A 63 year old woman from Miami, who was an administrator and employee of two Miami health care companies, was sentenced to serve 60 months in prison for her participation in a $74 million home health Medicare fraud scheme. In May 2013, she pleaded guilty, without a plea agreement, to one count of conspiracy to pay health care kickbacks and two counts of payment of health care kickbacks.
According to court documents, the woman was an administrator of LTC Professional Consultants Inc. (LTC) and an employee of Professional Home Care Solutions Inc. (Professional). Both LTC and Professional were Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. She and her co-conspirators agreed to and actually did operate LTC and Professional 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.
Her primary role in the scheme was to pay kickbacks and bribes to patient recruiters of LTC and Professional. As part of this role, the woman and others would distribute cash to patient recruiters in exchange for providing patients to LTC and Professional, as well as prescriptions, plans of care (POCs), and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. She and her co-conspirators would use these prescriptions, POCs, and medical certifications to fraudulently bill the Medicare program for home health care services, which she knew was in violation of federal criminal laws.
From approximately September 2007 through June 2012, LTC and Professional submitted approximately $41 million in claims for home health services that were not medically necessary and/or not provided. Medicare actually paid approximately $27 million for these fraudulent claims. The woman was part of an overall scheme that fraudulently billed Medicare more than $74 million.
See the DOJ Announcement