Showing posts with label HOME HEALTH CARE SCHEME. Show all posts
Showing posts with label HOME HEALTH CARE SCHEME. Show all posts

Wednesday, May 9, 2012

DOCTOR AND HOME HEALTH AGENCY OWNER PLEAD GUILTY FOR ROLES IN $13.8 MILLION FRAUD


FROM:  U.S. DEPARTMENT OF JUSTICE
Tuesday, May 8, 2012
Doctor and Home Health Agency Owner Plead Guilty in Connection with Detroit Fraud Scheme
WASHINGTON – Detroit-area residents Zahir Yousafzai and Dr. Dwight Smith pleaded guilty yesterday for their roles in a $13.8 million home health care fraud and money laundering scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Yousafzai, 42, pleaded guilty before U.S. District Judge Gerald E. Rosen of the Eastern District of Michigan to one count of conspiracy to commit health care fraud and one count of money laundering.  Smith, 59, pleaded guilty before Judge Rosen to one count of conspiracy to commit health care fraud.

According to information contained in plea documents, in 2009, Yousafzai and his co-conspirators acquired beneficial ownership and control over two home health companies, First Care Home Health Care LLC and Moonlite Home Care Inc.  Yousafzai also assisted in the operation of two home health care companies owned by co-conspirators, Physicians Choice Home Health Care LLC and Quantum Home Care Inc.  Yousafzai admitted that these home health agencies billed Medicare for home health visits that never occurred.  Between July 2008 and September 2011, Yousafzai and his co-conspirators submitted or caused the submission of approximately $13.8 million in fraudulent home health claims to the Medicare program by the four home health agencies.  Medicare paid more than $4 million to First Care and Moonlite, the companies that Yousafzai beneficially owned in whole or in part.

Yousafzai admitted to paying and directing the payment of various medical professionals, including doctors, nurses, physical therapists and physical therapy assistants, to create fictitious patient files to document purported home health services that were never provided.  Yousafzai, a physical therapy assistant, also signed fictitious patient files in which physical therapy services were documented, but never actually provided.

Yousafzai also admitted that he paid and directed the payment of kickbacks to recruiters who obtained beneficiaries’ information and used the information to submit claims for home health services that were never provided.  The beneficiaries sometimes pre-signed forms and visit sheets that were later falsified to indicate that they received home health services that were never provided.  Other times, the beneficiaries’ signatures were forged on forms and visit sheets.

Additionally, Yousafzai admitted that he incorporated a shell company known as A-1 Nursing and Rehab Inc. for the purpose of laundering the proceeds of health care fraud, which were obtained through the submission of false and fraudulent claims to Medicare.
According to plea documents, beginning in or around September 2009, Smith began referring Medicare beneficiaries for home health care services to Physicians Choice Home Health Care LLC and Quantum Home Care Inc.  During that time, Smith owned and controlled Supreme Medical Associates PLLC, a Michigan corporation doing business in Detroit under the assumed name of Smith Medical Center.  In May 2010, Smith incorporated Phoenix Visiting Physicians PLLC.

Smith Medical Center and Phoenix employed individuals who claimed to be doctors, but, in fact, were not licensed in the state of Michigan to perform any medical services.  The unlicensed doctors met with and purported to examine Medicare beneficiaries for home health care services.  Smith did not meet or examine these beneficiaries and they were not homebound.  Many of the beneficiaries were paid to pre-sign patient visit forms and did not receive home health services from Physicians Choice, First Care and Quantum.  From in or around September 2009 through in or around September 2011, Medicare paid approximately $6.5 million for fraudulent home health care claims submitted by Physicians Choice, First Care and Quantum based on Smith’s referrals.

The guilty pleas were announced by Assistant Attorney General Lanny A. Breuer of the Criminal Division; U.S. Attorney for the Eastern District of Michigan Barbara L. McQuade; Special Agent in Charge Andrew G. Arena of the FBI’s Detroit Field Office; and Special Agent in Charge Lamont Pugh III of the HHS Office of Inspector General’s (OIG) Chicago Regional Office.

This case was prosecuted by Trial Attorney Catherine K. Dick of the Criminal Division’s Fraud Section.  It was investigated by the FBI and HHS-OIG, and 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 Eastern District of Michigan.

Since their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,300 defendants who collectively have falsely billed the Medicare program for more than $4 billion.  In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Wednesday, April 4, 2012

OWNERS/EMPLOYEES PLEAD GUILTY IN MIAMI $20 MILLION HOME HEALTH CARE SCHEME


FROM:  DEPARTMENT OF JUSTICE
Monday, April 2, 2012
Two Owners and Two Employees of Miami Home Health Company Plead Guilty in $20 Million Health Care Fraud Scheme
WASHINGTON – Two owners and two employees of a Miami home health care agency pleaded guilty for their participation in a $20 million Medicare fraud scheme involving false billings for home health care services, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).

Ariel Rodriguez, 41, Reynaldo Navarro, 37, and Ysel Salado, 26, each pleaded guilty today before U.S. District Judge Marcia G. Cooke to one count of conspiracy to commit health care fraud, and Melissa Rodriguez, 24, pleaded guilty on March 28, 2012, before Judge Cooke to the same charge.
           
According to court documents, Ariel Rodriguez and Reynaldo Navarro were the owners of Serendipity Home Health Inc., a Florida home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries.  Melissa Rodriguez and Ysel Salado were employees at Serendipity Home Health.

According to plea documents, Ariel Rodriguez, Navarro and their co-conspirators paid kickbacks and bribes to patient recruiters.  In return, the recruiters provided patients to Serendipity, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services.  Ariel Rodriguez and Navarro used the prescriptions, POCs and medical certifications to fraudulently bill the Medicare program, which Ariel Rodriguez and Navarro knew was in violation of federal criminal laws.

Melissa Rodriguez and Salado admitted that they cashed checks from Serendipity and provided the cash to Ariel Rodriguez and Navarro to use for the kickback payments.
According to plea documents, Serendipity nurses and office staff falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services.  In fact, the beneficiaries did not actually qualify for and did not receive such services.  Ariel Rodriguez and Navarro admitted that they knew files were falsified so that Medicare could be billed for medically unnecessary services.

From approximately April 2007 through March 2009, Ariel Rodriguez, Navarro and their co-conspirators submitted approximately $20 million in false and fraudulent claims to Medicare.  Medicare paid approximately $14 million on those claims.

The pleas were announced today by Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; John V. Gillies, Special Agent-in-Charge 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.

This case is being prosecuted by Trial Attorney Joseph S. Beemsterboer of the Criminal Division’s Fraud Section.  The case was investigated by the FBI and HHS-OIG, and 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 their inception in March 2007, Medicare Fraud Strike Force operations in nine locations have charged more than 1,190 defendants who collectively have falsely billed the Medicare program for more than $3.6 billion.  In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

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