The owners and operators of several Miami home health care agencies and a patient recruiter pleaded guilty today in connection with a health care fraud scheme involving defunct home health care company Trust Care Health Services Inc. (Trust Care).
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; Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations Miami office; and Acting Special Agent in Charge Michael J. DePalma of the Internal Revenue Service—Criminal Investigation’s (IRS-CI) Miami Field Office made the announcement.
Roberto Marrero, 60; Sandra Fernandez Viera, 49; and Enrique Rodriguez, 59, all of Miami, pleaded guilty before U.S. Magistrate Judge Edwin G. Torres in the Southern District of Florida to conspiracy to commit health care fraud and conspiracy to receive and pay health care kickbacks.
Marrero and Fernandez Viera were owners and operators of Trust Care, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. Rodriguez worked as a patient recruiter on behalf of Trust Care and Marrero and Fernandez Viera.
According to court documents, Marrero and Fernandez Viera operated Trust Care for the purpose of billing the Medicare Program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.
Marrero largely controlled Trust Care and, in light of that role, oversaw the schemes operating out of the company. Fernandez Viera’s primary role, among others, involved managing and supervising personnel at Trust Care. Both Marrero and Fernandez Viera were responsible for negotiating and paying kickbacks and bribes, interacting with patient recruiters, and coordinating and overseeing the submission of fraudulent claims submitted to the Medicare program.
Marrero, Fernandez Viera and their co-conspirators paid kickbacks and bribes to patient recruiters, including Rodriguez, in return for the recruiters providing patients to Trust Care for home health and therapy services that were medically unnecessary and/or not provided. Marrero, Fernandez Viera and their co-conspirators at Trust Care also paid kickbacks and bribes to co-conspirators in doctors’ offices and clinics in exchange for home health and therapy prescriptions, medical certifications and other documentation. Marrero, Fernandez Viera and their co-conspirators used these prescriptions, medical certifications and other documentation to fraudulently bill the Medicare program for home health care services, which Marrero and Fernandez Viera knew was in violation of federal criminal laws.
Rodriguez offered and paid kickbacks and bribes to Medicare beneficiaries in return for those beneficiaries allowing Trust Care to bill Medicare for services that were medically unnecessary and/or not provided. Rodriguez solicited and received kickbacks and bribes from the owners and operators of Trust Care, including Marrero and Fernandez Viera, in return for his patient recruiting. Rodriguez knew that in many instances the patients he recruited for Trust Care did not qualify for the services billed to Medicare.
From approximately March 2007 through at least October 2010, Trust Care submitted more than $20 million in claims for home health services. Medicare paid Trust Care more than $15 million for these fraudulent claims.
Marrero, Fernandez Viera and Rodriguez also acknowledged their involvement in similar fraudulent schemes at several other Miami health care agencies in addition to Trust Care with estimated total losses of approximately $50 million, including Global Nursing Home Health Inc., Lovable Home Health Services Corp., New Concepts In Health Inc., Ubieta Health System Inc., R&M Health Care Inc., Vital Care Home Health Services Inc., Centrum Home Health Care Inc. and A&B Health Services Inc.
At sentencing, scheduled for Nov. 12, 2013, the defendants face a maximum penalty of 10 years in prison for conspiracy to commit health care fraud and five years in prison for conspiracy to receive and pay health care kickbacks.
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Source- http://www.justice.gov/usao/txs/1News/Releases/2013%20September/130905%20-%20Nowlin.html
HOUSTON – Yolanda Nowlin, 42, has been convicted of conspiracy to commit health care fraud, four counts of health care fraud, conspiracy to commit kickback fraud and aiding and abetting Social Security fraud, United States Attorney Kenneth Magidson announced today. The verdicts were returned late yesterday afternoon following seven days of trial and less than three hours of deliberations.
Nowlin, of Bryan, ran two durable medical equipment companies - Yellabone Medic Care Express Equipment Supply Company and Yellabone Medical Equipment Inc. Nowlin was arrested in December 2012 along with co-defendant Carla Parnell, 50, also from Bryan. Parnell pleaded guilty earlier this year to Social Security fraud and testified against Nowlin at the jury trial.
The evidence at trial showed that between July 2003 and December 2009, Nowlin engaged in a scheme to defraud Medicare and Medicaid. Nowlin submitted claims to Medicare and Medicaid for durable medical equipment (DME) and incontinence supplies that were not delivered, not wanted and not needed by Medicare or Medicaid beneficiaries and were often the result of illegal kickbacks. During the alleged conspiracy, Nowlin submitted approximately $3,391,771.90 in claims to Medicare and Medicaid and received $1,108,316.82 for those claims. Approximately $750,000 was identified as fraudulently paid.
The evidence at trial also showed that Nowlin paid kickbacks to a large number of recruiters over the course of the scheme in return for the referral of beneficiaries to Yellabone.
Nowlin was additionally convicted of aiding and abetting the theft of government money from the Social Security administration. Nowlin and Parnell concealed Parnell’s employment with Yellabone in order to continue Parnell’s receiving Social Security disability benefits to which she was not entitled.
Nowlin faces up to 10 years for aiding and abetting Social Security fraud, up to 10 years for each count of health care fraud, up to 10 years for conspiracy to commit health care fraud and a maximum of five years for conspiracy to commit kickback fraud. She could also face the possibility of up to a $250,000 fine.
Nowlin’s sentencing hearing is set for Dec. 13, 2013, while Parnell is scheduled to be sentenced Dec. 20, 2013. Both women were permitted to remain on bond pending their respective hearings.
The United States is additionally seeking forfeiture of approximately $750,000 to be paid as restitution to Medicare and Medicaid.
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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.
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PHILADELPHIA - Aleksandr N. Zagorodny, 40, of Southampton, PA, was sentenced today to 78 months in prison for a healthcare fraud scheme involving MedEx Ambulance, Inc., located in Feasterville, PA. Zagorodny was the President and a founder of MedEx Ambulance. His 36 year-old brother, Sergey Zagorodny, from Philadelphia, PA, the former Vice-president and co-owner of the company, was sentenced to 60 months in prison for his involvement in the health care fraud scheme. MedEx Ambulance was ordered to be dissolved after it has been excluded from participation in Medicare and its assets are transferred to the government to satisfy restitution and forfeiture obligations. Each defendant had pleaded guilty to all counts in a 41-count indictment including health care fraud, false statements in connection with health care matters, wire fraud, and conspiracy to commit health care fraud and wire fraud.
Defendant MedEx Ambulance and its owners transported patients who were able to walk and could travel safely by means other than ambulance and who were not eligible for ambulance transportation under Medicare requirements. Falsified reports made it appear that the patients needed to be transported by ambulance when the defendants and their employees knew otherwise. The defendants billed for the ambulance services as if those services were medically necessary. The Medicare program was bilked out of more than $3.4 million through this fraud.
U.S. District Court Judge Berle M. Schiller also ordered restitution to Medicare in the amount of $3,418,358.81, a special assessment of $4,100 for each individual defendant and $16,400 for the corporation, and a 3-year term of supervised release for the individuals and 5 years of probation for the corporation. The Court ordered the forfeiture of four ambulances that had been purchased for over $200,000, as well as forfeiture of bank accounts worth over $40,000, and entered a money judgment against the defendants for $3,418,358.81. In connection with the sentencing, the company agreed to sell its base of operations and to provide the proceeds of that sale to the government in partial satisfaction of the defendants’ restitution obligations. The defendants and their wives also pledged to sell their family homes, as well as additional property, and to provide the proceeds of the sale of those assets to partially satisfy the defendants’ restitution obligations.
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Source- http://www.justice.gov/usao/txs/1News/Releases/2013%20September/130904%20-%20Ramirez%20and%20Velasquez.html
CORPUS CHRISTI, Texas - Sylvia Salinas Ramirez, of Driscoll, and Debra Jean Velasquez, of Robstown, have been convicted of wire fraud and conspiring to do so as part of a scheme to defraud the Texas Medicaid program through fraudulent home health billings, United States Attorney Kenneth Magidson announced today along with Texas Attorney General Greg Abbott.
Ramirez, 52, and Velasquez, 41, were charged in a 14-count federal indictment returned Wednesday, May 8, 2013. Today, they appeared before U.S. District Judge Nelva Gonzales Ramos and entered pleas of guilty to conspiring to submit false and fraudulent bills to the Texas Medicaid Program by wire transmissions as well as wire fraud for using interstate wire transmissions to bill.
The two women admitted that from or about Aug. 1, 2009, through on or about June 15, 2010, they were employed by the Corpus Christi office of MRNG Inc. doing business as Caring Touch Home Health. During that time, they conspired to submit false and fraudulent bills through wire transmissions to the Texas Medicaid program and the Medicaid funded managed care organizations known as Evercare of Texas LLC and Superior Health Plan Inc. for home health services that had not been provided. Ramirez and Velasquez admitted they created false and fraudulent time sheets for former Caring Touch employees for home health services that had not been provided and then fraudulently billed Medicaid, Evercare and Superior in the name of Caring Touch for those non-existent services. They sent approximately 562 of those false and fraudulent bills by wire.
Ramirez and Velasquez also admitted that in order to personally profit from their fraudulent billings, they created phony payroll records from the fraudulent time sheet which they then sent to Caring Tough’s payroll staff. Ramirez and Velasquez then obtained the payroll checks generated from the false and fraudulent time records, forged the signatures of the former Caring Touch employees, then cashed the checks and divided the money among themselves. Caring Touch and the former employees whose names were used on the false time sheets and checks were not accused of any wrongdoing.
Ramirez and Velasquez admitted that as a result of their false and fraudulent claims, Texas Medicaid, Evercare and Superior paid the approximate aggregate sum of $155,127.72. As part of their pleas, the women have agreed to pay restitution in that amount.
Conspiracy to commit wire fraud and wire fraud each carry a maximum punishment of 20 years in federal prison without parole as well as a possible $250,000 fine. Judge Ramos has set sentencing Dec. 3, 2013. Ramirez and Velasquez were permitted to remain on bond pending that hearing.
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Source- http://www.justice.gov/opa/pr/2013/August/13-crm-981.html
A former office manager at the defunct health care provider Health Care Solutions Network Inc. (HCSN) was sentenced today in Miami to serve 68 months in prison for her role in a fraud scheme that resulted in more than $63 million in fraudulent claims to Medicare and Florida Medicaid.
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 B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) Office of Investigations Miami office made the announcement.
Lisset Palmero, 45, of Miami, was sentenced by U.S. District Judge Cecilia M. Altonaga in the Southern District of Florida. In addition to her prison term, Palmero was sentenced to three years of supervised release and ordered to pay restitution in the amount of $17.4 million.
During the course of the conspiracy, Palmero was employed as a receptionist and office manager at HCSN, a mental health facility that purported to provide Partial Hospitalization Program (PHP) services. A PHP is a form of intensive treatment for severe mental illness.
HCSN of Florida (HCSN-FL) operated community mental health centers at two locations. According to court documents, Palmero was aware that HCSN-FL paid illegal kickbacks to owners and operators of Miami-Dade County Assisted Living Facilities (ALF) in exchange for patient referral information to be used to submit false and fraudulent claims to Medicare and Medicaid. Palmero also knew that many of the ALF referral patients were ineligible for PHP services because they suffered from mental retardation, dementia or Alzheimer's disease.
Court documents reveal that Palmero was aware that HCSN-FL personnel were fabricating patient medical records. Many of these medical records were created weeks or months after the patients were admitted to HCSN-FL for purported PHP treatment. Palmero was also aware that medical records were fabricated for “ghost patients” who were never admitted to the HCSN-FL PHP. During her employment at HCSN-FL, Palmero actively concealed the fabrication of medical records by preparing, and causing others to prepare, documentation that was later utilized to support false and fraudulent billing to government-sponsored health care benefit programs, including Medicare and Florida Medicaid.
According to court documents, from 2004 through 2011, HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported HCSN-FL mental health services.
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Source- http://www.justice.gov/usao/ncm/news/2013/08_28_13.html
Ordered to serve prison time and pay restitution
GREENSBORO, N.C. – United States Attorney Ripley Rand of the Middle District of North Carolina announced today that two Alamance County residents have been sentenced to prison for defrauding the Medicaid program.
EVELYN FULLER, 61, and MICHAEL McLEAN, 57, were sentenced by United States District Judge Catherine Eagles in federal court in Greensboro, North Carolina, on Tuesday, August 27, 2013. FULLER was sentenced to 26 months imprisonment. Her co-defendant, McLEAN, was sentenced to 36 months imprisonment. FULLER and McLEAN were also ordered to pay restitution to the Medicaid program in the amount of $399,811.44. Both FULLER and McLEAN will serve three years of supervised release after serving their prison sentences.
FULLER and McLEAN plead guilty on February 27, 2013, to health care fraud charges in connection with a scheme to defraud the North Carolina State Medicaid program in connection with community support services. Both worked for a company called Harvest House Community Development Corporation, through which they submitted false claims to the Medicaid program for community support services which were not actually rendered. Community support services are rehabilitative services for eligible children and adults in which the clinical and diagnostic needs of the clients are arranged, coordinated, and monitored.
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