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Friday, June 27, 2014
Patient Recruiter Pleads Guilty for Role in $6.5 Million Health Care Fraud Scheme

A patient recruiter for a Miami home health care agency pleaded guilty today in connection with a health care fraud scheme involving defunct home health care company Nestor’s Health Services Inc. (Nestor HH). The owner and operator of Nestor HH pleaded guilty to charges related to the scheme earlier this month.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office, and Acting Special Agent in Charge Ryan Lynch of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office made the announcement.

On June 27, 2014, Euridice Borroto, 45, of Miami, Florida, pleaded guilty before U.S. Magistrate Judge Jonathan Goodman in the Southern District of Florida to one count of conspiracy to solicit and receive health care kickbacks and to defraud the United States. Sentencing is scheduled for Aug. 25, 2014.

According to court documents, Borroto was paid bribes and kickbacks for recruiting patients on behalf of Nestor HH, a Miami home health care agency that purported to provide home health and physical therapy services to Medicare beneficiaries. The owner and operator of Nestor HH operated Nestor HH 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.

According to court documents, Borroto solicited and received kickbacks and bribes from the owner and operator of Nestor HH in return for recruiting and providing patients to Nestor HH for home health care and therapy services that were medically unnecessary and, in many instances, were not provided. Nestor HH would then fraudulently bill the Medicare program for home health care services on behalf of the recruited patients, in violation of federal criminal laws. Borroto knew that in many instances the patients she recruited for Nestor HH did not qualify for the services billed to Medicare.

From approximately March 2009 through at least January 2014, Nestor HH submitted more than $6.5 million in claims for home health services. Medicare paid Nestor HH more than $6.1 million for these fraudulent claims before the fraud was exposed.

In documents filed with the court, Borroto also acknowledged her involvement in similar fraudulent schemes at other Miami health care agencies.

The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case is being prosecuted by Trial Attorneys Anne P. McNamara and A. Brendan Stewart of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $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.

To learn more about the Health Care Fraud Prevention and Enforcement Team (HEAT), go to: www.stopmedicarefraud.gov.

 

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