Fraud Care Plan

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Health care professionals rely on individualized care plans to successfully treat patients. (These plans can provide details on medical or home health care treatment recommendations and prescriptions.) Medical certificates are issued by physicians or health care providers to provide evidence of a health condition. (For example, John was in a car wreck and will need physical therapy for whiplash.) As you can imagine, these documents are extremely valuable to patients needing appropriate treatment as well as to fraudsters who need them to commit fraud. An article published by Home Health Care News attests that four patient recruiters were paid kickbacks and bribes by their home health care agency for delivering Medicare-eligible patients and their health care plan information. Their efforts enabled their employer to bilk Medicare of $20 million.

The story states that the four recruiters worked for a Miami home health agency that provided patient care and physical therapy services in the Miami area. According to court documents, the recruiters received payment from the agency owners for their efforts to deliver patients and care plan information. The home health care company then billed Medicare for services that were unnecessary or not provided to these patients. Over nearly three years, the agency submitted more than $20 million in fraudulent claims and was reimbursed for approximately $15 million.

All four recruiters pleaded guilty for their part in the health care fraud scheme. They await their fate at their upcoming sentencing.

Chalk this one up to the successful investigation and prosecution of the Medicare Fraud Strike Force, which has charged nearly 1,900 defendants who have altogether billed the Medicare program for more than $6 billion. (This program definitely has a comprehensive care plan for nipping fraud in the bud.) Congrats to the Health Care Fraud Prevention and Enforcement Action Team (HEAT) for tracking down these fraudsters and holding them accountable for their illegal actions.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Miami Patient Recruiters Plead Guilty in $20 Million Home Health Fraud,” written by Elizabeth Ecker and published by Home Health Care News on July 14, 2014.

Four patient recruiters have pleaded guilty for their participation in a home health fraud scheme that bilked the federal government out of an estimated $20 million in Medicare dollars.

The four recruiters, Estrella Perez, Solchys Perez, Abigail Aguila and Monica Macias pleaded guilty last week to various charges including conspiracy to defraud the United States, for their work as patient recruiters for Trust Care, a Miami home health care agency. As a home health agency, Trust Care provided home health and physical therapy services to Medicare beneficiaries in the Miami area.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.