The health care fraud cases against home health and hospice owners continue to get filed in federal court. The most recent case is one in which the owners, the director of nursing and patient recruiters of a home-health agency based in Houston were arrested November 10, 2015 for their alleged roles in conspiracies to defraud Medicare, to pay illegal healthcare kickbacks and to commit money laundering in an Indictment filed in the Southern District of Texas.
According to the Indictment, Ebong Tilong and Marie Neba used the Texas-based, home-health agency that they owned to bill Medicare for home-health services that were not provided or not medically necessary.
The Indictment then alleges they orchestrated this scheme by paying kickbacks to a series of individuals as follows:
First, Tilong and Neba allegedly paid illegal kickbacks to physicians in exchange for authorizing medically unnecessary home-health services.
Second, using the money that Medicare paid for such alleged unnecessary or fraudulent claims, Tilong and Neba allegedly paid illegal kickbacks to marketers (patient recruiters) Daisy Carter and Connie Ray Island in exchange for referring Medicare beneficiaries for home-health services.
Third, it is alleged that all four defendants allegedly paid illegal kickbacks to Medicare beneficiaries, in exchange allowing Tilong and Neba to bill Medicare using their Medicare information for home-health services that were not medically necessary or not provided.
Ms. Neba, who also served as the company’s director of nursing, also allegedly falsified medical records to make it appear that Medicare beneficiaries qualified for and received home-health services.
The Indictment goes back for nine (9) years and alleges that from in or around February 2006 to in or around June 2015, Tilong and Neba received approximately $13 million for these allegedly fictious or unnecessary home-health services. The Indictments in these cases allege all the billings and do not separate out the claims.
This was a joint investigation by the FBI, U.S. Department of Health and Human Services-Office of the Inspector General (HHS-OIG) and the Internal Revenue Service-Criminal Investigation Division (IRS-CI).
Attorney Commentary: Marketing in home health and hospice care that is not compliant with the law and regulations can bring charges against everyone involved. Criminal cases operate on old history but it is critical to change practices immediately and ensure that all marketing and referrals are compliant. If there is illegal marketing or kickbacks in violation of the Stark law or Anti-Kickback Statute, the entire claim is false even if medically necessary and provided.
The fabrication of records allegation is one that the government uses to show "scienter" or intent to defraud. Whether the fabrication of records occurs at the audit or patient treatment stage, it is used since juries tend to trust records more than witnesses in fraud cases. This case alleges services billed but not provided and services that were allegedly unnecessary.
Given that IRS Criminal Division was involved, it suggests that there were cash payments to beneficiaries or marketers that were not reported as income. Or it suggests that there were improper deductions for alleged illegal marketing.
Posted by Tracy Green, Esq.