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/
