Owner And Administrator Of Miami Home Health Companies Pleads Guilty For Role In $74 Million Health Care Fraud Scheme

Wifredo A. Ferrer, United States Attorney for the Southern District of Florida, Leslie R. Caldwell, Assistant Attorney General, Criminal Division Department of Justice, George L. Piro, Special Agent in Charge, Federal Bureau of Investigation, Miami Field Office and Ryan Lynch, Acting Special Agent in Charge, U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami announced that Elsa Ruiz, 45, of Miami pled guilty yesterday, for her participation in a $74 million Medicare fraud scheme, before U.S. District Judge Marcia G. Cooke to one count of conspiracy to commit health care fraud. Her sentencing is scheduled for October 8, 2014.

According to court documents, Ruiz was an owner of Professional Home Care Solutions Inc. (Professional Home Care) and an administrator of LTC Professional Consultants Inc. (LTC), Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. Ruiz and her co-conspirators operated LTC and Professional Home Care 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.

Also according to court documents, Ruiz ran and oversaw the schemes operating out of LTC and Professional Home Care. Ruiz and co-conspirators paid kickbacks and bribes to patient recruiters, who provided patients to LTC and Professional Home Care, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Ruiz and her co-conspirators used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for unnecessary home health care and therapy services.

From approximately January 2006 to June 2012, LTC and Professional Home Care submitted approximately $74 million in claims for home health care services that were not medically necessary and/or not provided, and Medicare paid approximately $45 million on those claims.

Mr. Ferrer commended the outstanding investigative efforts of the FBI and HHS-OIG. The case is being prosecuted by Assistant Chief Joseph S. Beemsterboer of the Department of Justice’s 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 Action Team (HEAT), go to: www.stopmedicarefraud.gov.

A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at http://www.usdoj.gov/usao/fls. Related court documents and information may be found on the website of the District Court for the Southern District of Florida at http://www.flsd.uscourts.gov or on http://pacer.flsd.uscourts.gov.