WASHINGTON – Ten Miami-area residents pleaded guilty today and yesterday in U.S. District Court in Miami for their participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, the Department of Health and Human Services (HHS) and the FBI.
Each defendant pleaded guilty before U.S. District Judge Joan A. Lenard to one count of conspiracy to commit health care fraud. According to plea documents, the defendants included an administrator, nurses and patient recruiters for two related Miami home health care agencies, ABC Home Health Inc. and Florida Home Health Providers Inc. ABC and Florida Home Health purported to provide home health and therapy services to Medicare beneficiaries. However, according to court documents, the agencies only existed to defraud Medicare.
The 10 defendants each admitted that they participated in a fraud scheme to bill the Medicare Program for expensive physical therapy and home health care services that were prescribed by doctors but were medically unnecessary and never provided.
According to court documents, beginning in approximately January 2006, and continuing until approximately March 2009:
According to court documents, Fry and Angulo, along with their co-defendant nurses, falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services. Fry and Angulo admitted that they knew the beneficiaries did not qualify for and did not receive the services. Fry, Angulo, and their co-defendant nurses described in nursing notes and patient files non-existent symptoms such as tremors, impaired vision, weak grip and inability to walk without assistance. Defendants included these symptoms to make it appear that the patients were unable to self-inject insulin and were homebound, thus appearing to qualify for home health care benefits under Medicare. The files were falsified so that Medicare could be billed for medically unnecessary therapy and home health related services.
According to plea documents, Diaz distributed kickback payments to the patient recruiters on behalf of the owners of ABC and Florida Home Health. Diaz worked in the offices of ABC and Florida Home Health and was aware that office staff manipulated the patient files and nursing notes for patients at ABC and Florida Home Health. Specifically, Diaz was aware that office staff manipulated the nursing notes by adding patient conditions, such as shortness of breath, hand tremors and poor vision, which were non-existent. The patient files and nursing notes were fabricated to make it appear that the patients qualified for the services.
Nine of the defendants admitted to recruiting Medicare beneficiaries who would allow ABC and Florida Home Health to bill Medicare for home health care and therapy services that were medically unnecessary and/or never provided. In doing so, the defendants solicited and received kickbacks and bribes from the owners and operators of the home health agencies in return for allowing the companies to bill the Medicare program on behalf of the recruited patients. The defendants knew that the patients they recruited did not qualify for the services billed to Medicare. In addition, the defendants knew that the patient files for their recruited patients were falsified in order to make it appear that the patients qualified for the services.
The defendants were originally charged in a February 2011 indictment. Five other co-conspirators have pleaded guilty for their roles in the fraud scheme: Jose Nunez, M.D., Lisandra Alonso, Luisa Morciego, Vicente Guerra and Farah Maria Perez.
Sentencings have been scheduled for various dates in October, November and December 2011.
The charge of conspiracy to commit health care fraud carries a maximum prison sentence of 10 years. The defendants also face fines and terms of supervised release, as well as forfeiture of any property or proceeds derived from their criminal activities.
The pleas were announced by Assistant Attorney General Lanny A. Breuer of the 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 and Acting Assistant Chief Benjamin D. Singer 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 Miami.
Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,140 individuals who collectively have falsely billed the Medicare program for more than $2.9 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.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov .