In just one week the Department of Justice (DOJ) announced three guilty pleas in three cases across the nation involving similar schemes of fraud in the home health care industry. In each of the three cases the defendants were guilty of billing Medicare for home health care services that were not medically necessary or never provided. Furthermore, all three cases involved the falsification of medical records in efforts to support the fraudulent claims submitted to Medicare for reimbursement.
The first case announced on the DOJ’s website December 13, 2012, a Houston, Texas federal jury convicted Dr. Ben Harris Echols of one count of conspiracy to commit health care fraud and six counts of false statements relating to health care matters. Echols worked with the Family Healthcare Group, Inc. and Houston Compassionate Care to commit the fraud. He signed plans of care which are required by Medicare in order to receive reimbursement for the provided home health care service. The plans of care he signed, however, were for patients who were not under his care and about whose health conditions he had no knowledge. Echols signed the documents even if other doctors were listed as the patient’s attending physician. During the trial, doctors in whose names the claims were submitted to Medicare testified that the patients did not need the services for which Medicare had been billed. Additionally, two patients testified that they had never been treated by Echols, they had different primary care doctors and they did not need or want home health care. Nonetheless, Echols submitted fraudulent claims for services that were never provided to these patients. Family Healthcare Group, Inc. and Houston Compassionate Care fraudulently billed Medicare for home health services and received approximately $17.3 million of which $5.5 million were for the patients for whom Echols signed a plan of care.
On December 18, 2012, the DOJ announced that in Detroit, Michigan, a physical therapist, Ankit Patel, pleaded guilty for his role in a $13.8 million home health care fraud scheme. Since 2009, Patel received payments from Physicians Choice Home Health Care, LLC to falsify medical documentation. Patel created evaluations, therapy revisit notes and other medical documentation to support physical therapy services for patients Patel never saw or treated. Patel admitted he knew that the documents he falsified and the documents he signed would be used to support false claims submitted to Medicare for reimbursement. Patel also falsified documents for home health care for First Care Home Health Care LLC, Quantum Home Care Inc. and Moonlite Home Care Inc., all Detroit area home health companies and owned by Patel’s alleged co-conspirators.
Between June 2009 and September 2011, Physicians Choice and Quantum received approximately $1,324,015 from Medicare for claims submitted for fraudulent physical therapy services based on the falsified files and notes created by Patel. Ten of Patel’s co-conspirators have already pleaded guilty for their roles in this health care scheme and one has been sentenced. Three co-conspirators are fugitives and five await their own trials.
And the resolution of the third home health care fraud case was announced on December 19, 2012. The owners and operators of two Miami home health care agencies pleaded guilty for their participation in a $48 million home health care Medicare fraud scheme. As with the first two cases discussed above, the defendants Rogelio Rodriguez and Raymond Aday conspired to bill Medicare for home health services that were never provided. And the medical records of Medicare beneficiaries were falsified to make it appear the patients qualified for the home health care services when in fact they did not and furthermore, the patients never received the care for which Medicare was subsequently billed.
Rodriguez and Aday conspired with patient recruiters through payments of kickbacks and bribes in exchange for providing patients to Caring Nurse and Good Quality, two home health care agencies in the Detroit area, as well as prescriptions, plans of care and certifications of medical necessity for unnecessary home health therapy and services. Rodriguez and Aday used these falsified documents to bill Medicare. Additionally staff at the two home health agencies falsified the patients’ medical records to make it appear that the patients qualified for such services, when in fact they did not qualify and they did not receive the services for which Medicare was billed.
Between January 2006 and June 2011, Caring Nurse and Good Quality submitted approximately $48 million in fraudulent claims and Medicare reimbursed the two entities approximately $33 million.