The U.S. Department of Justice (DOJ) announced that Ramon Regueira, the owner and operator of a Miami home health care agency (HHA), was sentenced to 106 months in prison for his participation in a $30 million Medicare fraud conspiracy. In addition to the prison sentence, Regueira, 66, of Miami, was ordered to pay $21 million in restitution, both jointly and severally with co-conspirators.
According to the DOJ, Regueira was an owner of Nation’s Best Care Home Health Corp. (Nation’s Best), a Miami HHA that purported to provide home health and therapy services to Medicare beneficiaries. Regueira admitted that from January 2007 through January 2011, he and his co-conspirators:
- operated Nation’s Best for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health services that were not medically necessary or not provided;
- paid kickbacks and bribes to patient recruiters who provided patients to Nation’s Best, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services; and
- used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for unnecessary home health services.
On September 26, 2013, the DOJ announced that co-conspirator Emilio Amador, 46, pleaded guilty to his involvement with fraudulent billings for Nation’s Best. Amador, who was an owner, operator, and the president of Nation’s Best, also received 106 months in prison and was ordered to pay restitution.
According to the DOJ, Nation’s Best submitted approximately $30 million in claims for HH services that were not medically necessary or not provided, and Medicare paid approximately $21 million for these fraudulent claims.