Articles Posted in Home Care Fraud

George L. Piro,  owner and operator of a home health care agency was sentenced today to 106 months in prison for his participation in a $30 million Medicare fraud scheme. Ramon Regueira, 66, owner of Nation’s Best Care Home Health Corp. (Nation’s Best), a Florida home health care agency, pleaded guilty to one count of conspiracy to commit health care fraud on Nov. 13, 2014.  In addition to the prison sentence, U.S. District Judge Cecilia M. Altonaga of the Southern District of Florida ordered Regueira to pay $21 million in restitution, both jointly and severally with his co-conspirator.

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CareAll Management LLC and its affiliated entities (collectively “CareAll”) have agreed to pay $25 million, plus interest, to the United States and the state of Tennessee to resolve allegations that CareAll violated the False Claims Act by submitting false and upcoded home healthcare billings to the Medicare and Medicaid programs, the Department of Justice announced today.  CareAll is based in Nashville, Tennessee, and is one of Tennessee’s largest home health providers.This settlement resolves allegations that between 2006 and 2013, CareAll overstated the severity of patients’ conditions to increase billings and billed for services that were not medically necessary and rendered to patients who were not homebound.

This is CareAll’s second settlement of alleged False Claims Act violations within the last two years.  In 2012, CareAll paid nearly $9.38 million for allegedly submitting false cost reports to Medicare.  As part of the settlement announced today, the companies agreed to be bound by the terms of an enhanced and extended corporate integrity agreement with the Department of Health and Human Services-Office of Inspector General (HHS-OIG) in an effort to avoid future fraud and compliance failures.

“Fraudulent home-based services are surging across the country,” said Special Agent in Charge Derrick L. Jackson of HHS-OIG in Atlanta.  “We will continue to protect both Medicare and taxpayers, and ensure that funds are not siphoned off by companies more concerned with the bottom line than patient care.”

Under the False Claims Act, private citizens, known as relators, can bring suit on behalf of the United States and share in any recovery.  The relator in this case, Toney Gonzales, will receive more than $3.9 million as his share of the recovery.

The settlement was the result of a coordinated effort by the Civil Division, the U.S. Attorney’s Office for the Middle District of Tennessee, HHS-OIG and the Tennessee Bureau of Investigation.

The case is docketed as United States ex rel. Gonzales v. J.W. Carell Enterprises, Inc., et al., No. 12-0389 (M.D. Tenn.).  The claims resolved by the settlement are allegations only; there has been no determination of liability.

Jeffrey Newman represents whistleblowers but not this one.

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Health care providers who use fraudulent billing cost Medicaid and Medicare billions of dollars every year but they also hurt the patients themselves. Two subcommittees at the House Oversight and Government Affairs Committee are looking at the effects of Medicare and Medicaid Fraud on patients themselves. One patient, Richard West, a New Jersey resident who blew the whistle on his heal care company by filing a whistleblower suit, testified last week. His lawsuit lead to a $130 million civil settlement. In case case, Mr. West discovered the fraud after being told that he had exceeded his monthly benefit cap and that his Medicaid services were being suspended as a result. West, who is in a wheelchair and on a ventilator, keeps careful records and learned that he had been over-billed for nursing services by $700 per month. Those were services never performed. West will receive over $17 million for his share of the recovery in accordance with the False Claims Act whistleblower law.