Articles Posted in Health Care Fraud

Emilio Amador, 46 brought potential patients to two South Florida Home Health Care companies in exchange for bribes and kickbacks while fully aware that those two companies would submit all costs to Medicare on behalf of the patients he referred to them for the supposed home health services they provided. Amador was a patient recruiter. He was also the owner/operator as well as president of Nation’s Best. He also pleaded guilty to relevant conduct for the fraudulent billing of approximately $30 million for his dealings associated to that company.

Earlier this month, Judge Federico Moreno sentenced Amador, to nine years in prison in U.S. District Court for the Southern District of Florida. His sentence was the result of his role in a $48 million scheme to defraud Medicare. Amador pleaded guilty to charges of two counts of receiving health care kickbacks and one count of conspiring to receive health care kickbacks this past September. Additionally at the conclusion of his stint behind bars, Amador has been ordered to a term of three years of supervised release. He has also been ordered to come up with $24 million in restitution, individually as well as jointly with other convicted co-defendants. But the $24 million in restitution is just a single drop in a very large bucket.

With Florida having the highest percentage of senior citizens in the United States with over 17%, according to the latest census report, it would be a logical conclusion to assume that health care services would also be the highest percentage in the country. It’s also reasonable to assume that health care, Medicare and Medicaid fraud would go hand-in-hand based on those statistics.

On a nationwide basis estimates of monies stolen through various methods in health care Medicare and Medicaid schemes are figured to be at least 100 billion; but according to some that are in the know regarding these statistics, that number is a low estimate. Other well-informed sources believe that the actual amount of stolen funds is closer in vicinity to 300 billion dollars annually.

Investigation and enforcement also generates a hefty tab. In total, last year’s costs (2012) amounted to over $217 million, broken down by the Federal government picking up over $162 million of the overall sum. There are fifty Medicaid Fraud Control Units which employ over 1,900 individuals including enforcement officers, as well as the FBI’s Federal Medicare Fraud Strike Force that through June of this year has brought charges against just short of 90 medical professionals including doctors and nurses in eight cities throughout the country, with schemes relating to Medicare fraud which has totaled close to $225 million in false billings according to government records. There are currently more than 400 law enforcement officers including agents from the FBI working to make the arrests in these types of cases in Miami, New York, Detroit, Los Angeles and other major US cities.

Florida is a breeding ground for Medicare and Medicaid fraud. Overall, the cost in trying to contain, arrest, and prosecute offenders is a multi-million dollar effort with hundreds of law enforcement officers working to detect and investigate these schemes throughout the state with the ever-present assistance of federal law enforcement agencies.

In this particular case, the sentencing of Amador was a segment of a Medicare Fraud Strike Force Operation that charged twenty-four South Florida residents in fraudulent billing schemes. It was part of a nationwide sweep that arrested and charged a total of ninety-eight people.

In February of this year, the heads of two Florida Home Health Care companies were sentenced as part of the $48 Million Health Care Fraud Scheme mentioned above. Rogelio Rodriguez, 44 was the president of Caring Nurse Home Health, Corp. and Raymond Aday, 49 the president of Good Quality Home Health Care Inc. were each sentenced to nine years, and more than four years respectively for their roles in the illegal billing scam. The sentencing was imposed after guilty pleas were accepted by the two in December 2012 for the Indictment which was made public earlier in October.

The Indictment charged them with one count each of conspiracy to commit health care fraud and it displayed that between the start of January 2006 through the period ending around mid-2011 the two companies submitted approximately $48 million in claims of which Medicare paid approximately $33 million. The claims submitted were for home health services that were either not medically necessary and/or not provided at all.

In Case number 13-20315-CR-Lenard which charged five defendants including Amador, the sentencing phase is now concluded. The other four defendants named in that individual case were Cristobal Gonzalez, Eduims Mora, Jose Contreras, and Elizabeth Monteagudo. All charges related to conspiracy to receive health care kickbacks and substantive counts of receiving kickbacks in connection with a federal health care program.

Monteagudo, 33, and Gonzalez, 39, both from Miami, were sentenced to serve 70 months and 46 months in prison respectively, followed by three years and two years of supervised release respectively. They were ordered to pay $3.5 million and $2 million in restitution respectively, jointly and severally with co-defendants. Mora and Contreras each received a 34-month prison sentence for their roles in the fraud.

To read other articles on this topic, some with the same defendants who faced other charges in different cases against them click here.

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Crimes relating to the Health Care Industry are one of the most costly issues that American taxpayers are forced to endure. The FBI has estimated that crimes of this nature cost taxpayers an average of $80 billion annually. Statistics show that as little as three percent of this money is recovered and in many cases whistle blowers get paid a substantial amount of the recovered funds for their participation in bringing the offenders of these criminalities to justice.

In an article posted here on August 20, our narrative conveyed a story of a married couple who pleaded guilty to the federal charge of conspiracy to commit health care fraud. Another of the charges that was originally levied against them in the indictment was the payment of kickbacks to patient recruiters in order to direct willing patients to Flores Home Health, the couple’s health care clinic. There, the therapy services offered turned out to be curatively deceitful and in many situations, not delivered in the least, although settlement by Medicare was conveyed for the fabricated and theoretical services rendered.

Elizabeth Monteagudo, 33, and Cristobal Gonzalez, 39, didn’t work for Flores Home Health but their job description of patient recruiters fit the same type of personnel that were paid by Marina Sanchez Pajon and Miguel Jimenez the owners of Flores. Yesterday, the two Miami residents pleaded guilty to receiving kickbacks for their part in a similar federal health care fraud; this scheme in its entirety netting $48 Million.

Throughout the duration of early 2009, concluding roughly in mid-2011, Monteagudo and Gonzalez operated as patient recruiters for Caring Nurse Home Health Care Corp., soliciting and receiving kickbacks and bribes from the owners and operators of the health care company in return for allowing the agency to bill the Medicare program on behalf of the recruited patients. Gonzalez also worked for Good Quality Home Health Care, Inc. in the same capacity. Comparable to the Flores case, these Medicare recipients were subsequently billed for therapy and home health care services that were medically needless or not provided at all, according to documents presented in court.

Additionally, Monteagudo who owned and operated a company named Starlite Home Health Agency Inc. also admitted to her participation with $7 million in fraudulent Medicare billings.

In a separate case that led to these two guilty pleas, the owner/operators of Caring Nurse Home Health Care Corp. and Good Quality Home Health Care, Inc. were sentenced to serve 9 years, and a little over 4 years in prison. On Feb. 27, 2013, Rogelio Rodriguez received the longer sentence while Raymond Aday was given the lesser. These sentences were announced subsequent to their guilty pleas in December 2012. Rodriguez was the owner of the two health care companies and Aday managed both. The two pleaded guilty to one count of conspiracy to commit health care fraud which was charged in an indictment unsealed in October of last year. That indictment charged that between the period of January 2006 and June 2011, each of the two companies submitted claims in the area of $48 million for home health services that weren’t necessary medically, and in many cases not provided at all. In lieu of these falsified claims $33 million of the total amount billed was actually paid by Medicare.

According to the court documents from that case, Rodriguez and Aday colluded with patient recruiters with their ultimate goal being the illegitimate charging of Medicare for unnecessary services rendered. The documents also stated that both defendants paid bribes and kickbacks to the above-mentioned patient recruiters, as well as others.

According to the Department of Justice, nurses and office staff at both health care companies were also implicated for falsifying files of their patients in their attempt to make it seem that the Medicare beneficiaries qualified for services when they in fact did not.

In addition to the term of their incarceration, U.S. District Judge Federico A. Moreno sentenced Aday to pay $2.1 million and Rodriguez to pay $33 million in restitution. They will each also have to pay a fine of $100,000. The two were also penalized to a term of three years of supervised release at the completion of their prison terms.

Both cases were investigated by the FBI and Department of Health & Human Services-Office of the Inspector General, which was conveyed as a measure of the Medicare Fraud Strike Force.

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The family business was thriving. Between late 2009 and mid 2012 Flores Home Health, a Miami based health care agency billed and were paid roughly $8 million for the care and services they provided to their patients.

Marina Sanchez Pajon, 29 and Miguel Jimenez, 43, a married couple from Dade County found success in the health care industry. They put together a top-notch sales force of patient recruiters. They also had excellent “contacts” in doctors’ offices and clinics that were paid very well for providing clientele for the couple’s enterprise.

Jimenez controlled and managed the company’s everyday activities and oversaw all aspects of its operation. His wife Maria was responsible for supervising the “employees”, and taking care of the mountain of paperwork that is customary in this type of enterprise.

Regrettably, the patient recruiters of Flores Home Health were not compensated with a typical salary structure. They were given kickbacks and bribes to steer patients to the married couple’s clinic. Once the patients were attained they would receive home health and therapy services that were therapeutically pointless and in some cases, not provided at all. Their doctors’ office “contacts” were also retained by the inducements of bribes and payoffs that would provide the couple’s firm with medical certifications, therapy prescriptions, and various other required documents. These forms and documents made it possible for them to bill their “chief purchaser” for physical and occupational therapy provided to their patients. The firm’s “chief purchaser” was Medicare.

Flores Home Health is no longer operating and the said “employees” and “contacts” are now branded as coconspirators. On May 14, 2013 Pajon and Jimenez were indicted. The indictment charged them with the crimes of conspiracy to receive and pay health care kickbacks, conspiracy to commit health care fraud, and substantive kickback charges. At the time, The Asset Forfeiture Section of the Department of Justice that prosecutes criminal and civil asset forfeiture matters, dealing with an extensive assortment of federal offenses had acquired seizure warrants and restraining orders on five vehicles and bank accounts holding $160,000. The HHS-OIG has also filed “*lis pendens” (Latin for “suit pending” see footnote) against four real properties that were acquired with profits derived from the scheme.

The indictment was brought as the result of sweeping arrests by the Medicare Fraud Strike Force which was responsible for the takedown of 24 individuals from the South Florida area in March. 89 Individuals in total were rounded up nationally for the submission of over $45 million in fabricated billings to Medicare.

On August 13, in Miami, the couple each pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Ursula Ungaro in the Southern District of Florida. Sentencing is scheduled for Oct. 30. The pair is each facing a sentence of 10 years in prison as a maximum penalty.

The case was investigated by the FBI as well as the Office of Inspector General’s U.S. Department of Health and Human Services as a part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. The case was just one of many where indictments were unsealed regarding investigations conducted by the M.F.S.F. The strike force is currently functioning in nine cities across the country. Since its inception it has indicted more than 1,500 defendants that have fraudulently billed Medicare more than $5 billion.

In the words of U.S. Attorney Wifredo Ferrer, “Health care fraud continues to be a drain on scarce Medicare dollars, as unscrupulous individuals insist on using the Medicare Trust Fund as their private ATMs. We are undaunted and remain committed in our resolve to help preserve and protect Medicare for those who need it, the sick, the elderly and the poor.”

U.S. Attorney General Eric Holder also commented in reference to the work done by the Strike Force “Today’s announcement marks the latest step forward in our comprehensive efforts to combat fraud and abuse in our health-care systems…” they are “protecting the American people from all forms of health-care fraud, safeguarding taxpayer resources and ensuring the integrity of essential health-care programs.” Mr. Ferrer commended the investigative efforts of the multiple agencies involved as well as the FBI.

*As it now stands, a lis pendens is a printed announcement stating that a lawsuit has been filed in regard to real estate, which involves either the title to the property or a claimed proprietorship concern in it. A lis pendens that is recorded against a complete entity or a section of property signals a potential buyer or financier that the property’s title is presently in question.

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Her boss accepted a guilty plea and was sentenced for his crimes.
Last week, Wondera Eason, 51, of Miami came to the realization that she will suffer the same fate.

Armando Gonzalez the owner of health provider Health Care Solutions Network Inc. (HCSN) was doing so well in Florida that he expanded his operations to a third facility in Hendersonville, North Carolina.

The only problem was that his method of collecting most of his company’s revenues from Medicare and Florida Medicaid programs was performed illegally. He also followed the same practices in his North Carolina facility.

In an April plea agreement, in front of U.S. District Judge Cecilia M. Altonaga, Gonzalez agreed to accept guilty charges of conspiracy to commit health care fraud and conspiracy to commit money laundering. His sentence for his guilty plea was to serve 14 years in prison. He was also ordered to pay over $28 million in restitution for monies collected through the fraud. The government’s attempt to recover as much money as possible forced Gonzalez to sell his property valued at several million dollars as well as several high-end automobiles that were registered to him. His savings account of slightly less than 1 million dollars was also seized by the feds. Upon completion of his prison term Gonzalez will also have to submit to three years of supervised liberty.

On Monday, Ms. Eason, was sentenced to 10 years in prison in what has been labeled her central role in the more than $63 million of fraudulent claims that were submitted and consequently paid from Medicare and Florida’s Medicaid Department. Upon completion of her prison term, she was also sentenced to serve three years of supervised release. The amount she was ordered to pay in restitution was just less than 15 million. U.S. District Judge Cecilia M. Altonaga also sentenced Eason.

The sentence was announced on July 8 in collaboration with the U.S. Attorney’s Office of the Southern District of Florida; the Justice Department’s Criminal Division; the FBI’s Miami Field Office; and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.

Health Care Solutions Network Inc.’s Website was taken down in early May and the company is no longer operating. But when they were, Eason’s title was “director of medical records at HCSN’s PHP” (partial hospitalization program).

A PHP is a type of arduous treatment for persons that suffer from severe mental illness and substance abuse. The patient, in most cases resides at home, but travels to the treatment center as often as daily, during a seven day week. Partial hospitalization concentrates on the total treatment of the individual, and its intent is to avert or lessen the amount of time the patient needs to spend their actual time hospitalized.

Evidence at trial showed that Eason, a certified medical records technician, oversaw the fraudulent billing practices for supposed PHP treatment. Her oversight included the forgery, alteration, and fabrication of a vast amount of documents that supported the fraudulent claims
A statement from the Justice Department cited that the therapy given to the patients at HCSN was basically bogus. It regularly consisted of no more than the patients playing bingo, watching Disney movies, or participating in barbecues.

Eason is not the final collaborator who has been or will be facing penalties attributed to this fraud. Just today, the Department of Justice released a statement naming Roger Rousseau, 71, another Miami resident with two counts of health care fraud and a separate charge of conspiracy to commit health care fraud.

Additionally, six therapists have been charged in the same indictment with the latter charge. Ruben Busquets, 49, Doris Crabtree, 61, Angela Salafia, 65, Alina Fonts, 47, Liliana Marks, 46, and Blanca Ruiz, 59, all Miami residents.

Busquets, Marks, Salafia and Crabtree were all charged with two counts of making false statements related to the scheme, and Fonts was charged with two counts of health care fraud.

Additionally, many other South Floridians are facing charges stemming from similar cases.

In one example, Odalys Fernandez, Yumidia Naranjo, Kelvin Soto, Servando Raya, Jose Guerra, and Yanuris Lima have been charged with conspiracy to commit health care fraud. In this particular analogous case the two registered nurses and four recruiters have been charged for supposedly providing services, such as skilled nursing and physical therapy, to homebound beneficiaries. In fact, it is charged, the services were either medically unnecessary or weren’t provided at all. The allegations go on to state that they falsified medical paperwork to make it seem that they had provided theses services. The four recruiters are alleged to have compensated Medicare recipients in the effort that they would attend as patients at Ideal Home Health. Overall, the six health care workers are charged with submitting to Medicare in excess of $40 million in false billing for that company.

The list goes on and on.

In cases such as these, the swindled monetary quantities are staggering. According to a FBI press release, made available last year shows that a total of 59 persons from South Florida alone have been charged in various schemes defrauding Medicare for more than $137 million. The press release also goes on to demonstrate that 107 more individuals in seven other cities were charged involving over $450 million in bogus billing.

To read the latest Department of Justice press release, in regard to the case against Ms. Eason, click here.

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