Federal Jury Convicts Head of Schaumburg Home Health Company in Scheme to Fraudulently Bill Medicare for Unnecessary Care
CHICAGO — A federal jury has convicted the head of a Schaumburg home health company on fraud charges for scheming to bill Medicare for millions of dollars in unnecessary services.
As the manager of Suburban Home Physicians, which did business as Doctor at Home, DIANA JOCELYN GUMILA directed employees to perform in-home visits with patients who were physically capable of leaving their residences and not in need of the in-home treatment. Gumila also inflated the costs incurred by Medicare by directing employees to bill the treatment at the most complicated levels, even though the visits were typically routine and did not qualify for the elevated billing.
After a two-week trial in federal court in Chicago, the jury Friday night convicted Gumila, 46, of Streamwood, on 21 counts of health care fraud and three counts of making false statements in a health care matter. Each count of health care fraud is punishable by up to ten years in prison, while each false-statement count is punishable by up to five years in prison.
U.S. District Judge Charles P. Kocoras scheduled a sentencing hearing for July 26, 2016, at 9:45 a.m.
GUMILA became the latest defendant convicted in the federal investigation of Doctor at Home. The prior convictions include ALAN NEWMAN, a physician from Chicago, and JAMES ADEMIJU, a nurse from Matteson who operated two nursing agencies. In a plea agreement, Newman admitted falsely certifying patients for nursing services even when he knew that the patients did not need such care. Newman admitted causing approximately $2.6 million in losses to Medicare, according to his plea agreement. Ademiju pleaded guilty to making illegal payments for patient referrals, and he acknowledged billing for services that were improperly authorized by physicians from Doctor at Home.
Evidence presented at Gumila’s trial included a surreptitious audio recording in which Gumila can be heard telling a new doctor to “paint the picture” of patients so as to make them appear confined to their homes. Emails from Gumila were also shown to the jury, including one in which she referred to a physician who did not read orders before signing them as “the type of doctor we need [b]ecause he will just do what we tell him to do.”
Gumila’s conviction was announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Lamont Pugh III, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General; Michael J. Anderson, Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation; and Joseph Del Favero, Deputy Assistant Inspector General for Investigations of the Railroad Retirement Board Office of the Inspector General.
The investigation was carried out by the Medicare Fraud Strike Force, which is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the U.S. Justice Department and the U.S. Department of Health and Human Services to prevent fraud and to enforce anti-fraud laws around the country. Dozens of defendants have been charged in numerous fraud cases since the strike force began operating in Chicago in 2011.
The government is represented by Assistant U.S. Attorneys Stephen Chahn Lee and Vikas Didwania.