Ft. Lauderdale Home Health Care Agency Notes Forbes Article on the Epidemic of Florida Medicare Fraud

 By Bill Singer, Forbes Contributor

www.Forbes.com

August 24, 2011

On February 10, 2011, federal prosecutors indicted 21 Miami-area residents (including two doctors, six nurses, eleven patient recruiters) in connection with their alleged participation in a $25 million home health care Medicare fraud scheme. The Indictment alleged charges including conspiracy to commit health care fraud, making false statements, and soliciting kickbacks.

Note: An Indictment is merely an accusation and defendants are presumed innocent unless and until proven guilty in a court of law.

The Defendants: Jose Nunez, M.D., Francisco Gonzalez, M.D., Eneida Fry, L.P.N, Jorge Pineiro, R.N., Maritza Vidal, R.N., a/k/a “Maritza Casas,” Ignacio Angulo, L.P.N., Farah Maria-Perez, R.N., Luisa Morciego, R.N., Odalys Alvarez-Medina, Lesder Casanova, Oscar Martinez, Richard Diaz, Beatriz Torres-Cruz, Juana Rivas, Jose Ros, Fidel Castro, Barbara Gonzalez, Vicente Guerra, Raul Alvarez, Lisandra Alonso and Licet Diaz.

Medically Unnecessary Services

The Indictment alleges that ABC Home Health, Inc. (“ABC”) and Florida Home Health Care Providers, Inc. (“Florida Home Health”) referred Medicare beneficiaries to Drs. Nunez and Gonzalez for medically unnecessary home health care, and that the doctors received illegal kickback payments from the owners and operators of ABC and Florida Home Health in consideration for their signing prescriptions for therapy and home health services. Additionally, the doctors received Medicare payments for home health care services, including office visits and diagnostics tests.

It is further alleged that the defendant nurses, recruiters, and employees also received kickbacks and bribes for recruiting Medicare beneficiaries to be referred for home health services through doctors working with ABC and Florida Home Health (pointedly, Defendant Licet Diaz was charged with distributing kickbacks to patient recruiters on behalf of the owners of ABC and Florida Home Health).

On February 17, 2011, federal prosecutors announced the arrest of the Defendants.

Guilty Pleas

On August 23, 2011, Defendant Jose Nunez, 63, a physician who owned two medical offices, pleaded guilty in federal court in Miami to one count of conspiracy to commit health care fraud.  According to his plea, Nunez admitted to having provided home health care and therapy prescription referrals to ABC and Florida Home Health from about January 2006 until March 2009, and that he knew co-conspirators at ABC and Florida Home Health had operated those agencies in order to fraudulently bill Medicare for expensive physical therapy and home health care services (which he and other doctors had prescribed) that were medically unnecessary and/or were never provided.

Federal prosecutors alleged that Nunez furthered the scheme by falsifying patient files with descriptions of non-existent medical conditions, including hand tremors, unsteady gait and poor vision. Those specific symptoms were reported by Nunez in order to create the false impression that the subject patients were unable to self-inject insulin and were homebound, which would qualify them for Medicare home health care benefits. As a result of Nunez’s fraud, Medicare was defrauded to the extent of $1.5 million in home health care services that were medically unnecessary or never even provided.

On February 10, 2011, federal prosecutors indicted 21 Miami-area residents (including two doctors, six nurses, eleven patient recruiters) in connection with their alleged participation in a $25 million home health care Medicare fraud scheme. The Indictment alleged charges including conspiracy to commit health care fraud, making false statements, and soliciting kickbacks.

Note: An Indictment is merely an accusation and defendants are presumed innocent unless and until proven guilty in a court of law.

The Defendants: Jose Nunez, M.D., Francisco Gonzalez, M.D., Eneida Fry, L.P.N, Jorge Pineiro, R.N., Maritza Vidal, R.N., a/k/a “Maritza Casas,” Ignacio Angulo, L.P.N., Farah Maria-Perez, R.N., Luisa Morciego, R.N., Odalys Alvarez-Medina, Lesder Casanova, Oscar Martinez, Richard Diaz, Beatriz Torres-Cruz, Juana Rivas, Jose Ros, Fidel Castro, Barbara Gonzalez, Vicente Guerra, Raul Alvarez, Lisandra Alonso and Licet Diaz.

Medically Unnecessary Services

The Indictment alleges that ABC Home Health, Inc. (“ABC”) and Florida Home Health Care Providers, Inc. (“Florida Home Health”) referred Medicare beneficiaries to Drs. Nunez and Gonzalez for medically unnecessary home health care, and that the doctors received illegal kickback payments from the owners and operators of ABC and Florida Home Health in consideration for their signing prescriptions for therapy and home health services. Additionally, the doctors received Medicare payments for home health care services, including office visits and diagnostics tests.

It is further alleged that the defendant nurses, recruiters, and employees also received kickbacks and bribes for recruiting Medicare beneficiaries to be referred for home health services through doctors working with ABC and Florida Home Health (pointedly, Defendant Licet Diaz was charged with distributing kickbacks to patient recruiters on behalf of the owners of ABC and Florida Home Health).

On February 17, 2011, federal prosecutors announced the arrest of the Defendants.

Guilty Pleas

On August 23, 2011, Defendant Jose Nunez, 63, a physician who owned two medical offices, pleaded guilty in federal court in Miami to one count of conspiracy to commit health care fraud.  According to his plea, Nunez admitted to having provided home health care and therapy prescription referrals to ABC and Florida Home Health from about January 2006 until March 2009, and that he knew co-conspirators at ABC and Florida Home Health had operated those agencies in order to fraudulently bill Medicare for expensive physical therapy and home health care services (which he and other doctors had prescribed) that were medically unnecessary and/or were never provided.

Federal prosecutors alleged that Nunez furthered the scheme by falsifying patient files with descriptions of non-existent medical conditions, including hand tremors, unsteady gait and poor vision. Those specific symptoms were reported by Nunez in order to create the false impression that the subject patients were unable to self-inject insulin and were homebound, which would qualify them for Medicare home health care benefits. As a result of Nunez’s fraud, Medicare was defrauded to the extent of $1.5 million in home health care services that were medically unnecessary or never even provided.

To view this story on Forbes.com, go to:  http://www.forbes.com/sites/billsinger/2011/08/24/the-epidemic-of-florida-medicare-fraud/2/