Twenty arrested in New Orleans with ties to $30 million home health fraud scheme

State investigators busted a 20-person fraud ring tied to a home health scam that took more than $30 million from Medicare, according to an announcement from the U.S. Attorney's Office in the Eastern District of Louisiana. But prosecutors are getting an earful from the owner and operator of the home health company, a prominent business owner in New Orleans and the 2004 Zulu Queen, who contends the feds acted with racial bias when they seized more than $1 million in property one year ago.

Federal prosecutors allege that Lisa A. Crinel, owner and operator of Abide Home Care Services Inc., and her daughter, Wilneisha Harrison Jakes, hired four "house doctors" to sign fraudulent home health orders and plans of care for Medicare beneficiaries that did not need home care. In one instance, Crinel and Jakes hired the wife of Michael Jones, M.D., and allegedly inflated her salary to cover the fees paid to Jones for signing the orders.

Prosecutors further allege that Abide would use marketers to seek out and schedule appointments with Medicare beneficiaries. One of five registered nurses listed in the indictment would go to the homes of the identified patients to complete assessments on the patients. Afterward, nurses would falsely document the beneficiary's homebound status and document unnecessary diagnosis that suggested the need for home health services. Abide then generated false plans of care, which were certified by physicians, and carried out by licensed practical nurses, who further falsified documentation to support Medicare claims for unnecessary services.

Crinel also was charged with wire fraud for allegedly filing fraudulent claims totaling $37,800 on behalf of three Abide employees, seeking reimbursement from damages that occurred during the Deepwater Horizon oil rig explosion in 2010.

But in a court filing following her arrest, Crinel, who is African-American, accused prosecutors of racial bias, claiming the property that investigators seized a year ago had exceeded measures taken against white defendants, according to NOLA.com. In her motion, Crinel sought to throw out all evidence seized from the 2014 raid, citing three recent Louisiana cases in which feds did not seize property of white defendants charged with fraud before releasing the indictment. In addition to seizing Abide's office and Crinel's home, valued at more than $800,000 combined, Crinel claims authorities alerted her bank of the impending indictment, leading them to cut off a $300,000 line of credit.

Home health fraud scams have been particularly problematic for the last several years, FierceHealthPayer: AntiFraud previously reported, and states often struggle to balance necessary services against fraud vulnerabilities. Some states, such as Ohio, have taken a stronger legislative stance against home health fraud. Others, such as Minnesota, fail to recoup fraudulent payments.

Elsewhere in Louisiana, a Baton Rouge home healthcare company was indicted for racketeering charges in connection with allegedly scamming Medicaid $15 million from January 2008 through March 2013, according to the Advocate. The indictment of Extraordinary Care Network, Inc. came five weeks after the company's COO Sedric C. Blakes was indicted for healthcare fraud. According to Blakes's indictment, Extraordinary Care Network claimed to provide medical services to the mentally impaired and financially needy; however, Blakes and co-conspirators submitted false claims for which no services were provided.

For more:
- here's the U.S. Attorney's announcement
- read the NOLA.com article
- read the Advocate article

Related Articles:
Rampant home health fraud in Ohio prompts action from legislators
Minnesota fails to recoup money from home health fraud
Cleaning up Dodge: The challenge of home care fraud and abuse
Home care fraud plagues government programs

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.