Kusserow’s Corner: $74 Million Home Health Fraud Case in Miami

The Department of Justice (DOJ) reported more sentencing involving criminal home health fraud in the Miami area on October 23, 2013. Over the course of this year the federal government has taken legal action involving hundreds of millions dollars of fraud involving home health programs. The cases all revolve around a pattern of activity that includes:

  1. A store front home health agency
  2. Falsification of information used for submitting claims
  3. Kickbacks for referral of beneficiaries to recruiters
  4. Kickbacks to physicians, physical therapists, or other care givers to assist in the fraud
  5. Billing Medicare for services not performed or unnecessary

In the current case Myriam Acevedo, a home agency administrator and employee of two Miami health care companies, was sentenced to serve 60 months in prison for her participation in a $74 million home health Medicare fraud scheme. She was an administrator of LTC Professional Consultants Inc. (LTC) and an employee of Professional Home Care Solutions Inc. (Professional), Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. She had previously pleaded guilty to one count of conspiracy to pay health care kickbacks and two counts of payment of health care kickbacks.

Acevedo and her co-conspirators agreed to and actually did operate LTC and Professional 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. Her main role in the scheme was to pay kickbacks and bribes to patient recruiters of LTC and Professional. She and others would distribute cash to patient recruiters in exchange for providing patients to LTC and Professional, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. She and her co-conspirators would use these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for home health care services, which Acevedo knew was in violation of federal criminal laws. This scheme involved approximately $41 million in claims for home health services that were not medically necessary and/or not provided with Medicare paying $27 million on these fraudulent claims.

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.

Connect with Richard Kusserow on Google+ or LinkedIn.

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