El Centro Regional Medical Center Settles Qui Tam Medicare Fraud Suit By Paying U.S. $2.2 Million and Entering Into A Corporate Integrity Agreement

On September 20, 2010, the El Centro Regional Medical Center in Imperial County, California (near the Mexico border) agreed to pay the United States $2.2 million, plus interest, to settle allegations that it defrauded Medicare. El Centro is a nonprofit community based hospital owned by the city of El Centro. It was formed in 1956.

The United States has agreed to dismiss the lawsuit as a result of the settlement announced today. In addition, as a condition of continued participation in federal health care programs, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG-HHS) has required El Centro Regional Medical Center to enter into a Corporate Integrity Agreement. The agreement subjects the hospital to strict policies and procedures to ensure future compliance with applicable statutes and regulations that govern the use of federal health care funds.

Smaller providers often do not get the opportunity to enter into Corporate Integrity Agreements but given the nonprofit status of this hospital and the fact that it has been around for 40 years, that probably made a difference. Smaller providers when faced with overpayments and fraud allegations, however, should work on creating their own compliance plans and present them to Medicare or Medi-Cal in order to show their commitment to following the rules and regulations.

The government alleges that the 165-bed acute care hospital fraudulently inflated its charges to Medicare patients to obtain larger reimbursements from the federal health care program. The settlement covers claims submitted by the hospital for short inpatient admissions, usually of one day or less, when the services should have been billed on an outpatient “observation” basis or as emergency room visits.

The allegations arise from a lawsuit that was brought under the qui tam, or whistleblower, provisions of the False Claims Act (FCA), which permit private citizens with knowledge of fraud against the government to bring an action on behalf of the United States and to share in any recovery. The whistleblower in this case, Pietro Ingrande, a former employee of El Centro Regional Medical Center, will receive $375,000 as his share of the recovery.

Attorney Commentary:  The qui tam lawsuit shows the importance of having an operative compliance plan where employees are encouraged to report to the provider first before reporting to outside agencies. Exit interviews are also important to the process so former employees report any alleged wrongdoing that can be investigated by the provider to avoid qui tam lawsuits.  I encourage providers to adopt the saying "there is no such thing as a bad fact, only something I do not know." If an employee believes there is improper billing -- even if unfounded -- it is better for the provider to know it and address it internally before there is outside reporting.

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.  

Any questions or comments  should be directed to Tracy Green, a very experienced California health care fraud attorney and qui tam defense attorney who understands fraud and the Medi-Cal Medicare programs at tgreen@greenassoc.com.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and in health care fraud related matters in California and throughout the country.
Their website is: http://www.greenassoc.com/

Miami-Area HIV Injection and Infusion Clinic Owner Pleads Guilty To Conspiracy to Commit Health Care Fraud - Sentencing Set For November

In Florida, you do not need to be a physician to own a medical clinic. On September 9, 2010, non-physician clinic owner Flor Crisologo, 58, pleaded guilty before Magistrate Judge Barry L. Garber in U.S. District Court in Miami to one count of conspiracy to commit health care fraud. Ms. Crisologo owned and operated an HIV infusion clinic and was originally charged in a May 2010 indictment. This case involved kickbacks, medically unnecessary tests, and some tests that were not performed.

According to the plea documents, Ms. Crisologo was the owner and operator of J and F Community Medical Center Inc. Ms. Crisologo admitted that she submitted approximately $23 million in false and fraudulent claims to Medicare for HIV injection and infusion services purportedly provided through J and F. According to court documents, Ms. Crisologo hired a physician at J and F and conspired with the physician and others to order unnecessary tests, sign false medical analyses and diagnosis forms, and authorize treatments to make it appear that medical services were being provided to patients who were Medicare beneficiaries. The services included medically unnecessary injection and infusion therapies.

On the marketing and kickback side, Ms. Crisologo admitted that she and her conspirators paid Medicare beneficiaries kickbacks to induce the beneficiaries to claim they received legitimate services at the clinic when in fact the HIV infusion services were either not provided or were not medically necessary. The kickbacks make defense difficult in these cases since violation of the anti-kickback statute automatically makes a claim for a service that is provided a "false claim." The kickbacks also play into the medical necessity where the marketer encourages the beneficiary to falsely report symptoms in order to obtain services. 

The maximum sentence for conspiracy to commit health care fraud is 10 years in prison. This is a high loss amount and unless there is significant cooperation, it is expected that the sentence could be lengthy.  Ms. Crisologo also faces fines and forfeiture of any property or proceeds derived from the clinic.  Sentencing is scheduled for November 23, 2010.

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.

Any questions or comments  should be directed to Tracy Green, a very experienced California health care fraud attorney and California Medicare fraud attorney at tgreen@greenassoc.com.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and in health care fraud related matters in California and throughout the country. Their website is: http://www.greenassoc.com/

Physicians and Nine Others Indicted For Online Pharmacies & Charges Of Illegally Distributing Drugs In San Francisco Federal Court

On September 1, 2010, a San Francisco federal grand jury indicted 11 defendants including one physician for participating in three separate but related conspiracies to distribute controlled substances outside the scope of professional medical practice. It is Case Number CR 10 - 0642 RS. The United States Drug Enforcement Agency issued a press release summarizing this multi-defendant case. 

This indictment was obtained in connection with an international investigation of illegal Internet pharmacies that began in 2005. The investigation has resulted in the indictment of 37 federal defendants, the conviction of 26 individuals on federal criminal charges, and the dismantling of more than five Internet pharmacies. Please note: An indictment contains only allegations against an individual and, as with all defendants, the individuals listed in the government's press release must be presumed innocent unless and until proven guilty.

There are three related conspiracies in the Indictment. In the first alleged conspiracy, called the "Safescripts Online" conspiracy, eight individuals allegedly conspired to distribute in excess of $22.2 million worth of controlled substances outside the scope of professional medical practice and without establishing a legitimate medical purpose for the drugs from November 2004 and continued until December 2006. The second is the "Pitcairn conspiracy" which allegedly ran between May 2003 and April 2007.  The third one is the "United Mail Pharmacy Services" conspiracy, which allegedly began in January 2006 and ended in March 2008.

This case related to Internet pharmacy website selling Schedule III and IV drugs (a) phendimetrazine; (b) diazapam (Valium); (c) phentermine; and (d) clonazepam. In essence, the Indictment alleges that the defendants at the pharmacy reviewed online questionnaires which asked customers to briefly describe medical history. The doctor defendants allegedly did not examine the "customers" and did not obtain a complete medical history and there was no effort made to confirm the accuracy of the information provided.  The doctor defendant authorized the prescription and the owners/employees of fulfillment pharmacies filled and shipped the orders to the customers.

The individuals charged are from around the United States and outside the country and reflect the geographic spread of internet pharmacies. All of the defendants were charged with (1) conspiracy to distribute schedule III and IV controlled substances, in violation of 21 U.S.C. § 846, and (2)  conspiracy to launder money, in violation of 18 U.S.C. § 1956(h). In addition, all but one defendant were charged with distribution of the schedule IV controlled substance Phentermine, in violation of 21 U.S.C. § 841(a)(1), and all but another defendant were charged with conspiracy to launder money, in violation of 18 U.S.C. § 1956(h).

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.

Any questions or comments  should be directed to Tracy Green, a very experienced California health care fraud attorney, prescription fraud attorney, California physician lawyer, and California Medical Board attorney at tgreen@greenassoc.com.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers in California and throughout the country. Their website is: http://www.greenassoc.com/

Two Painting Contractors Pleaded Guilty To Workers Compensation Premium Insurance Fraud In Ventura County - Sentencing Set

In California, the District Attorney's Office continue to investigate and prosecute workers' compensation premium fraud. A recent case in Ventura County involved two painting contractors and pleas were entered with sentencing set for September 22, 2010. 

Premium insurance fraud is committed when an employer intentionally misrepresents to the State or his/her insurance company the number of employees, the nature of work performed by certain employees, the amount of payroll, and the loss history. These misrepresentations allow employers to purchase Workers’ Compensation Insurance at a significantly lower rate, or to avoid purchasing the insurance at all. This practice also places their competitors at a disadvantage because it forces them to compete against a company with lower operating costs.

On July 23, 2010, Michael Nuciforo and James Nuciforo, owners of D and J Drywall Painting, Inc. in Newbury Park, California, pleaded no contest to three felony counts of workers' compensation premium fraud and admitted a special allegation that their conduct caused losses of over $100,000.

 

Michael and James Nuciforo were accused of lying to their workers' compensation insurers over a period of nine years in order to lower their workers' compensation premiums. The Ventura County District Attorney's Office Workers' Compensation Unit froze $1.5 million of defendants' assets pursuant to California's “freeze and seize” law (Penal Code §  186.11) in order to preserve money for the purpose of paying restitution and fines. Restitution is expected to exceed $500,000.

 

The sentencing hearing for Michael and James Nuciforo is set for September 22 at 1:30 a.m. in courtroom 12. They are facing up to nine years in state prison. 

Attorney Comments: We note several things about this case. I have written several other posts regarding premium workers' compensation fraud. I will not repeat those comments here but these articles are: "Workers Compensation Premium Fraud in Los Angeles" and "Workers' Compensation Fraud: Attorney Comments on Premium Fraud Case in Orange County."

First, restitution will be the most important factor at sentencing. If full restitution has been made it is much easier to obtain a non-state prison or jail sentence. Given that assets of $1.5 million were seized, these assets can be used to fund the restitution if they can be made liquid. This is critical and strategy and creativity has been used in many of our cases to fulfill this requirement.

Second, Ventura County is different that Los Angeles County or San Francisco County. Ventura (and Orange County) are tougher on white collar crime sentencing. First-time offenders are frequently given jail time. Thus, every extra effort to obtain probation or house arrest must be made in counties such as Ventura. Where judges are used to sentencing people to 60 days county jail for minor offenses involving less than $1,000 when the loss amounts exceed $100,000 - judges and prosecutors are insisting on jail time. However, payment of restitution is a clear indicator of acceptance of responsibility.

Third, this case went back 9 years. The statute of limitation does not begin to run until the date of discovery of the fraud and under People v. Zamora there should be an allegation in the complaint about the failure to discover the alleged fraud. Thus, if your company has engaged in this activity, now is the time to hire a lawyer, change practices immediately, and seek advice on how to proceed. Do not use an accountant or non-lawyer given that your statements to them are NOT protected by the attorney-client privilege.

Fourth, there will be a civil lawsuit by State Fund or the workers' compensation carrier and this should be handled at the same time as the criminal case in order to resolve the case in its totality.


Fifth, each case is different but it requires an assessment early on at the first notice that there is an audit or investigation. I have seen attorneys not take these audits or preliminary investigations seriously and seen individuals arrested without any notice and been saddled with a high bail equaling the cost of restitution.  Although I have been successful in getting bails reduced from $10 million or $1 million in a workers' compensation fraud case - it is much easier if I have contacted the District Attorney's Office early, offer a self-surrender in the event charges are filed, and make all efforts to evaluate the case pre-filing in order for there to be damage control.

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.  

Any questions or comments  should be directed to Tracy Green, a very experienced workers compensation fraud attorney, workers compensation premium fraud attorney, and white collar criminal defense attorney at tgreen@greenassoc.com.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing professionals in fraud related matters in California and throughout the country. Their website is: http://www.greenassoc.com/

Los Angeles Physician Charged With Misdemeanor Counts For Prescribing Painkillers: What's The Real Story Here?

A Los Angeles physician from the San Gabriel area, Dr. Zhiwei Lin, 52, a board-certified neurologist, was arrested September 2, 2010 for allegedly prescribing pain medication to homeless people who didn't need the drugs, according to the Los Angeles Times' article "L.A. Doctor Arrested For Allegedly Prescribing Painkillers to Homeless People Who Didn't Need Them."

A misdemeanor complaint and arrest warrant is only an accusation is not evidence of guilt. Dr. Lin is presumed innocent and is entitled to a fair trial at which the government must prove guilt beyond a reasonable doubt.

Dr. Zhiwei Lin was arraigned on Friday, September 3 on five counts of illegally prescribing drugs, misdemeanors each punishable by up to a year in County Jail and a $20,000 fine, according to the arrest warrant filed in Los Angeles County Superior Court.

This case shows that a multitude of agencies are investigating and prosecuting prescription fraud or health care fraud: Attorney General's Office, U.S. Drug Enforcement Administration (DEA), District Attorney's Office, U.S. Attorney's Office and City Attorney's Office. This case was investigated by the Health Authority Law Enforcement Task Force (HALT) and Sgt. Steve Opferman has many years of experience with health care issues, beginning with his years at the Los Angeles County Sheriff's Department.  

Sgt. Opferman runs the medical fraud unit that made the arrest and was quoted in the Los Angeles Times as stating that Dr. Lin is suspected of prescribing Vicodin, a powerful pain reliever popular among drug abusers, to homeless people without legitimate medical need.

Sgt. Opferman was further quoted as stating that it is believed that homeless "patients" were brought to the doctor by recruiters, also known as cappers. The cappers would pay the homeless people for their prescriptions and turn them over to dealers who sold them by the pill at a huge mark-up. Presently, there is no allegation of Medi-Cal or Medicare fraud and it is not clear how the billing was done for medications that were allegedly medically unnecessary. This is a case that could grow if fraud allegations are added to the case.

Dr. Lin appears to have two practices: one in San Gabriel and one on Western. At this point, it is not clear if Dr. Lin knew what was going on in his Western office and whether he was involved in the alleged patient recruitment. The fact that he was not charged with patient recruitment or capping makes it appear as if there must be more to this story and whether someone else other than Dr. Lin is involved in some of the alleged wrongdoing. Otherwise, it seems like a case where the counts charged would be felonies rather than misdemeanors.

The L.A. Times quoted a security officer at the building as stating that that Dr. Lin's practice drew "strange characters" on the days it was open and that police had been called to at least one disturbance. This means that the practice was not open every day.

The L.A. Times indicated that Dr. Lin's case would be referred to the Medical Board of California, which could pursue action against his license. Generally, the Medical Board will wait until the criminal case is resolved before it take administrative action unless there is  a danger to patient health. In addition, the  DEA is also reported to be involved and could pull Dr. Lin's federal permit to prescribe drugs prone to abuse. 

Attorney Commentary: I have several thoughts on this case.  First, the misdemeanor counts indicate that Dr. Lin may have been out of the loop on the alleged capping or selling or dealing of drugs afterwards. If there were videotape of Dr. Lin paying referral fees or being involved in either, generally felony counts would have been filed. The real money in this type of alleged scam is in the money obtained by selling the prescriptions. Dr. Lin or his office would have only received money for the office visit.

Second, when physicians have second offices which are not the primary offices, these issues are more likely to happen. The L.A. Times article noted that the office was not always open. When physician assistants or office managers have more presence in the office than the physician -- these issues are more likely to occur. The article does not mention anyone else being involved, but based on my experience -- some part of the story is missing.

Third, this may have been a rejected case by the District Attorney's Office and this is why it was charged as a misdemeanor. Hard to tell. Based on my experience, Sgt. Opferman has a reputation for being pragmatic and understanding what happens in the "real" world since he spends a lot of time coordinating investigations between agencies. He also has a reputation for being fairly straight forward. Thus, we will have to wait and see what the real facts are in this case. 

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation. 

Any questions or comments  should be directed to Tracy Green, a very experienced California prescription drug fraud attorney, Medical Board attorney, DEA physician lawyer, and California physician attorney at tgreen@greenassoc.com.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and in health care fraud related matters in California and throughout the country. Their website is: http://www.greenassoc.com/

Restitution In Fraud Cases: Fake Nurse Must Repay Wages Earned & Importance Of Repayment of Restitution

An unlicensed woman who stole the identities of registered nurses to obtain work as a nurse must pay back wages and benefits she received, even though she actually did the work for which she was paid, the Ninth U.S. Circuit Court of Appeals ruled on August 20, 2010.  The case is United States v. Hunter, No. 09-30246. This case is a lesson on how the courts interpret "making the victim whole" even when services are performed by a defendant that have some value and did not require a license. This tracks the 6th Circuit in a similar case.

Upholding a restitution order by a federal judge in Fairbanks, Alaska, the three-judge panel said Becky Nadine Hunter had to repay former employers more than $18,000 because they did not receive the services they paid for: those of a “licensed” nurse.

Ms. Hunter was convicted of five counts of mail fraud and other crimes after federal prosecutors accused her of devising as many as 21 aliases to defraud employers and lenders, as well as the state and federal governments. The mail fraud charges arose from a series of false documents Ms. Hunter mailed to obtain employment as a nurse when she moved to Alaska in 1998. Prosecutors said she acquired nursing licenses in the state using the names, Social Security numbers, birth dates and credentials of two nurses who lived in New York and Canada.

Ms. Hunter used the first license she obtained, along with a false employment history and other information, to get a job in 1998 as a school nurse with the Fairbanks North Star Borough School District. The district paid her $12,558 in wages and benefits, but fired her after discovering her false identity. Ms. Hunter later used a similar set of false documents to obtain a nursing position with the U.S. Department of Labor, where she was paid $5,457. She was arrested in 2004 following an investigation by the FBI, the Internal Revenue Service and the U.S. Postal Service. 

U.S. District Court Judge Ralph R. Beistline of the District of Alaska sentenced Ms. Hunter to 96 months incarceration after she successfully appealed her initial sentence, and he ordered her to make restitution in full to the North Star Borough and the Department of Labor under the federal Mandatory Victims Restitution Act (MVRA).

Ms. Hunter appealed, arguing that her former employers would receive windfalls if she was required to repay wages for work she actually performed, but the Ninth Circuit rejected the argument in an opinion by U.S. District Judge G. Murray Snow of the District of Arizona, sitting by designation.

Noting that the purpose of restitution under the MVRA is not to punish a defendant but to make victims whole by reimbursing actual losses, Snow said the district court did not err in concluding that Ms. Hunter’s former employers were victims of her conduct.

“Both [North Star] Borough and the Department of Labor were directly and proximately harmed by Hunter’s mail fraud because they paid for the services of a licensed nurse that were never received…,” he wrote. “If Hunter had not mailed false documents reflecting fictitious nursing credentials, she could not legally have been employed in positions that required a valid nursing license, and a qualified licensed nurse could have been employed instead.”

Snow similarly rejected Hunter’s assertion that the restitution order should have deducted the value of services she provided that did not require her to hold a nursing license.

“This conclusion accords with traditional principles of contract law,” he explained, pointing to treatises by Corbin and Farnsworth. “When an individual fails to comply with licensing requirements aimed at protecting health and safety rather than merely raising revenue, that individual can maintain ‘no action for the promised compensation or for quantum meruit.’ ”  Judges Raymond C. Fisher and Marsha S. Berzon joined Snow in his opinion.

Attorney Commentary:  Restitution is key in fraud cases. There are some cases where there has been no fraud. But in those cases where there has been fraud or a mistake of judgment so severe that it amounts to fraud, restitution is important.  Assessment of restitution and payment before charges or sentencing is key to obtaining a great result in a criminal fraud case. 

If there is 1 thing I could teach my clients it is to pay restitution at some amount -- no matter how small -- every month. If the restitution is $100,000 and the client has no money, the payment of $100 a month or taking a second job to pay $2,000 a month will earn the respect of the court, the prosecution and the victim. There may be some dispute over the amount but payment is critical.

All too often even though I preach this regularly, my clients or potential clients fail to appreciate how important this fact is in the system. I make my clients earn the right to say they are sorry and to show true acceptance of responsibility where my client has made a mistake or done something wrong. If this means borrowing money, selling items through a yard sale or otherwise or second or third jobs -- this may be the difference between probation and jail time.

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.  Ms. Green's office at Green and Associates is located at 800 West Sixth Street, Suite 450, Los Angeles, CA 90017.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed providers and in audits, administrative board and discipline matters in California and throughout the country. Our website is: http://www.greenassoc.com/

Charging Physicians & Nurses For Making False Statements In Patient Files And Issuing Orders For "Unnecessary" Home Health Services: Guilty Pleas In Federal Home Health Care Fraud Case

The other day I posted an article about guilty pleas in a home health care federal criminal case in South Florida. That article is entitled "Home Health Care Fraud Case: Miami-Area Clinic Owner, Patient Recruiter, Two Nurses and Medicare Beneficiary Plead Guilty."

This post is about a related case. What is notable about these cases from a physician standpoint is that there is an increase in criminal investigations relating to physicians who have written prescriptions or orders where there is "lack of medical necessity." Thus, even where the home health services were provided to patients the physician has been charged for writing orders when there was evidence of no medical necessity.  In both of these two cases, the patients were obtained through illegal marketing efforts by the home health agency (not the physician). It appears that this doctor plead guilty to false statements in patient files and conspiracy to commit health care fraud since he did not want to risk the incredible risk of getting up to 10 years in prison if he went to trial.

This case is also notable for nurses since the nurses in this case admitted to "falsifying" patient files for Medicare beneficiaries so they could qualify for services.Thus, if the nurses documented certain complaints or vital signs in the chart that were not accurate to get a patient a home health service, this would be enough to constitute a "falsification." The nurses in this case did not own the business and were working for hourly pay for others. Perhaps they aggressively documented or added false notes in the chart to "help" the patient get home health and perhaps due to pressure from their employer.

In this related case, on August 30, 2010, medical doctor Fred Dweck, clinic owner Yudel Cayro, and four nurses, all South Florida residents, pleaded guilty before U.S. District Judge Adalberto Jordan in U.S. District Court in Miami for their participation in Medicare home health care billing for beneficiaries. Another nurse pleaded guilty on August 25, 2010, to charges for her role. The individuals were originally charged in a December 2009 indictment.

Dr. Fred Dweck pleaded guilty to one count of conspiracy to commit health care fraud and one count of making false statements in patient files. According to plea documents, Dr. Dweck admitted to referring 858 Medicare recipients for unnecessary home health care services. Specifically, Dr. Dweck admitted to signing prescriptions, plans of care, and medical certifications for these patients, making it appear that they qualified for home health care services, when in fact they did not qualify for the services. The services included therapy and skilled nursing visits for purported diabetic insulin injections. As a result of Dr. Dweck’s referrals, Miami-area home health care agencies billed the Medicare program for more than $37 million. Medicare paid more than $22 million of the claims. The government claimed that these claims were "false and fraudulent."

Clinic Owner.  Dr. Dweck’s co-defendant and clinic owner, Yudel Cayro, pleaded guilty to one count of conspiracy to commit health care fraud. According to plea documents, Mr. Cayro admitted to being an owner and operator of Courtesy Medical Group Inc., a Miami-area clinic that employed Dr. Dweck. Mr. Cayro admitted that he received kickbacks and bribes from people who recruited Medicare recipients into the scheme and from the owners and operators of Miami-area home health agencies in return for having Dr. Dweck issue prescriptions, plans of care and medical certifications for unnecessary home health care and therapy services. Mr. Cayro admitted that approximately 344 Medicare recipients were referred for such unnecessary services through his clinic, resulting in more than $16 million of billing to the Medicare program by home health agencies.

Nurses.  Nurses Teresita Leal, Armando Sanchez, Lissbet Diaz, Marlenys Fernandez and Silvio Ruiz each pleaded guilty to one count of conspiracy to commit health care fraud and one count of making false statements in patient files. According to court documents, each of the nurses worked at various times for ABC Home Health Care Inc. and/or Florida Home Health Care Providers Inc., two Miami-area home health care agencies. The nurses admitted to falsifying patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services. The nurses admitted that they did so in agreement with their co-conspirators so that the Medicare program could be billed for medically unnecessary services. The owners and operators of ABC and Florida Home Health pleaded guilty last year in a separate case for their roles in the scheme. According to court documents, each nurse accepted responsibility for the billings to the Medicare program for certain patients each nurse purported to treat through ABC and/or Florida Home Health.

Sentencing set for December 2010.  At sentencing, each defendant faces a maximum of 10 years in prison for each conspiracy to commit health care fraud count and five years in prison for each false statement count. However, plea bargains mean that there will be reductions in sentencing for acceptance of responsibility. In addition, some of these defendants may be cooperating in other cases in order to obtain downward departures in sentencing. The loss amounts in these cases are significant and all of the defendants are facing federal prison time although in some cases probation can be obtained depending on the role of the defendant, the facts and the level of cooperation.

Posted by Tracy Green, Esq. Please email Ms. Green at tgreen@greenassoc.com or call her at 213-233-2260 to schedule a complimentary 30-minute consultation.

Any questions or comments  should be directed to Tracy Green, a very experienced California health care fraud attorney, home health fraud attorney, California home health lawyer, and California Medicare fraud attorney.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing licensed health care providers and in health care fraud related matters in California and throughout the country. Their website is: http://www.greenassoc.com/