Fraud Watch: Miami, Detroit Sentencing and Conviction

Two Miami Home Health Agency Owners Sentenced in Separate Fraud Schemes

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