The settlement is being paid to resolve allegations that Oak Street violated the False Claims Act, specifically by paying kickbacks to third-party insurance agents. The DOJ alleged that Oak Street paid kickbacks to those agents in exchange for the recruitment of seniors to its primary care clinics.

The violations occurred from September 2020 to December 2022, through Oak Street’s “Client Awareness Program,” which involved those insurance agents, who then urged seniors eligible for Medicare Advantage (MA) to consider Oak Street services. 

“Agents then referred interested seniors to an Oak Street Health employee via a three-way phone call, otherwise known as a ‘warm transfer,’ and/or an electronic submission,” the DOJ said. “In exchange, Oak Street Health paid agents typically $200 per beneficiary referred or recommended. These payments incentivized agents to base their referrals and recommendations on the financial motivations of Oak Street Health rather than the best interests of seniors.”

The settlement acknowledges that Oak Street knowingly provided kickbacks to these insurance agents during the above time period.

As part of the overall settlement, the whistleblower will receive $9.9 million.

“Health care providers that attempt to profit from kickbacks will be held accountable,” Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division, said in a statement. “We are committed to rooting out illegal practices committed by Medicare Advantage providers, insurance agents and brokers that undermine the interests of federal health care programs and the patients they serve.”

Oak Street Health is a senior-focused primary care provider. CVS Health purchased the company for more than $10 billion in 2023. Like its peer Walgreens Boots Alliance (Nasdaq: WBA), CVS has built out a significant health care services arm as part of a company evolution. In addition to Oak Street – which does provide some care in the home – CVS Health has the home-focused, value-based care platform Signify Health under its belt. It also owns Aetna.

CVS acquired Signify Health for $8 billion, around the same time it acquired Oak Street.

Oak Street’s violations came before it was officially a part of CVS.

The post Senior-Focused Primary Care Provider Oak Street Health To Pay $60M Settlement Over Kickbacks appeared first on Home Health Care News.

Partners and shareholders with the Polsinelli law firm detailed the latest updates within the Department of Justice (DOJ) on a webinar Thursday. They also covered how new partnerships between divisions in the federal government should promote competitive labor markets, not only in health care, but in the country at large.

One of the main focuses from the current administration include “no poach” clauses in franchise agreements.

In fact, the Federal Trade Commission (FTC) recently issued a civil investigative demand (CID) with an undisclosed home care provider, which Polsinelli shareholder Will Vail said should be noted by the industry.

“It’s pretty clear that the FTC doesn’t really understand home care, but it does seem that they want to learn, so this is definitely an example of why the industry has to be really careful,” Vail said. “I’m not saying that this company has done anything wrong, but the government is looking more into figuring out, ‘What is the state of play in this industry and how may it be violative of the antitrust laws?’”

This is another example of the federal government becoming more interested in the home care space following news that private equity scrutiny and more OIG audits could be on the horizon.

Vail also pointed to four owners and managers of home health care agencies in Maine being indicted on no-poach and wage-fixing charges as examples of an increased crackdown.

“The DOJ has the most antitrust grand jury investigations in over 30 years,” Vail said. “They’re hiring 120 new lawyers and 900 FBI agents to support this initiative. This is something you definitely want to be cognizant of when you are approached by a competitor or anyone else in your marketplace. Be very, very careful of any sorts of agreements in this space.”

Vail offered three suggestions to providers to avoid any antitrust violations: carefully examine franchise agreements to ensure “no-poach” clauses are removed, analyze antitrust issues early in M&A transactions and avoid discussions on agreements with competitive businesses about wage rates.

Unionization momentum

Polsinelli’s experts also gave guidance to providers on how to better retain staff, with a specific focus on avoiding labor groups unionizing.

Specifically, they said that the Biden administration wants to make it easier for home care employees to unionize.

“We don’t want this kind of third party interference between employers and employees, but there’s a tension that’s happening in this system,” Polsinelli’s Denise Delcore said. “Home care providers have had greater challenges than we’ve ever seen before. As employees are struggling to deal with those — particularly in the wake of COVID — there’s a renewed effort to organize this industry.”

Delcore argued that the collective bargaining “schemes” from unions don’t apply well in the home care industry in the same way they have historically in traditional workplaces.

“[Home care labor unions] don’t meaningfully engage the workers in the collective bargaining process, which jeopardizes further alienating workers at a time where worker retention is more critical than ever,” she said. “In fact, in some cases, we have workers in states where the dues are being skimmed off of Medicaid payments, learning that they have a labor union only when they’re looking and seeing that deduction.”

Many union organizers in the home care space are capitalizing on worker’s discontent coming out of the COVID-19 pandemic, Delcore said.

“Of course, in no event is any employer ever entitled to thwart or threaten an employee’s desire to learn about unions, to organize, to make concerted complaints as a group,” Delcore said. “However, there’s a distinction between that versus the sort of surreptitious effort to gain access to employees.”

Supporting employees, giving them a space to talk, providing them meaningful training and making workers feel important and valued are just some of the things that providers can do in order to avoid some of the issues that could lead to unionization, Delcore said.

“If you’re not on top of it and actively engaging with your workers and communicating with them, they won’t have the opportunity to hear the actual facts about what a union would mean for them,” she said.

The post What Home-Based Care Providers Should Know About DOJ’s Antitrust Focus, Employee Unionization appeared first on Home Health Care News.

The U.S. Attorney’s Office for the Southern District of Florida announced Friday that Rodolfo Pichardo and Marta Pichardo — husband and wife — were each sentenced to several years in prison for their roles building “a vast empire of fraud” from May 2010 through September 2016. The couple’s empire included at least six fraudulent home health agencies, three fraudulent therapy staffing companies and two fraudulent pharmacies.

Over the years, the Pichardos and their co-conspirators used their phony network — located throughout Florida’s Miami-Dade County — to submit more than $38 million in false and fraudulent claims, according to Department of Justice officials. Medicare ultimately paid out more than $33 million of that.

With millions from Medicare, the Pichardos went on to purchase multiple properties, high-end vehicles, expensive jewelry, plane tickets, vacations, cosmetic procedures and more, both for themselves and family members, court documents state.

That lavish lifestyle is a stark contrast to the husband and wife’s humble beginnings in the United States. The Pichardos came to the U.S. from Cuba, arriving on a raft “seeking refuge and a better life.”

Quality Care Home Health Agency, Rapid Home Health Services and Tender Home Health Services were just some of the business names reportedly in the Pichardos’ fraud scheme. Other company names included Alegre’s Home Health Care, B&M Home Health Care, Apple Health Care Services, RP Staffing Inc. and more.

Contextually, the Pichardos’ empire of fraud was tied to a bigger takedown involving $1 billion in fraud.

Philip Esformes — the owner of more than 30 Miami-area skilled nursing and assisted living facilities — was the mastermind of that bigger case, unveiled in July 2016.

“This case involves the largest fraud scheme in terms of loss amount ever charged in the history of the Medicare fraud strike force,” U.S. attorney Wilfredo A. Ferrer said at a press conference at the time. “The case allegedly involved an elaborate cycle and network of bribery, deceit and kickbacks that compromised Medicare care services for thousands of [Medicare and Medicaid beneficiaries] at south Florida hospitals, skilled nursing and assisted living facilities.”

Rodolfo Pichardo, 71, was sentenced to more than 15 years in prison for health care fraud and wire fraud scheme. Marta Pichardo, 66, was sentenced to eight years in prison for her role in the scheme.

As part of the Pichardos’ scheme, the couple offered and paid kickbacks to numerous patient recruiters in exchange for referrals to home health agencies that he owned. The conspirators also offered and paid cash kickbacks to owners and operators of multiple Miami-Dade medical clinics in return for acquiring medically unnecessary home health prescriptions for the recruited Medicare beneficiaries.

Prescriptions were then used by the Pichardos’ various home health agencies and pharmacies to bill Medicare for purported services and pharmaceutical drugs that were provided to allegedly qualified Medicare beneficiaries.

During the long-running scheme, the Pichardos took several “calculated steps” to conceal the fraud and avoid detection, according to DOJ officials. That included using nominee owners, changing names and locations of their fraudulent entities, and creating shell companies to hide assets.

“These schemes … are incredibly complex,” Ferrer said. “They’re elaborate. And their incredibly difficult to detect.”

In fiscal year 2018, federal watchdog investigations resulted in criminal actions against 764 individuals or entities and civil actions against 813. The Department of Health and Human Services Office of Inspector General (OIG) recovered $2.91 billion last year.

The post Home Health Owners Pay Price for $38 Million ‘Empire of Fraud’ appeared first on Home Health Care News.

Caris Healthcare, L.P. and its wholly-owned subsidiary, Caris Healthcare, LLC, have agreed to pay $8.5 million to settle allegations they violated the False Claims Act by knowingly submitting false claims and retaining overpayments for patients who were ineligible for the Medicare hospice benefit because they were not terminally ill, the Department of Justice (DOJ) announced.

Caris Healthcare is a for-profit hospice chain that operates in Tennessee, Virginia and South Carolina.The government’s complaint alleged that Caris admitted patients whose medical records did not support a terminal prognosis.

The complaint further alleged that when Caris was alerted to the ineligibility of patients, the hospice provider continued to submit claims and took no meaningful action to determine if it had received improper payments. 

Barbara Hinkle, a registered nurse who formerly worked for Caris Healthcare, filed allegations in a lawsuit as a whistleblower. Under the False Claims Act, the whistleblower’s share will be $1,402,500.

Texas Doctor and Nurses Convicted in Home Health Fraud Scheme 

One physician and two nurses were found guilty of health care fraud in Texas, and one physician and one nurse guilty of conspiracy to commit health care fraud, for their roles in a home health fraud scheme topping $11.3 million, according to the DOJ. 

According to trial evidence, the defendants engaged in the scheme to defraud Medicare by submitting and causing the submission of fake and fraudulent claims through Timely Home Health Services, a home health agency, and Boomer House Calls, a physician house call company. 

Kelly Robinett, M.D., 70, of Denton County, Texas, and Kingsley Nwanguma, 47, of Dallas County, were each convicted of one count of conspiracy to commit health care fraud and three counts of health care fraud. Joy Ogwuegbu, 42, of Collin County, was convicted of four counts of health care fraud

The evidence showed Robinett, a doctor of osteopathic medicine, certified services that were often not provided for patients he had never seen, the DOJ stated. Ogwuegbu, a registered nurse, falsified nursing assessments. Nwanguma, a licensed vocational nurse, falsified nursing notes, making it appear as if Medicare beneficiaries were qualified for and were provided skilled nursing services, according to the DOJ.  

Written by Amy Baxter

The post Fraud Watch: Caris to Pay $8.5 Million in False Claims Settlement appeared first on Home Health Care News.

Zahir Shah, 48, of West Bloomfield, Michigan, pleaded guilty to fraud charges for his role in a scheme involving approximately $8 million in fraudulent Medicare claims for home health services procured through illegal kickbacks, according to the Department of Justice (DOJ).

Shah pleaded guilty to one count of conspiracy to commit health care fraud and wire fraud and one count of conspiracy to pay and receive kickbacks in connection with Medicare beneficiaries. As part of the guilty plea, Shah admitted that he submitted false certifications to enroll and stay enrolled as a Medicare provider.

He further admitted to paying illegal kickbacks to recruiters in exchange for Medicare beneficiary referrals and billed Medicare for claims procured through these illegal kickbacks. Shah caused a loss of about $8 million to Medicare through false and fraudulent claims from 2007 to 2017.

In a separate case, another home health care agency owner based in Michigan pleaded guilty to charges for his role in a scheme involving Medicare claims for services that were procured through the payment of illegal kickbacks.

Atheir Amarrah, 43, of West Bloomfield, the owner of Prompt Care Home Health Services Inc. pleaded guilty to one count of conspiracy to pay and receive health care kickbacks in connection with Medicare beneficiaries and to four substantive counts of paying health care kickbacks. Sentencing is scheduled for Sept. 25. The scheme is alleged to have resulted in a loss up to $1.8 million to the Medicare program, spanning from 2013 through 2017.

Texas Nurse Convicted in $3.5 Million Fraud Scheme

A 51-year-old nurse of Sugar Land, Texas, has been convicted of conspiracy to commit health care fraud and six counts of health care fraud and conspiracy to violate the anti-kickback statute, announced U.S. Attorney Ryan K. Patrick.

John Dubor, who owned and operated Care Committers Health Services home health care agency in Richmond, was convicted after the jury deliberated for less than six hours following a three-day trial. The jury heard evidence that Dubor paid marketers and group home owners for Medicare beneficiary information and subsequently billed Medicare and Medicaid for home health services for which the beneficiaries did not quality and/or did not receive.

He also personally falsified home health patient assessment forms documents to make beneficiaries appear sicker on paper to receive higher reimbursement rates from Medicare, according to the DOJ. Dubor instructed his employees to falsify home health certifications and forge physician signatures. Medicare paid him approximately $3.5 million.

The beneficiaries had no recollection of ever being treated by the Houston physicians listed on their home health orders, according to the DOJ. Lorraine Whitaker, 59, Dubor’s co-conspirator, had previously pleaded conspiracy to violate the anti-kickback statute and is awaiting sentencing. Dubber faces up to 10 years in federal prison for each count of health care fraud and up to five years for conspiracy to violate the anti-kickback statute. A hearing is set for Sept. 7, 2018.

Doctor Convicted in $8.9 Million Health Care Fraud Scheme

A jury found a physician guilty today for her role in a scheme involving approximately $8.9 million in fraudulent Medicare claims for home health care and other physician services that were procured through illegal kickbacks, were not medically necessary, not actually provided, or were provided by the defendant, who was not a licensed physician during the conspiracy.

Millicent Traylor, 47, of West Bloomfield, Michigan, was convicted of one count of conspiracy to commit health care fraud, one count of conspiracy to pay and receive kickbacks in connection with Medicare beneficiaries, and five counts of health care fraud following a four-day trial, the DOJ reported. Sentencing is scheduled for Sept. 27.

Taylor, who was unlicensed at the time of the scheme—which ran from 2011 to 2016—acted as a physician for companies, providing services that were not medically necessary and were billed to Medicare as if they were provided by a licensed physician, according to the DOJ. She also conspired to bill Medicare for services that were never rendered and falsified records.

Evidence showed Taylor and co-conspirators paid and received kickbacks in exchange for referring Medicare beneficiaries to serve as patients at clinics, and she fraudulently signed the names of licensed physicians on prescriptions for opioid medications, such as oxycodone, as a means of inducing patient participation in the scheme.

Written by Amy Baxter

The post Fraud Watch: Michigan Agency Owner Guilty in $8 Million Fraud Case appeared first on Home Health Care News.

Three Miami-area home health care agency owners were charged in an indictment for their alleged participation in a health care fraud scheme involving a now-defunct business, the Department of Justice (DOJ) announced in March.

Ailin Consuelo Rodriguez Sigler, 39; Ziola C. Rios, 57; and Thomas A. Rodriguez, 66, were charged in the indictment with one count of conspiracy to commit health care fraud and wire fraud, and three counts of health care fraud. The three operated Florida Patient Care Corp.

The indictment alleges that from approximately January 2011 through November 2014, Sigler, Rios and Rodriguez were involved in a fraudulent scheme whereby they agreed with the owners and operators of multiple home health therapy staffing companies and others to bill Medicare for services that were medically unnecessary, were never provided, or were not eligible for Medicare reimbursement.

Michigan Home Health Employee Sentenced to Prison in $1.6 Million Fraud

An assistant nursing director of a Michigan-based home health care agency was sentenced to 36 months in prison for his role in a scheme involving approximately $1.6 million in fraudulent Medicare claims, according to the DOJ.

Juan Yrorita, 63, of Sterling Heights, Michigan, was also ordered to pay $1,524,951.88 in restitution, jointly and severally with his co-conspriatoes, and to forfeit $49,823.41. Yrorita pleaded guilty to one count of conspiracy to commit health care fraud and wire fraud in November 2017.

As part of his guilty plea, Yrorita admitted he and his co-conspiratoes at Detroit-based Anointed Care Services paid kickbacks to recruit Medicare beneficiaries. He also admitted that as director of nursing, he falsified medical records to support Anointed Care’s claims to Medicare for services that were medically unnecessary and never provided.

Ohio Home Health Owner Sentenced for Committing $2 Million Fraud

Cheryl McGrath, 50, of Guysville, Ohio, was sentenced to 36 months in prison for committing healthcare fraud and willful failure to pay over tax, the DOJ announced.

McGrath, who has owned and operated Home Health Care of Southeast Ohio since 1993, executed a $2.2 million scheme to defraud the Ohio Medicaid program for nursing services that were never rendered, the DOJ stated. McGrath routinely changed the claim information in the billing software to falsely reflect that additional hours of nursing services had been provided, and falsely increased the number of nursing visits from one visit per week to between three and five visits.

She also submitted claims for services for Medicaid beneficiaries who were ineligible because they were residing in nursing homes or were deceased. The scheme ran from 2009 to 2013, according to the DOJ.

McGrath pleaded guilty to health care fraud and tax fraud charges in June 2017. She agreed to pay more than $2.2 million in restitution to the Ohio Medicaid Program and nearly $367,000 to the IRS.

Written by Amy Baxter

The post Fraud Watch: Miami Home Health Owners Indicted in Scheme appeared first on Home Health Care News.

On Friday, the Office of Inspector General (OIG) released its annual 2017 fiscal year Health Care Fraud and Abuse Control Program report for 2017, revealing that the Department of Health and Human Services (HHS) and Department of Justice (DOJ) recovered $2.6 billion from health care fraud last year. Click here to find the full report.

Netsmart, the nation’s largest provider of behavioral health electronic health records (EHRs) announced it was acquiring the home care and hospice solutions of Change Healthcare, formerly known as McKesson Homecare and McKesson Hospice. The transaction is expected to close in the second quarter of 2018, subject to customary closing conditions. Netsmart has more than 600,000 user in more than 25,000 organizations.

While Amazon (Nasdaq: AMZN) has been relatively mum about its recently announced health care venture with JPMorgan Chase & Co. and Berkshire Hathaway, JPMOrgan CEO Jamie Dimon did reveal some of the ambitions of the plan in his annual letter to shareholders. He noted that the companies would start with technology solutions for employees and their families, but long-term goals include aligning incentives across doctors, insurers and patients. Dimon also pointed out the extreme waste in the health care system, alluding to needed improvements in telemedicine and wellness programs. He even went so far as to say the joint venture could “possibly help inform public policy for the country.”

Most read

Last week, we broke the news that the Centers for Medicare & Medicaid Services (CMS) officially added non-skilled in-home supports as a supplemental benefit in Medicare Advantage plans for 2019. Investors and providers in both the home health and home care space were particularly excited about the new opportunities the supplemental benefit could bring in the years ahead.

We also covered an exciting way that UnityPoint at Home, a hospital-based home health care provider with UnityPoint Health system, is helping extend care to patients after they are discharged through care coordination and an interdisciplinary team.

Written by Amy Baxter

The post Must-Read News: HHS Recovered $2.6 Billion From Health Care Fraud appeared first on Home Health Care News.

The U.S. government has declined to intervene in a False Claims Act (FCA) case brought against HCR ManorCare’s hospice division, Heartland, though it asked to be kept updated on pleadings in the case.

The decision to not intervene marks another victory in FCA cases for ManorCare; in November, a Medicare fraud case against the Toledo, Ohio-based skilled nursing provider was dismissed. But it’s not necessarily out of the woods yet; the government declining to intervene doesn’t mean an FCA case won’t go forward, Brian Roark, a partner at Bass, Berry & Sims PLC in Nashville, Tenn., told Bloomberg BNA.

Heartland Hospice, which is owned by HCR ManorCare, was accused by a whistleblower of “a corporate-wide pattern of conduct that has resulted in the submission of thousands of false claims and statements.” The case was filed in the U.S. District Court of the Northern District of Ohio in 2010.

Heartland Hospice was accused of falsifying patients’ life expectancy to qualify them for hospice reimbursement and maintaining them on hospice after their medical condition stabilized. The complaint also said that Heartland’s auditors were instructed to review only the most recent benefit period for audited patient files, rather than the whole time of treatment.

The government decided not to intervene in the action, according to a notice filed March 1 that was obtained by Home Health Care News. As a result, the qui tam plaintiff, Kathi Holloway, is the sole prosecutor, though the order noted that the government could decide to intervene “upon the showing of a good cause.”

It’s a bit of good news for the skilled nursing provider, which recently entered Chapter 11 bankruptcy so it could be taken over by Quality Care Properties (NYSE: QCP) after a long run of financial difficulties.

Carter Healthcare Under Investigation

Multiple agencies are investigating Carter Healthcare, the FBI confirmed to Fox affiliate KOKH on March 9.

Based in Oklahoma City, Carter provides home health, hospice, pharmacy and other services across seven states. It employs more than 750 people, according to the company website.

Authorities are not revealing why Carter is under scrutiny, but the corporate office was blocked off following a raid on Friday, KOKH reported. The company had not returned a phone call from Home Health Care News as of press time.

Miami-Area Home Health Agency Owner Gets 20 Years for $66 Million Fraud Scheme

The owner and operator of several home health care agencies in Miami was sentenced to 240 months in prison at the end of February for his role in a $66 million conspiracy to defraud Medicare.

Rafael Arias, 52, was sentenced and ordered to pay $66.4 million in restitution and to forfeit the gross proceeds traced to the offense, the Department of Justice (DOJ) announced. Arias pleaded guilty on Nov. 30, 2017, to one count of conspiracy to commit health care fraud and wire fraud.

As part of his guilty plea, Arias admitted he was the owner and operator of more than 20 home health agencies between Dec. 2007 and Sept. 2015. To hide his identity and ownership interests, Arias recruited nominee owners to fraudulently present themselves as agency owners. He and his co-conspirators also paid illegal bribes and kickbacks to patient recruiters and submitted false and fraudulent home health care claims to Medicare for patients who did not qualify of for whom services were never performed.

See the full announcement here.

Hospice Company and Owner Settle False Claims Act Case for $1.24 Million 

Horizons Hospice, LLC and its owner and CEO John C. Rezk have agreed to pay the United States $1.24 million to resolve allegations that the company fraudulently billed Medicare and Medicaid services for patients who were ineligible for hospice care.

The defendants allegedly submitted false claims to Medicare and Medicaid for patients who did not qualify from June 27, 207, to August 1, 2012. The company also changed its name to 365 Hospice, LLC.

Home Health Owner Gets 18 Month Sentence for Kickback Scheme

Norma de la Cruz, owner of Glenview, Illinois-based TLC Healthcare, has received an 18 month federal prison sentence for her role in a kickback scheme, the U.S. Department of Justice announced on March 6.

The 81-year-old de la Cruz pleaded guilty last year to one count of conspiracy to offer and pay unlawful kickbacks. From 2012 to 2014, de la Cruz used a personal account as well as a TLC business account to pay bribes and kickbacks to recruiters, offering $500 to $600 for each patient referral. TLC fraudulently billed Medicare for home health services purportedly provided to these patients, causing the Medicare program to pay out $390,000 in that two-year period.

In one instance, de la Cruz paid a recruiter at least $65,000, according to the DOJ. She reportedly used proceeds from the scheme to gamble at Chicago-area casinos, where she accumulated losses of about $245,0000 during the approximate time period of the kickback scheme.

Written by Amy Baxter and Tim Mullaney

The post Fraud Watch: Feds Sit Out ManorCare Case, Carter Health Under Investigation appeared first on Home Health Care News.

The owner of two Miami home health care agencies, now defunct, has been sentenced to 80 months in prison for her role in a $74 million conspiracy to defraud the Medicare program, the Department of Justice (DOJ) announced in late November.

Sila Luis, 59—who pleaded guilty on June 28 to one count of conspiracy to commit heath care fraud—was sentenced by U.S. District Judge Marcie G. Cooke of the Southern District of Florida. Luis was also ordered to pay $45 million in restitution and to forfeit the gross proceeds traced to the scheme.

Luis admitted that she and her co-conspirators operated LTC Professional Consultants, Inc. (LTC) to fraudulently bill for home health care services, including diabetic injections, skilled nursing visits, physical therapy and more. She also admitted to enlisting and paying patient recruiters kickbacks and bribes in exchange for the referral of Medicare beneficiaries.

Read the full report here.

Another Miami home health care agency owner, Yunesky Fornaris, 38, was sentenced to 115 months in prison on Dec. 11, 2017, for his role in a $15 million conspiracy to defraud the Medicare program. Fornaris was also ordered to pay $15.1 million in restitution and forfeit the gross proceeds traced to the offense. He pleaded guilty on Oct. 3, 2017, to one count of conspiracy to commit wire fraud.

Fornaris admitted he owned, controlled and managed Elite Home Care LLC, and that he and his co-conspirators submitted false and fraudulent home health care claims from Elite to the Medicare program via interstate wire, the DOJ stated. Fornaris also admitted to hiding his ownership interest in Elite and that he had reason to believe that most of the company’s patients were not eligible to receive home health care services.

Agency Owner Convicted in $1.6 Million Fraud Scheme in Detroit 

A Detroit home health care agency owner was found guilty for her role in a scheme involving approximately $1.6 million in fraudulent Medicare claims for home health care services, the DOJ announced on Dec. 4. The claims were procured through the payment of kickbacks. Claims were also not medically necessary and not provided, according to the DOJ.

Edith Manzano, 69, of Troy, Michigan, was convicted of one count of conspiracy to commit health care and wire fraud, one count of conspiracy to pay and receive kickbacks in connection with Medicare beneficiaries, and one count of health care fraud. The trial lasted seven days, and her sentencing has been scheduled for April 9, 2018, before U.S. District Judge Gershwin Drain of the Eastern District of Michigan, who also presided over the trial. Five defendants were charged in the case.

Manzano and her co-conspirators engaged in a scheme between 2013 and 2016 to defraud Medicare of approximately $1.6 million for services in connection with Anointed Care Services, based in Detroit, according to evidence presented at trial. The evidence showed Manzano paid illegal kickbacks for patients to sign up for home health care with Anointed; that Manzano conspired with physicians to admit patients when they did not qualify for home health care; and that Manzano and co-conspirators falsified medical records and signed false documents.

Read the full report here.

Massachusetts Agency to Cough Up $14 Million in Improper Billings 

Maxim Healthcare Services Inc., a national home care provider, has agreed to pay $14 million to settle allegations it improperly billed Massachusetts’ Medicaid program, the Associated Press reported. Maxim operates six locations in Massachusetts.

Centrus Premier Home Care Inc., which does business in the state as Maxim Healthcare, billed MassHealth for services that were not eligible for reimbursement under state regulations, Attorney General Maura Healey announced.

The company improperly submitted claims that MassHealth subsequently paid, Healey’s office said, including for home health aide services provided through Maxim or unnecessary skilled therapy services.

New Orleans Woman Sentenced to 4 Years in $2 Million Scheme 

Kim Ricard, 51, of Gonzales, Louisiana, was sentenced to 51 months in prison for her role in a $2 million home health kickback scheme carried out through a New Orleans-area home health care agency, the DOJ announced Jan. 4.

Ricard was also ordered to pay $1.958 million in restitution. She was convicted of one count of conspiracy to pay and receive kickbacks, three counts of receiving kickbacks, three counts of identity theft and one count of making false statements to federal agents on Sept. 12, 2017.

From 2008 to 2013, Ricard and others engaged in a scheme to refer mental ill Medicare patients to home health agencies in and around New Orleans in exchange for kickbacks, according to evidence presented at trial. Co-defendent Milton Diaz, 65, of Harvey, Louisiana, pleaded guilty on July 13, 2017, and is awaiting sentencing.

Written by Amy Baxter

The post Fraud Watch: Miami, Detroit Sentencing and Conviction appeared first on Home Health Care News.

Just before the long weekend, A federal judge in Texas scrapped a controversial Obama-era wage rule that would have extended overtime pay to millions of American workers. The rule, which likely didn’t pose a significant threat to the home health care industry, was met with challenges from multiple states and was put on pause at the end of 2016. The rule would have guaranteed overtime pay to salaried workers making $47,476 per year, or $913 per week, or less, and impacted an estimated 4.2 million salaried workers. U.S. District Judge Amos Mazzant cited the new salary threshold as too high, reuters reported.

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After days of torrential downpours, Texas is finally recovering from Hurricane Harvey, which dropped more than 50 inches of rain on the Houston area. Hundreds of thousands of residents were displaced by unprecedented flooding, and several images of seniors in flood waters went viral on social media. Fortunately, assisted living seniors pictured in wheelchairs in chest deep water were rescued, and followup images show the residents—and their cat, Bozo—safe and warm in another facility.

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Read about how Amedisys (Nasdaq: AMED) reduces rehospitalization rates—and cuts financial risks.

We covered what Addus Homecare (Nasdaq: ADUS) and Bayada Home Health Care are doing to meet the rising demand of Hispanic clients, and how they’re keeping up by recruiting Spanish-speaking caregivers.

Written by Amy Baxter

The post Must-Read News: Overtime Rule Invalidated appeared first on Home Health Care News.