Feds dole out stiff penalties for home health fraud

Home health clinicians and executives embroiled in fraud schemes are facing as much as 80 months in prison after billing Medicare for medically unnecessary care.

Last week, New Orleans physician Barbara Smith, M.D., was sentenced to 80 months in jail and ordered to pay $9.4 million in restitution for her role in a decade-long home health scheme that stole more than $50 million from Medicare, according to the U.S. Attorney's Office in the Eastern District of Louisiana. Smith was sentenced alongside another physician, Roy Berkowitz, M.D., and a registered nurse, Beverly Breaux, who received sentences of 64 months and 50 months respectively. Smith and Berkowitz falsely certified that patients were homebound and required medical and therapy services, while Breaux filed claims for patients she never treated.

Joe Ann Murthil, the owner of the home health company, Memorial Home Health Inc., was previously sentenced to four years in prison for submitting 8,000 fraudulent claims, according to NOLA.com.

On the same day, the owner of a Detroit-area home health agency was sentenced to 80 months in jail and ordered to pay $4.5 million for conspiring with physicians, physical therapists and patient recruiters to bill Medicare $7 million in unnecessary services, according to the Department of Justice. Amer Ehsan admitted to paying physicians to refer beneficiaries to his company, Advance Home Health Care Services Inc., and falsely certify they needed home healthcare. Ehsan also paid beneficiaries to sign blank physical therapy records, which he used to bill Medicare.

Ehsan used another company, Michigan Rehab and Management Services LLC, to sell information and patient files to other home health agencies throughout Detroit.

In Miami, Jorege Lorenzo, his wife and another man were arrested and charged with stealing $39 million from Medicare through numorous home health companies, according to the Miami Herald. The three are accused of paying recruitors to supply patients, filed bogus claims and then laundered the money thorugh various shell companies.  

All three of these cases came on the heels of a case in which Jacqueline Tuanqui, the owner of Chicago-based Hexagram Home Health Care LLC, was indicted for paying kickbacks to marketers in exchange for patient referrals, according to the U.S. Attorney's Office in the Northern District of Illinois. The kickback payments led to $450,000 in false claims paid by Medicare.

Home health fraud schemes have taken hold in certain parts of the country, particularly the Midwest, including Ohio, Illinois and Minnesota. Perhaps the most notable home health prosecution this year came last month when husband and wife owners of a District of Columbia home health agency were convicted for orchestrating an $80 million scheme. Although more states are turning to home health as a viable option for elderly care, even programs with the best intentions are often vulnerable to high-priced fraud.

To learn more:
- here's the announcement from the U.S. Attorney's Office in the Eastern District of Louisiana
- read the NOLA.com article
- see the DOJ announcement
- read the Miami Herald article
- here's the announcement for the U.S. Attorney's Office for the Northern District of Illinois

Related Articles:
Home health programs have the best intentions but are often plagued with fraud
Home health owners found guilty for largest fraud scheme in DC's history
Seven indicted for home health fraud scheme in Chicago
Rampant home health fraud in Ohio prompts action from legislators
Minnesota fails to recoup money from home health fraud