Kusserow’s Corner: More Home Health Fraud Cases

The month of September was a banner month for crackdown on home health care fraud cases. Almost on a daily basis the Department of Justice (DOJ) has been announcing indictments, convictions, and sentencing of individuals engaged in fraudulent activities related to these programs. Many of these have been in the Miami area. Once again, the DOJ is reporting new cases by unsealing indictments against five Miami residents for their roles in a $48 million home health Medicare fraud scheme. In an eleven 11-count indictment, charges were brought against Marianela Martinez, Mireya Amechazurra, Lissett Jo-Moure, Omar Hernandez, and Celia Santovenia. Each was charged with one count of conspiracy to receive health care kickbacks and two counts of receiving kickbacks in connection with a Federal health care program. The indictments stated the defendants participated in a scheme involving Caring Nurse Home Health Care Corp. (Caring Nurse) and Good Quality Home Health Inc. (Good Quality), Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. The scheme involved referral of Medicare beneficiaries to Caring Nurse and/or Good Quality in exchange for kickbacks, knowing that Caring Nurse and/or Good Quality would in turn bill Medicare for home health services purportedly rendered for the recruited Medicare beneficiaries. This case was related to another involving Rogelio Rodriguez and Raymond Aday, the owners and operators of Caring Nurse and Good Quality. They were sentenced to 108 and 51 months in prison, respectively. These related cases involved $48 million in claims for home health services that were not medically necessary and/or not provided. Medicare paid approximately $33 million for those 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.

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