Sunday, November 29, 2015

Wisconsin Home Health Business and Owner Agree to Criminal and Civil Resolution of Health Care Fraud Charges

The Acting United States Attorney for the Eastern District of Wisconsin announced November 18, 2015 that the United States has filed a criminal information charging Deaconess Home Health, Inc. ("Deaconess") and its owner, Lazarus Bonilla, with committing health care fraud against the Wisconsin Medicaid Program.  

Deaconess has agreed to plead guilty to the crime under a plea agreement filed with the information.  Mr. Bonilla and the United States have entered into a deferred prosecution agreement.  The United States also reached a civil settlement agreement with Deaconess and Bonilla for $3,724,000 pursuant to the federal False Claims Act.

The agreements arose out of an investigation into the false billing of personal care worker services Deaconess (formerly known as Outreach Home Health) to the Wisconsin Medicaid Program.  The Wisconsin Medicaid Program pays for personal care services, which are medically orientated services intended to assist a recipient with activities of daily living necessary to maintain a recipient in his or her place of residence in the community.  

As charged in the criminal information and the stipulated statement of facts, the defendants engaged in a scheme to defraud the Medicaid program by:

(1) intentionally recruiting patients and personal care workers without regards to whether to whether personal care worker services were medically necessary for those patients; 

(2) instructing nurses employed by Deaconess to routinely inflate, without regard to medical necessity, the assessment of the patient that was provided to the Medicaid program; 

(3) failing to conduct required supervisory visits to ensure that services were in fact being provided, that services continued to be medically necessary, and that any services provided were appropriate for the needs of the patient; and 

(4) hiring physicians to act as medical directors to sign plans of care for patients on whom they had not completed a physical examination.

As a result of these practices, the defendants allegedly submitted claims to the Medicaid Program for services that were not medically necessary or that Deaconess could not verify had ever been provided. Between 2011 and 2012, Deaconess increased its billing to the Medicaid Program for personal care service by over 100%.

Deaconess ceased operation after Medicaid stopped paying claims submitted by Deaconess in April 2013.  Pursuant to a plea agreement, Deaconess will plead guilty to a felony charge of health care fraud and the government is entering into a deferred prosecution agreement with Bonilla.   Bonilla has agreed to be voluntary excluded from participating in any federal health care program, including Medicare and Medicaid, for fifteen (15) years. 

The Civil Settlement resolves there (3) lawsuits filed under the qui tam, or whistleblower, providers of the False Claims Act.  The False Claims Act allows private citizens with knowledge of fraud against the government to bring civil actions on behalf of the United Sates and share in any recovery.  Two of the whistleblowers are former employees of Deaconess.  As part of the resolution, the whistleblowers will receive payment of approximately $600,000.

The criminal cases are captioned United Sates v. Deaconess Home Health, Inc,  and United States v. Lazarus Bonilla, 15-CR-207.  The civil cases are captioned U.S. and State of Wisconsin ex rel. Ritacca v. Atlas Healthcare Inc., et al., Case No. 10-C-253;  U.S. and State of Wisconsin ex rel. Komlodi v. Outreach Healthcare Inc., et al,. Case No. 11-C-973; and U.S. and State of Wisconsin ex rel. Campbell v. DHH, et al., Case No. 13-C-488.


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