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Fraud claims involve SNFs, home healthcare and DME providers

December 6, 2013
by Lois A. Bowers, Senior Editor
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Several recent multimillion dollar Medicare fraud case convictions and settlements relate to the actions or alleged actions of home healthcare agencies, skilled nursing facilities and durable medical equipment companies and their employees.

In the latest news, four patient recruiters of Miami home healthcare agency Caring Nurse Home Health Care Corp. have pleaded guilty for their roles in a $48 million home health Medicare fraud scheme, one year after the company owners and operators pleaded guilty.

  • Emilio Amador was sentenced Dec. 4 to serve 108 months in prison after pleading guilty to one count of conspiring to receive healthcare kickbacks and two counts of receiving healthcare kickbacks. His sentence also includes serving three years of supervised release and, with his co-defendants, paying $24 million in restitution.
  • Marianela Martinez, Omar Hernandez and Celia Santovenia pleaded guilty Dec. 3 to one count each of conspiracy to receive health care kickbacks. Santovenia also worked for Good Quality Home Health Care Inc. Sentencing has been scheduled for Feb. 11.

The companies purported to provide home health and therapy services to Medicare beneficiaries. From about January 2006 through June 2011, according to the Department of Justice, the defendants recruited patients for Caring Nurse and/or Good Quality, and then solicited and received kickbacks and bribes from the owners and operators in return for allowing the companies to bill the Medicare program on behalf of the recruited patients. The Medicare beneficiaries were billed for home healthcare and therapy services that were medically unnecessary and/or not provided.

Amador also pleaded guilty to his involvement in $30 million in fraudulent billings for Nation’s Best Care Home Health Corp., a company he owned, operated and was president of.

The owners and operators of Caring Nurse and Good Quality pleaded guilty in December 2012 to one count each of conspiracy to commit healthcare fraud. In February, Rogelio Rodriguez and Raymond Aday were sentenced to serve 108 and 51 months in prison, respectively.


In other justice department news: