Director of Waltham home health agency sentenced in $3.5 million Medicare fraud scheme

The clinical director of a Waltham-based home nursing agency, At Home VNA, was sentenced on Monday in connection with her role in a multi-million dollar scheme to defraud Medicare. Janie Troisi, 66, of Revere, was sentenced to three years in prison and three years of supervised release. In August, 2015, Troisi was convicted after a five-day trial of conspiracy to commit health care fraud and 10 counts of health care fraud.

From 2009 to 2012, Troisi conspired with Galatis to submit more than $3.5 million in fraudulent home health care claims to Medicare, said United States Attorney Carmen M. Ortiz. The Medicare program only pays for home health services under certain conditions, including that a physician has certified that the patient is homebound and needs certain skilled services.

Troisi ignored these requirements and trained AHVNA nurses to recruit healthy individuals with Medicare insurance who lived in large apartment buildings. She also held “wellness clinics” at the buildings at which nurses convinced senior citizens to enroll with AHVNA and have a nurse visit them in their home.

Troisi and Galatis trained AHVNA nurses to create  patients’ Medicare assessment forms to make it look like the patients qualified for Medicare home health services, when that was often not the case. Troisi also worked  with Dr. Spencer Wilking, AHVNA’s in-house medical director, who was paid to sign the home health care orders, even though Dr. Wilking did not examine the most of AHVNA’s patients.

The patients’ primary care physicians did not refer the patients to AHVNA and were unaware that AHVNA was sending nurses to see their patients in their homes. A number of primary care physicians who learned of AHVNA’s services complained to Troisi, informing her that the patients did not need a visiting nurse, but Troisi ignored these complaints. AHVNA’s nurses frequently informed Troisi that the patients did not need a visiting nurse, but Troisi refused to discharge the patients and continued to cause Medicare billing.

Medicare passed a new requirement in 2011 that a physician certify that she or he had a face-to-face encounter with the patient about the need for home health care. Even after this regulation was enacted, Troisi continued to cause the submission of millions of dollars of Medicare claims for home health care even though Dr. Wilking continued to sign each order without examining any of the patients.

Galatis was convicted of conspiracy to commit health care fraud, 10 counts of health care fraud, and seven counts of money laundering. He was sentenced in February 2015 to 92 months in prison. Dr. Wilking pleaded guilty to health care fraud and sentenced to one year of home confinement and a fine of $7,500.