Lisa Crinel, Abide Home Health, Inc., and Three Others Plead Guilty to Health Care Fraud-Related Charges
U.S. Attorney Kenneth A. Polite announced that LISA CRINEL, age 52; THREASA ADDERLEY, age 64; RHONDA MABERRY, age 48; SHEILA MATHIEU, age 46, all of New Orleans, and PCAH, INC. a/k/a PRIORITY CARE AT HOME, INC. d/b/a ABIDE HOME CARE SERVICES INC. pled guilty today to health care fraud-related charges.
LISA CRINEL pled guilty to Count 1 of the Indictment charging her with conspiracy to commit health care fraud and Count 2 of the Indictment charging her with conspiracy to pay and receive illegal kickbacks. CRINEL faces a maximum term of imprisonment of 10 years, a $250,000 fine, and 3 years of supervised release following imprisonment, as to Count 1 of the Indictment. As to Count 2, CRINEL faces a maximum term of 5 years imprisonment, a fine of $250,000, and a term of supervised release of up to three years. CRINEL owes restitution in the amount of $16,088,222 jointly and severally with her co-defendants. U.S. District Judge Susie Morgan set sentencing for January 13, 2016.
THREASA ADDERLEY pled guilty to Count 2 of the Indictment charging her with conspiracy to pay and receive illegal kickbacks. ADDERLEY faces a maximum term of 5 years imprisonment, a fine of $250,000, a term of supervised release of up to 3 years and owes any applicable restitution. ADDERLEY’s sentencing date is January 13, 2016
RHONDA MABERRY pled guilty to a one-count Superseding Bill of Information filed on October 1, 2015, charging her with conspiracy to commit health care fraud. MABERRY faces a maximum term of 5 years imprisonment, a fine of $250,000, a term of supervised release of up to 3 years, and owes restitution in the amount of not less than $272,982.61, as to Count 1 of the Superseding Bill of Information filed against her. U.S. District Judge Susie Morgan set sentencing for January 27, 2016.
SHEILA MATHIEU pled guilty to a one-count Superseding Bill of Information filed on October 1, 2015, charging her with aiding and abetting the theft of Government money or property. MATHIEU faces a maximum term of 1 year imprisonment, a fine of $100,000, a term of supervised release of up to 1 year, and owes any applicable restitution, as to Count 1 of the Superseding Bill of Information. MATTIEU’s sentencing date is January 27, 2016.
PCAH, INC. a/k/a PRIORITY CARE AT HOME, INC. d/b/a ABIDE HOME CARE SERVICES INC. (“ABIDE”) pled guilty to Count 1 of the Indictment, charging the company with conspiracy to commit health care fraud. ABIDE faces a maximum fine of $500,000, as to Count 1 of the Indictment, and agreed that restitution in the amount of $16,088,222 is jointly and severally due by ABIDE and its co-defendants. Sentencing is scheduled for January 16, 2016.
“Today’s guilty pleas are further evidence of our commitment to fighting health care fraud in our region,” stated U.S. Attorney Polite. “Those engaged in similar criminality should take note: our investigation in this case, and other related matters, is on-going.”
According to Court documents, CRINEL was the owner and operator of ABIDE, a business that provided home health care services to homebound individuals who were primarily Medicare beneficiaries. As the owner and Chief Operating Officer of ABIDE, CRINEL took a “100 percent hands on approach” that extended to “almost every aspect of the operation” of the business. Home health experts trained CRINEL and her staff on who qualified for home health and how home health services should be documented. Evidence seized at the search of ABIDE’s office established that CRINEL maintained ABIDE’s Medicare Provider Number and routinely certified on behalf of ABIDE that she would not knowingly present or cause to be presented false or fraudulent claims for payment by Medicare. Nevertheless, CRINEL instructed her staff not to discharge patients, even those who did not require home health services. ABIDE, under CRINEL’s direction also routinely falsified diagnoses codes and medical records to cause inflated reimbursements from Medicare. CRINEL and ABIDE created an atmosphere where RNs and other health care professionals would compromise their medical and ethical judgment in order to defraud Medicare. Court documents also show that CRINEL and ABIDE entered into sham employment contracts and medical director contracts with doctors and others to cover up the illegal kickback relationship between CRINEL, ABIDE, and those doctors and other individuals.
According to Court documents, ADDERLEY, was one of the physicians who entered into a sham contract with ABIDE to act as a medical consultant for the home health care agency. As such, she was required to submit monthly documentation detailing the services she provided to or on behalf of ABIDE. The agreements called for ADDERLEY to meet with ABIDE supervisors, at least annually, and to measure and evaluate overall performance of ABIDE. Quarterly meetings were also to be held to evaluate and discuss the ongoing home health program. ADDERLEY was also to perform in-services or educational programs to ABIDE and to review charts to determine if ABIDE was meeting expected outcomes. According to court documents, ADDERLEY didn’t give any in-service of any kind at ABIDE nor did she meet with ABIDE supervisors to measure and evaluate the performance of ABIDE personnel. ADDERLEY routinely compromised her medical judgment by certifying ineligible Medicare beneficiaries for home health provided by ABIDE who did not meet requirements for services because the patients were neither homebound nor medically in need of the services. Over the period covered by the Indictment, ABIDE paid ADDERLY more than $48,000 of Medicare funds for medically unnecessary home health billing.
According to Court documents, MABERRY worked as an Advanced Practice Registered Nurse who practiced under a collaborative agreement with a charged co-defendant/conspirator, DR. SHELTON BARNES. DR. BARNES, like ADDERLY, operated under sham contracts with ABIDE to perform medical director services. MABERRY was required to collaborate with DR. BARNES to initiate appropriate referrals for home health care based on current standards of practice and keep appropriate patient files. Both MABERRY and DR. BARNES were enrolled Medicare providers. Evidence establishes that ABIDE paid MABERRY for seeing patients that ABIDE sent MABERRY and that MABERRY approved every patient ABIDE referred to her for home health, whether or not medically necessary. Court documents also show that DR. BARNES signed the plans of care approving medically unnecessary home health services. MABERRY knew that at least half of the patients she saw for ABIDE or DR. BARNES were not homebound and did not qualify for home health. MABERRY received payments totaling approximately $272,982.61 from Medicare from January 2006 until December 2012, for home visits and care plan oversight for beneficiaries referred to ABIDE and certified as medically necessary for home health by DR. BARNES. The trial for DR. BARNES is presently scheduled for August 1, 2016, before U.S. District Judge Susie Morgan.
According to Court documents, MATHIEU worked as an RN for ABIDE, beginning in June 2012. Her duties included assessing the status of her patients, initiating a plan of care, evaluating patient needs, providing comprehensive nursing care, among other things. Payroll records would demonstrate that between July 5, 2012, and March 18, 2014, ABIDE paid MATHIEU approximately $48,794.69 for performing false and fraudulent home health certifications for episodes of home health which were largely medically unnecessary.
U.S. Attorney Polite praised the work of the Federal Bureau of Investigation in investigating this matter. Assistant U.S. Attorneys Patrice Harris Sullivan, Sharan Lieberman and Andre Lagarde are in charge of the prosecution.