changed patient records to denote longer treatment times or more serious conditions. He also said he instructed his staff to do the same, and Mobile Doctors reportedly billed Medicare and the Railroad Retirement Board of Chicago approximately $1.9 million in fake claims as a result.

Mobile Doctors contracted with physicians to arrange in-home visits for customers in Illinois, Michigan, Indiana and other states. Ajiri was arrested in September 2013, and the firm has since gone out of business.

A sentencing hearing has been scheduled for April. Ajiri faces up to 10 years in prison.

Also arrested during an investigation into the company was Banio Koromo, a physician who had worked for Mobile Doctors since 2007. He is charged with falsely claiming patients homebound and has a trial scheduled for December.

Written by Kourtney Liepelt

Owners of a home health agency in Texas and two patient recruiters were arrested Tuesday for their alleged roles in conspiracies to defraud Medicare, to commit money laundering and to pay illegal health care kickbacks.

The defendants were charged in an indictment unsealed on Nov. 10.

The owners of Houston-based Fiango Home Healthcare, Marie Neba and Ebong Tilong, allegedly used the agency to bill Medicare for home health services that were not medically necessary, or not provided.

From in or around February 2006 to in or around June 2015, Neba and Tilong, both of Sugar Land, Texas, received about $13 million for these allegedly unnecessary or fictious home health services, according to a release from the U.S. Department of Justice.

According to the indictment, Tilong and Neba carried out this scheme by paying kickbacks to a series of people.

The owners allegedly paid illegal kickbacks to doctors in exchange for authorizing medically unnecessary home health services.

Using the money that Medicare paid for such fraudulent claims, Neba and Tilong purportedly paid illegal kickbacks to Connie Ray Island of Houston and Daisy Carter of Wharton, Texas, in exchange for referring Medicare beneficiaries for home health services.

All four defendants also allegedly paid illegal kickbacks to Medicare beneficiaries, in exchange enabling Tilong and Neba to bill using their Medicare information for home health services that were non-existent or were medically unnecessary.

In addition, Neba, who also served as the home health agency’s director of nursing, allegedly falsified medical records to make it seem as though Medicare beneficiaries qualified for and received home health services.

Written by Mary Kate Nelson

A case heard by the Supreme Court on Tuesday may make it easier for individuals accused of Medicare fraud to hire a lawyer. The defendant in the case is a former home health agency owner who has been under house arrest.

The case, Luis v. United States, in particular is seeking to determine whether the government can legally freeze a defendant’s legitimately acquired assets.

The defendant, Sila Luis, was indicted on charges of committing Medicare fraud in 2012. Over a six-year period, the owner of Miami home health agencies allegedly received $45 million dollars in fraudulent reimbursements, according to SCOTUSblog.

For two years Luis has been detained in her home as her case traveled to the Supreme Court, NPR reported. Now, Luis wants to utilize some of her “untainted” assets to hire an attorney for her trial.

The Supreme Court has previously ruled that the government may freeze property and money linked to criminal activity, or “tainted” assets, prior to a trial, NPR reported.

Luis v. United States is seeking to determine whether the government can freeze assets not linked to the alleged crime, like land, jewelry or cars obtained beforehand.

The government acknowledges that some of Luis’ financial holdings are not linked to her alleged criminal behavior, NPR reported. Still, prosecutors say that Luis has already spent so much of her tainted assets that if she is found guilty, she will not be able to pay back the Medicare Trust Fund the amount she owes — unless her untainted assets are available to be tapped.

Defense lawyer Howard Srebnick disagrees, arguing that the asset freeze adds up to a denial of the Sixth Amendment right to counsel.

“What the government proposes to do is financially cripple someone before they’ve been convicted, before they’ve had a trial and not allow them to use assets that are theirs to try to match the government in the courtroom,” Srebnick told NPR.

Medicare fraud has emerged as an ongoing problem in the home health industry. Earlier this week, for instance, owners of a home health agency in Texas and two patient recruiters were arrested for allegedly defrauding Medicare.

Last month, Lexington, Kentucky-based Nurses’ Registry and Home Health Corp. was ordered to pay the federal government $16 million for committing Medicare fraud.

Written by Mary Kate Nelson

The owners of a Washington, D.C., home care agency have been found guilty of bilking the District of Columbia Medicaid program of more than $80 million.

On Nov. 12, a jury found Florence Bikundi, 52, and her husband Michael Bikundi, 63, guilty of a slew of charges, including health care fraud, Medicaid fraud, money laundering and additional charges stemming from the scheme, which lasted from August 2009 to February 2014, according to a news release from the U.S. Attorney’s Office of the District of Columbia. The couple owned a home care agency called Global Healthcare, Inc.

Evidence presented during the trial indicated that Florence Bikundi, a former nurse, was not authorized to participate in the Medicaid program and was fraudulently approved as a provider. She and Michael Bikundi subsequently led a conspiracy to bill Medicaid for services that were not provided. The couple recruited other people to take part in the scheme and made up fraudulent paperwork to conceal the illegal activity.

The massive fraud scheme stemmed from Florence Bikundi hiding her turbulent past.

Back in 1999, Florence Bikundi went by Florence Igwacho, her maiden name. The Virginia Board of Nursing revoked Florence Igwacho’s nursing license in August of that year. In March 2000, the U.S. Department of Health and Human Services, Office of Inspector General told Florence Igwacho in writing that she was excluded from participation in Medicaid, Medicare and all federal health care programs because of the revocation.

In June 2009, under the name Florence Bikundi, she went on to conceal the revocation of her nursing license and the Medicaid exclusion when she applied for a Medicaid provider number for Global Healthcare.

Then, between August 2009 and February 2014, Florence and her husband billed the D.C. Medicaid program for personal home health aide services that were never provided to Medicaid beneficiaries. Bogus time sheets, employment files and patient files were created, as well.

Global Healthcare generated increasing amounts of payments as the years went on, going from about $1.35 million in 2009 to $14.27 million in 2011 to $27.16 million in 2013, according to the U.S. Department of Justice.

The Bikundis used the proceeds to support a high-end lifestyle, according to government evidence.

“The money they stole for their own benefit could and should have been used to help others who were truly in need,” said Channing D. Phillips, U.S. Attorney for the District of Columbia, in a prepared statement. “Instead, they used the proceeds to finance a lavish lifestyle, including a million-dollar home, a $140,000 Land Rover, a $120,000 Porsche and a $75,000 Mercedes Benz.”

The Bikundis are scheduled to be sentenced on Feb. 26, 2016. The charges involve statutory maximums of decades in jail. Along with prison terms, Florence and Michael Bikundi are subject to a forfeiture money judgment equal to the total proceeds they acquired from this scheme.

Seven others previously pled guilty to charges in the investigation, including Florence Bikundi’s two sisters and Florence Bikundi’s son.

Written by Mary Kate Nelson

A Philadelphia-area home health agency and its president have been charged with Medicaid fraud by the Pennsylvania Attorney General’s Office.

Hearts of Love Home Care Inc. and its president, David Adenaike, allegedly defrauded Medicaid out of more than $100,000 between November 2010 and June 2013, the Philadelphia Business Journal reported. A statewide investigating grand jury recommended the charges, which were filed by the Office of Attorney General’s Medicaid Fraud Control Section, according to the publication.

Hearts of Love Home Care employed home health care attendants to provide community- and home-based services to clients in the Philadelphia region.

An audit allegedly showed the agency did not have documentation to support several services for which it had billed Medicaid, the Philadelphia Business Journal reported. The grand jury presentment says signatures on various documents could not be validated, timesheets could not be provided, and several activity reports and timesheets allegedly seemed to be photocopies that were identical, except for the dates of service.

An office manager and four attendants who all worked for Hearts of Love Home Care also allegedly told investigators their signatures were forged on daily activity reports or timesheets, the grand jury heard.

Written by Mary Kate Nelson

The owner of an Illinois home health care company has been accused of defrauding Medicare out of at least $450,000, according to a new federal indictment.

Jacqueline Tuanqui, who owns Harwood Heights, Illinois-based Hexagram Home Health Care LLC, allegedly paid kickbacks to marketers to generate referrals of Medicare beneficiaries to Hexagram. An outside marketer, Susie Avellanosa, supposedly received payments from Tuanqui in exchange for referring non-homebound Medicare beneficiaries to the agency.

Avellanosa, who was also charged in the indictment, owns Elgin, Illinois-based Allied Care Services Inc.

The indictment contends that the scheme started around November 2012 and went on until about April 2014. As part of the scheme, Tuanqui and Avellanosa signed written contracts that were intended to hide the true nature of the kickback deal, which involved Avellanosa being paid for supplying a pre-determined number of patients to Hexagram every month. The written agreements fraudulently stated that Avellanosa would be paid based on the number of hours she worked, without mentioning the real nature of the conspiracy, the U.S. Department of Justice reported.

Tuanqui paid the bribes despite the fact that some of the patients did not qualify for the in-home treatment Hexagram provided, according to the indictment. Medicare allegedly paid Hexagram at least $450,000 for treatment given to patients who were referred there because of a kickback.

Tuanqui has been charged with one count of conspiracy to pay or receive healthcare kickbacks, and eight counts of paying kickbacks to induce referrals of Medicare beneficiaries. Avellanosa, meanwhile, has also been charged with one count of conspiracy to pay or receive healthcare kickbacks, and eight counts of receiving kickbacks in return for referring Medicare beneficiaries.

Both women pleaded not guilty during arraignments before U.S. Magistrate Judge Mary M. Rowland on Dec. 9. Their next court appearance is scheduled to take place Jan. 28, 2016.

Written by Mary Kate Nelson

Two physicians and a registered nurse in Louisiana were sentenced Dec. 16 for their participation in a scheme defrauding Medicare out of more than $50 million.

Barbara Smith, a 67-year old doctor from Metairie, Louisiana, was sentenced to 80 months in jail and ordered to pay $9.5 million, The Times-Picayune reported. Roy Berkowitz, a 69-year-old physician from Slidell, Louisiana, was sentenced to 64 months in jail and ordered to pay $5 million.

Meanwhile, Beverley Breaux, a 67-year-old registered nurse from New Orleans, was ordered to pay $2 million and sentenced to 50 months in prison.

In November, Joe Ann Murthil, an office manager and biller at Memorial Home Health Inc., was sentenced to four years in jail and ordered to pay $14.1 million for her involvement in the scheme. Memorial Home Health reportedly submitted about 8,000 false claims over a period of more than six years, ending in August 2013.

Berkowitz and Smith were accused of referring Medicare beneficiaries to Memorial and three additional sham agencies for home health services that were not medically necessary and, in some cases, were not performed. Breaux, meanwhile, was accused of having the home health agency submit false claims.

Slidell, Louisiana, resident Mark Morad, whom the FBI called the “mastermind” of the scheme, owned Memorial and other companies that conducted business in a similarly fraudulent manner, The Times-Picayune reported. He and Divini Luccioni, a physician, plead guilty to conspiracy charges in December 2014. Sentencing is scheduled for Luccioni on Jan. 13 and for Morad on March 9, The Times-Picayune reported, citing Justice Department spokesman Peter Carr.

Seven additional people have pled guilty in the scheme and are waiting to be sentenced, The Times-Picayune reported.

Written by Mary Kate Nelson