The HHS Office of Inspector General (OIG) has identified Home Health Agencies as major fraud-prone areas. Last December, the OIG Office of Evaluation and Inspection (OEI) issued a report on “CMS and Contractor Oversight of Home Health Agencies” where they reported that 11,203 HHAs received nearly $20 billion in for home services provided to 3.4 million beneficiaries. Since then there have been a large number of enforcement actions taken by the OIG and Department of Justice (DOJ). On November 7, 2013, a couple of Detroit cases went to resolution. Javed Rehman, owner of Quantum Home Care Inc., was sentenced to serve two years of supervised release and was ordered to pay $1,734,801 in restitution, jointly and severally with his co-defendants. Last July, he pleaded guilty for his role in a $13.8 million Medicare fraud scheme. Rehman had purchased Quantum Home Care Inc. with co-conspirators Tausif Rahman and Muhammad Ahmad. Rehman paid kickbacks to recruiters to obtain Medicare beneficiary information used to bill Medicare for home health services—including physical therapy and skilled nursing services—that were never rendered. Rehman was the administrator of Quantum and was responsible for the submission of false and fraudulent claims to Medicare based on falsified files created by the co-conspirators. Medicare paid approximately $1.7 million to Rehman’s co-conspirators acquired control of three other home health care companies. The four companies, including Quantum, received approximately $13.8 million from Medicare in the course of the conspiracy. Rahman pleaded guilty on Jan. 5, 2012, to one count of conspiracy to commit health care fraud and one count of money laundering and is scheduled for sentencing on May 21, 2014. Ahmad pleaded guilty on Aug. 28, 2012, to one count of conspiracy to commit health care fraud and is scheduled for sentencing on May 14, 2014.
Mehran Javidan, who had been an owner of Acure Home Care Inc. (Acure), a Detroit-area home health care agency, was sentenced to 65 months in prison for her leading role in a $2.2 million Medicare fraud scheme, as well as to serve three years of supervised release and was ordered to pay $2.2 million in restitution, jointly and severally with her co-defendants. Javidan was convicted by a federal jury on April 2, 2013 for making false statements related to health care matters and one count of conspiracy to solicit or pay health care kickbacks in exchange for referrals of patients to home health care company. He paid doctors to refer non-homebound patients for physical therapy treatment that was medically unnecessary, as well as paying patient recruiters to obtain Medicare information and pre-signed physical therapy documents from Medicare beneficiaries. The recruiters for Acure obtained the Medicare information and pre-signed forms by paying patients in cash and by promising that the referring doctors would prescribe them narcotic prescriptions.
The most prevalent types of Home Health fraudulent activity include the following:
- Services being billed, but not performed.
- In some cases, beneficiaries were not living at home, in a hospital, nursing home or in jail
- Personal assistants and beneficiaries being in collusion and splitting the benefits
- Personal care assistant to be a relative or family friend, who often is a phony
- Payment of kickbacks to patient recruiters to obtain Medicare beneficiary information
- Falsifying documents to make it appear beneficiaries are qualified for home health services
Other blog articles on the subject:
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.
Copyright © 2013 Strategic Management Services, LLC. Published with permission.