Kusserow’s Corner: Continued Crackdown in Miami on Home Health Recruiter Kickbacks

DOJ Announcing New Medicare Kickback Cases Almost Daily

In the first week of September the DOJ has made announcements in three separate cases regarding Medicare recruiter kickback cases. The first two cases were out of Miami. The third announcement came at the end of the week on September 6th. That case came out of Brooklyn, NY. Gregory Konoplya pleaded guilty for his role as a patient recruiter in a $13 million in a fraud conspiracy case involving the paying and receiving illegal health care kickbacks. This was the fourth defendant in that case to plead guilty to the scheme based at the Cropsey Medical Care PLLC clinic in Brooklyn. Konoplya, working through an ambulette company in Brooklyn, recruited patients to attend Cropsey Medical. An ambulette is a vehicle that is licensed by New York State’s Medicaid program to transport beneficiaries to and from medical facilities when such transportation is medically necessary. Konoplya paid employees of Cropsey Medical a per beneficiary cash kickback to accept beneficiaries as patients and so he could bill Medicaid for the transportation of beneficiaries to and from Cropsey Medical. The beneficiaries were paid cash kickbacks to induce them to continue to attend the clinic and to receive medically unnecessary physical therapy, diagnostic testing and other services.

On September 5, the owners and operators of several Miami home health care agencies and a patient recruiter pleaded guilty to a $20 million health care fraud scheme involving Trust Care Health Services Inc. (Trust Care), that provided expensive home health and physical therapy services to Medicare beneficiaries that were not medically necessary and/or not provided. Roberto Marrero, Sandra Fernandez Viera, and Enrique Rodriguez of Miami, pleaded guilty to conspiracy to commit health care fraud and conspiracy to receive and pay health care kickbacks, in return for the recruiters providing patients for home health and therapy services that were medically unnecessary and/or not provided. They also paid kickbacks and bribes to co-conspirators in doctors’ offices and clinics in exchange for home health and therapy prescriptions, medical certifications and other documentation.

Marrero, Fernandez Viera and Rodriguez also acknowledged their involvement in similar fraudulent schemes at several other Miami health care agencies with estimated total losses of approximately $50 million, including Global Nursing Home Health Inc., Lovable Home Health Services Corp., New Concepts In Health Inc., Ubieta Health System Inc., R&M Health Care Inc., Vital Care Home Health Services Inc., Centrum Home Health Care Inc. and A&B Health Services Inc.

This follows only two days after Elizabeth Monteagudo and Cristobal Gonzalez pleaded guilty on September 3 for of conspiracy to receive health care kickbacks in a $48 million home health Medicare fraud scheme. They were patient recruiters for Caring Nurse Home Health Care Corp., and Quality Home Health Care, Inc. Caring Nurse and Good Quality, Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. All this suggests the government is continuing to widen its net in finding those that are defrauding Medicare in Miami, paying kickbacks to recruiters who generate beneficiary names that can be billed to the program.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

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Copyright © 2013 Strategic Management Services, LLC. Published with permission.