Kusserow’s Corner: More Recruiter Kickback Cases

Elizabeth Monteagudo and Cristobal Gonzalez pleaded guilty on September 3 to 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., Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries.  The scheme involved recruiting patients and receiving kickbacks and bribes from the owners and operators of the home health care agencies. These Medicare beneficiaries were billed for home health care and therapy services that were medically unnecessary and/or not provided.  Monteagudo also admitted to her involvement with $7 million in fraudulent billings for Starlite Home Health Agency Inc., which she owned and operated. In a related matter, the owners of the home health agencies, Rogelio Rodriguez and Raymond Aday were previously convicted and sentenced.

Last month, a Los Angeles man was sentenced to prison for receiving more than $1 million in kickbacks by recruiting homeless people on Skid Row as part of a Medicare scheme.  A total of eleven individuals were either charged or convicted in connection with that scam.  In another notable recruiter kickback case, Robert Glenn Baker, of Houston, was been sentenced for recruiting and referring Medicare and Medicaid beneficiaries to clinics who paid him a referral fee, typically in cash, for each individual he referred.  In June, four people were convicted in a jury trial in Florida for their participation in a Medicare fraud scheme involving nearly $70 million in fraudulent billings by a mental health care hospital. The case involved paying bribes to a network of patient recruiters and falsifying documents for qualifying beneficiaries for un-needed intensive psychiatric care

All these cases were the latest in a series of prosecutions related to health care fraud.  In May, the Department of Justice (DOJ) announced the Medicare Fraud Strike Force operations in eight cities has resulted in charges against 89 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $223 million in false billings.  According to court documents, the defendants allegedly participated in schemes to submit claims to Medicare for treatments that were medically unnecessary and often never provided. In many cases, court documents allege that patient recruiters, Medicare beneficiaries and other co-conspirators were paid cash kickbacks in return for supplying beneficiary information to providers, so that the providers could then submit fraudulent billing to Medicare for services that were medically unnecessary or never performed. Collectively, the doctors, nurses, licensed medical professionals, health care company owners and others charged are accused of conspiring to submit a total of approximately $223 million in fraudulent billing.  The latest cases are in addition to those previously reported.

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.