The owners and operators of two home health agencies pleaded guilty to participating in a $48 million home health Medicare fraud scheme.
Rogelio Rodriguez and Raymond Aday operated Caring Nurse Home Health Corp. and Good Quality Home Health Inc. in Miami, Florida. According to the government, the two defendants submitted claims to Medicare for home health care and therapy services that were not medically necessary. They also engaged in phantom billing or billing for services not provided.
The fraudulent scheme involved paying kickbacks to patient recruiters who supplied the home health care agencies with patients, prescriptions, plans of care, and certifications for therapy and home health services. The owners used these documents to submit false claims to Medicare.
In addition, nurses and office staff at the home health agencies created false medical records to make it appear that Medicare beneficiaries qualified for home health care and therapy services when, in fact, the beneficiaries did not qualify for and did not receive such services.
Between 2006 and 2011, the two home health care agencies submitted approximately $48 million in claims for home health services that were not medically necessary and/or not provided.
The two defendants each pleaded guilty to one count of conspiracy to commit health care fraud. They each face up to 10 years in prison and exclusion from Medicare in the future.
Home healthcare fraud is a top priority for government investigators and prosecutors. They are constantly monitoring Medicare and Medicaid claims data to identify suspicious billing patterns. And when government investigators find evidence of Medicare or Medicaid fraud, they go after everyone involved – not just the owners and managers, but every single employee who was aware of the fraud or signed false medical records.
Do not go to prison for your employer’s fraud. Consult with a Medicare and Medicaid fraud attorney to protect yourself before the FBI shows up at your door. An experienced defense lawyer can help you avoid prosecution or minimize the charges. You may even be entitled to legal protections and a substantial reward as a whistleblower by bringing a qui tam case under the False Claims Act.
You should also consult with a Medicaid and Medicare fraud lawyer immediately if you are under investigation or have been charged with a crime. You may have options and defenses, but only an experienced defense lawyer can help you assert them.
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