Owner Of Pennsylvania Medical Staffing Company Sentenced For Billing Medicaid for Services Not Provided, Provided by Others or Not Qualified to Provide Services

Medical staffing companies need to be careful when billing for services and for providers. One issue that arises is when a licensed provider is not available and the services are provided by a different person or someone who is not licensed yet. 

We have seen this with home health agencies as well. Companies must be very careful about controls on who performs services in staffing agencies. A recent staffing company case shows what can happen when there are shortcuts and false documentation. The case can go criminal.

On December 21, 2016, Rose Umana, owner and operator of Vision Healthcare Services, Inc. (Vision) of Pennsylvania, was sentenced by United States District Court Judge Sylvia H. Rambo to 36 months in prison. Vision is a medical staffing company and home care services provider servicing several Pennsylvania counties and has been enrolled under Medicaid since 2006. This sentence was for making false statements relating to health care matters, engaging in monetary transactions involving criminally-derived property, and identity theft.  

According to the United States Attorney's Office, between January 2012 and January 2014, Ms. Umana, in her position as owner of Vision, created false identification documents and fictitious occupational licenses for workers. It is also alleged that Ms. Umana and Vision: 
(1) submitted bills to Medicaid for medical services not provided by the workers, 
(2) billed Medicaid for services provided by someone other than the person claimed to be the provider, and 
(3) billed Medicaid for services not provided or provided by someone not qualified to provide the service.

The total loss resulting from Umana’s conduct as owner of Vision was $1,184,224. In addition to the three- year-term of imprisonment, Judge Rambo also ordered Ms. Umana to pay $1,184,224 in restitution and ordered the forfeiture of $656,421.  Judge Rambo ordered Ms. Umana to report to the Bureau of Prisons on January 23, 2017.

Medicaid is the joint federal–state program that provides health care and nursing home coverage to low asset/income individuals.  Medicaid in Pennsylvania is administered by the Department of Human Services and this was a joint state and federal investigation. The case was investigated by the Office of Inspector General, U.S. Department of Health and Human Services; Internal Revenue Service Criminal Investigations; and the Medicaid Fraud Control Section of the Pennsylvania Office of Attorney General.  

Posted by Tracy Green, Esq.
Phone: 213-233-2260
Email: tgreen@greenassoc.com
Green and Associates, Attorneys at Law