A husband and wife owner of a home health business in Tucson, Arizona have been sentenced after guilty pleas in federal court. The case involved upcoding of services, billing for services of physicians or nurse practitioners when those professionals did not perform the services and for the forging of some names of the Medicare providers. Husband owner Stephen Allen Lamont pled guilty to federal health care fraud.
The wife Elvia Lorena Lamont plead guilty to "misprision of a felony" which is a felony that does not have fraud as an element and we attorneys like to use it where possible as an alternative plea. Misprision of a felony is used where someone knows of a felony but conceals it and does not make it known to others. Usually, with misprision of a felony one would expect probation, but in this case both owners received a federal prison sentence.
In his plea agreement, Mr. Lamont admitted that he knowingly submitted false claims for services to Medicare. Mr. Lamont admitted that he fraudulently billed for services that were provided by nurses, medical assistants and a phlebotomist as if they had been performed by a medical doctor or nurse practitioner. Mr. Lamont also admitted that he upcoded or billed at the highest complexity level in order to increase the billings.
On some occasions, Mr. Lamont admitted that he forged the signature of a medical doctor or other Medicare-approved provider before the claims were submitted for reimbursement. Elvia Lamont admitted that she knowingly shared in the proceeds from the Medicare fraud and concealed it from authorities.
On May 15, 2019, Mr. Lamont received a sentence of 30 months in prison, and Mrs. Lamont was
sentenced to 13 months. The government alleged and the Lamonts admitted in their plea agreements that from
2012 to 2015, they owned and operated Ascension In Home Medical Care
NP’s Group, Inc., a home health care business that provided services to the
elderly. Prosecutors will often claim in these type of cases that the elderly on Medicare are being short-changed on care which can be used to persuade the jury that these are serious offenses even where quality of care is not an issue.
In
addition to imprisonment, the Court ordered both defendants to pay a total of $1,054,839
in restitution to the Centers for Medicare and Medicaid
Services. The loss amount and restitution of over $1 million was quite likely a significant factor in the amount of the Lamonts' respective sentences. The plea agreement, however, resulted in the dismissal of numerous charges as the Indictment had a total of 47 counts including ones for identity theft that carry mandatory minimum sentences of two years.
Posted by Tracy Green, Esq.
