WASHINGTON – An office manager for a Miami home health care agency was sentenced today to 78 months in prison for her participation in a $25 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS). Two of her co-defendants were also sentenced to prison today for their roles in the fraud scheme.
The defendants were sentenced by U.S. District Judge Joan A. Lenard in the Southern District of Florida.
Alonso, Ros and Perez each pleaded guilty earlier this year to one count of conspiracy to commit health care fraud. They were each ordered to pay their restitution jointly and severally with co-conspirators and defendants in a related case.
According to court documents, Alonso was an office manager and patient recruiter for ABC Home Health Care Inc., a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. Ros was a patient recruiter for both ABC and Florida Home Health Care Providers Inc., another related home health care agency. Perez was a registered nurse and a patient recruiter for Florida Home Health. According to court documents, ABC and Florida Home Health only existed to defraud Medicare.
Alonso, Ros and Perez admitted that beginning in approximately January 2006 and continuing until approximately March 2009, they recruited 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. Alonso, Ros and Perez solicited and received kickbacks and bribes from the owners and operators of ABC and Florida Home Health in return for the recruited patients. Alonso, Ros and Perez knew that the patients they recruited did not qualify for the services billed to Medicare and that the files for the recruited patients were falsified to make it appear that the patients qualified for the services.
According to court documents, Perez and her co-defendant nurses falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services. Perez admitted that she knew the beneficiaries did not qualify for and did not receive the services. The files were falsified so that Medicare could be billed for medically unnecessary therapy and home health related services.
According to plea documents, as office manager, Alonso taught the owners and operators of ABC how to operate a fraudulent home health agency. Alonso explained the importance of recruiters, kickbacks, doctors, beneficiaries and Medicare billing. In this role, Alonso negotiated the kickback payment rates between the patient recruiters and the owners and operators of ABC. Alonso distributed the kickback payments to the patient recruiters on behalf of the owners and operators of ABC.
As office manager, Alonso also taught nurses at ABC how to falsify patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services when, in fact, she knew that the beneficiaries did not qualify for and did not receive such services.
As a result of the participation of Alonso, Ros and Perez in the illegal scheme, the Medicare program was billed approximately $17 million, $395,000 and $118,000, respectively, for purported home health care services that were not medically necessary and/or were not provided.
The sentences were announced 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 1,160 defendants 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 .