Five Miami residents have been charged for their alleged involvement in a $48 million home health Medicare fraud scheme, the US Department of Justice reports.
On Tuesday, a federal grand jury in Miami charged Marianela Martinez, Mireya Amechazurra, Lissett Jo-Moure, Omar Hernandez, and Celia Santovenia each with two counts of receiving kickbacks from a federal healthcare program and one count of conspiracy to receive health care kickbacks.
The defendants allegedly participated in a health care fraud scheme involving Miami-based home healthcare agencies, Caring Home Health Care Corp., also known as Caring Nurse, and Good Quality Home Health Inc., known as Good Quality.
According to the indictment, the defendants referred Medicare beneficiaries to Caring Nurse and Good Quality in exchange for kickbacks. The five Miami residents knew that the agencies would bill Medicare for home health services supposedly rendered for the Medicare beneficiaries they recruited.
If convicted, each of the five defendants faces up to five years in prison for each charge.
In February, the owners and operators of Caring Nurse and Good Quality were sentenced to 108 and 51 months in prison, respectively. Rogelio Rodriguez and Raymond Aday plead guilty to one count each of conspiracy to commit health care fraud.
The two were indicted in October 2012 for Caring Nurse and Good Quality’s submission of $49 million in fraudulent claims for home health care services that were either not medically necessary or never provided. Medicare paid approximately $33 million for the fraudulent claims, according to the DOJ.
“This case is another example of the size and scope of the fraud that some small Healthcare facilities are capable of if their false billing schemes go unabated,” commented Christopher Paulos, an associate attorney with the Levin, Papantonio law firm who practices in the areas of qui tam and bad drug and defective medical device litigation. “Thankfully, the government pursues these cases vigorously, and with the help of whistleblowers and others who disclose such activities, the government has been able to recoup nearly $5 billion in improper payments in the last year.”