The Department of Justice reported last week that it was concluding investigations into a health care fraud scheme based in Miami, Fl. As result of the investigation, the individuals involved the fraud will be spending time behind bars and ordered to pay millions of dollars in restitution.
The organizations behind the scheme were Caring Nurse Home Health Care Corporation and Good Quality Home Health Care Incorporated. The organizations were used as fronts through which two individuals, Elizabeth Monteagudo and Cristobal Gonzalez would file false claims for payment for health care services to Medicare.
The individuals reportedly filed for as much as $48 million in payment. The Department of Justice announced that Medicare had paid the respective organizations approximately $33 million for fraudulent claims between January 2006 and June 2011. These claims often included services that were either misrepresented, overbilled or never performed.
“Health care fraud is a growing problem in the United States – one that the DOJ and other government agencies are working diligently to end,” commented Christopher Paulos an attorney with the Levin, Papantonio law firm who practices in the areas of qui tam or whistleblower and False Claims Act Litigation. “Regrettably, the government’s efforts alone are often not enough to address the rampant health care fraud in the United States. Often, without the knowledge of an insider coming forward to blow the whistle on corruption that they have knowledge of, the illegal practices of companies, like those here, go on unchanged.”
Monteagudo and Gonzalez each pleaded guilty for their involvement in the health care fraud scheme in September. According to the DOJ, they would recruit patients for their respective companies and receive kickbacks from the owners and operators of Caring Nurse Home Health Care Corporation and Good Quality Home Health Care Incorporated. Monteagudo has also admitted to involvement in a $7 million fraudulent billing scheme through her own company, Starlite Home Health Agency Incorporated.
Monteagudo received a sentence of 70 months in prison, 3 years of supervised released and has been ordered to pay $3.5 million.
Gonzalez received a sentence of 46 months in prison, two months of supervised release and has been ordered to pay $2 million.
The owners of Caring Nurse Home Health Care Corporation and Good Quality Home Health Care Incorporated have also received sentences in a separate but related case. Rogelio Rodriguez and Raymond Aday were the individuals responsible for paying Monteagudo and Gonzalez in the kickback scheme.