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OIG Online Portfolio: Home Health

Enforcement

Enforcement Actions Taken in the Home Health Industry

Home health services fraud in Medicare and Medicaid is an OIG priority and represents a significant portion of our enforcement efforts. Home health fraud schemes often include billing for services not rendered, misrepresentation of services, medically unnecessary services, and falsification of medical records and physician authorizations. They also often involve the false certification of patients as homebound or requiring home health services. Home health fraud can also involve criminal enterprises, which may use patient recruiters to solicit Medicare beneficiaries who do not qualify for services and who may receive kickbacks and are complicit in the scheme.

Billing for Services Not Rendered or Medically Unnecessary

Dallas Doctor and Three Dallas-Area Home Health Agency Owners Convicted for Running Large-Scale, Sophisticated Health Care Fraud Scheme (U.S. Attorney; Northern District of Texas; April 13, 2016)

"As part of the conspiracy, [the defendants] improperly recruited individuals with Medicare coverage to sign up for Medicare home health care services. [Charity Eleda, R.N.] recruited patients from The Bridge homeless shelter in Dallas, sometimes paying recruiters $50 per beneficiary they found and directed to her vehicle parked outside the shelter's gates. Eleda and other nurses would falsify medical documents to make it appear as though those beneficiaries qualified for home health care services that were not medically necessary. Eleda and the nurses prepared Plans of Care (POC), also known as 485's, which were not medically necessary, and these POCs were delivered to [Jacques Roy, M.D.] or another physician working under his direction at Medistat. Dr. Roy instructed his staff to certify these POCs, which indicated to Medicare and Medicaid that a doctor, typically Dr. Roy, had reviewed the treatment plan and deemed it medically necessary. That certifying doctor, typically Dr. Roy, certified that the patient required home health services, which were only permitted to be provided to those individuals who were homebound and required, among other things, skilled nursing. This process was repeated for thousands of POCs, and, in fact, Medistat's office included a "485 Department," essentially a "boiler room" to affix fraudulent signatures and certifications."

Read Full U.S. Department of Justice News Release

Falsification of Medical Records and/or Physician Authorizations

Federal Jury Convicts Head of Schaumburg Home Health Company in Scheme to Fraudulently Bill Medicare for Unnecessary Care (U.S. Attorney; Northern District of Illinois; April 18, 2016)

"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."

Read Full U.S. Department of Justice News Release

Kickbacks Paid to Patients, Patient Recruiters, Physicians and Other Home Health Providers

Detroit-Area Home Health Care Agency Owner Sentenced for Role in $2.2 Million Medicare Fraud Scheme

"According to evidence presented at trial, [Mehran] Javidan owned and operated Acure, a home health care company in Oak Park, Mich., and later Troy, Mich. Javidan paid doctors to refer non-homebound patients for physical therapy treatment that was medically unnecessary. The evidence showed that she also paid patient recruiters to obtain Medicare information and pre-signed physical therapy documents from Medicare beneficiaries. The recruiters for Acure obtained the Medicare information and pre-signed forms by paying patients in cash and by promising that the referring doctors would prescribe them narcotic prescriptions."

Read Full U.S. Department of Justice News Release

Solicitation of Medicare Beneficiaries Who Don't Qualify for Home Health Services

New Orleans Office Manager Sentenced for Role in $50 Million Fraud Scheme

"The office manager of a home health company at the center of a $50 million fraud scheme in New Orleans was sentenced to prison today for participating in the scheme. Murthil, Memorial Home Health Inc.'s (Memorial's) office manager, assisted with the payment of illegal kickbacks to patient recruiters and submitted claims to Medicare falsely stating that patients were homebound and had received services. From 2007 through 2014, Memorial and the other companies in this scheme submitted more than $56 million in claims to Medicare, the vast majority of which were fraudulent. Medicare paid approximately $50.7 million on these claims."

Read Full U.S. Department of Justice News Release

Affirmative Exclusions and Civil Monetary Penalties

OIG has the authority to seek civil monetary penalties (CMPs), assessments, and exclusion against an individual or entity based on a wide variety of prohibited conduct. The cases listed below represent recently closed cases initiated by the OIG's Office of Counsel to the Inspector General. Visit our Affirmative Exclusions and Civil Monetary Penalties webpage for more cases.

Former Owner of Illinois Home Health Agency Enters Settlement Agreement with OIG Based on Kickback Allegations (06-22-2016)

On June 22, 2016, Tariq Chaudhry entered into a settlement agreement with OIG for $50,000 to resolve kickback allegations. Chaudhry is a former owner of a Chicago-area home health agency (HHA). OIG contends that Chaudhry paid illegal remuneration to a Chicago physician in exchange for the physician's referral of patients for home health care services to Chaudhry's HHA. The kickback was disguised as medical director fees, when, in fact, no services were performed. OIG also contends that Chaudhry and the HHA he formerly owned made the payments to the physician through one or more of its marketer employees or contractors.

South Florida Business Owner Agrees to Voluntary Exclusion and Divestiture (05-27-2015)

Tracy Nemerofsky - a Palm Beach Gardens, Florida private business owner - agreed to be excluded from participation in all Federal health care programs for a period of five years. OIG conducted an investigation of Nemerofsky for knowingly submitting or causing to be submitted to Medicare false claims in violation of the Anti-Kickback Statute. Based upon that investigation, OIG alleged that Nemerofsky violated the Anti-Kickback Statute through her company, A Plus Home Healthcare, Inc. (A Plus), when she directed and managed A Plus' payments to eight different physicians' spouses, in exchange for the physicians' Medicare referrals. OIG alleged that the eight spouses were not bona fide employees of A Plus and that these arrangements did not fit within the exception to the Anti-Kickback Statute payment prohibition. OIG alleged that Nemerofsky offered and paid the remuneration described above and this conduct forms a basis for her exclusion.

Nemerofsky agreed to enter a voluntary exclusion with OIG for a period of five years after she resolved the above mentioned conduct through a False Claims Act monetary settlement with the United States, a settlement in which OIG expressly reserved its exclusion authority. In order to resolve her companies' exclusion liability as well, Nemerofsky also agreed to divest herself of five health care businesses: A Plus; A Plus Private Care Services; Ocean Therapy Group, Inc.; Professional Touch Rehab, Inc.; and RockHill Rehab Services Inc. Senior Counsels Kristen Schwendinger and Tamara Forys represented OIG.

Page last updated: June 22, 2016

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201