The owners and operators of two Miami health care agencies were sentenced to prison and ordered to pay millions in restitution for their participation in a $48 million home health Medicare fraud scheme that billed for unnecessary home health care and therapy services.
A U.S. District Judge in federal court in the Southern District of Florida sentenced the two defendants, both of the Miami-Dade area, to 108 months and 51 months in prison, respectively. In addition to the prison term, one defendant was sentenced to pay $33 million in restitution, and the other defendant was sentenced to pay $2.1 million in restitution. Both defendants were also sentenced to serve three years of supervised release and pay a $100,000 fine. In December 2012, each pleaded guilty to one count of conspiracy to commit health care fraud.
According to court documents, one defendant was the owner of both Caring Nurse Home Health Corp. and Good Quality Home Health Inc., and the other defendant was a manager at Caring Nurse and owner of Good Quality.
According to plea documents, the two defendants conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services. The two defendants and their co-conspirators paid kickbacks and bribes to patient recruiters. In return, recruiters provided patients to Caring Nurse and Good Quality, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. The two defendants used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for home health care services, which both defendants knew was in violation of federal criminal laws.
According to court documents, nurses and office staff at Caring Nurse and Good Quality falsified patient files to make it appear the Medicare beneficiaries qualified for services they did not. One defendant admitted to knowing that these files were falsified so the Medicare program could be billed for medically unnecessary therapy and home health related services.
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 were not provided. According to court documents, Medicare paid approximately $33 million for these fraudulent claims.
The case 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 Southern District of Florida. 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.
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