Home Health Agency Employees Get Jail Time for $60 Million Fraud Bust

Three operators of a Miami health care agency were sentenced to a combined 24 years in prison for their role in a $60 million home health Medicare fraud scheme last week.

United States District Judge Ursula Ungaro in Miami sentenced Roberto Gonzalez to 120 months in prison, Olga Gonzalez to 87 months in prison, and Fabian Gonzalez to 87 months in prison. Each defendant was also sentenced to three years of supervised release and was ordered to pay $40 million in restitution, jointly and severally with co-defendants.

Roberto, Olga, and Fabian Gonzalez each pleaded guilty last year to one count of conspiracy to commit health care fraud.

According to court documents, the defendants were part of Nany Home Health Inc., a Florida home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries. The defendants conspired with patient recruiters, including Miami-area staffing agencies, for the purpose of billing the Medicare program for unnecessary home health care and therapy services. The staffing agencies functioned as patient recruiters and provided patients to the company.

The Gonzalezes and their co-conspirators paid kickbacks and bribes to patient recruiters and the staffing agencies in return for providing patients to Nany, as well as prescriptions, plans of care (POCs), and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries.

The Gonzalezes used the prescriptions, POCs, and medical certifications to fraudulently bill Medicare for home health care services, which the Gonzalezes knew was in violation of federal criminal laws.

According to court documents, Nany nurses and office staff falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services from Nany when, in fact, the Gonzalezes knew that the beneficiaries did not qualify for and did not receive such services. The nurses and office staff at Nany described in the nursing notes and patient files symptoms that were non-existent. The Gonzalezes knew that these files were falsified so that Medicare could be billed for medically unnecessary services.

From approximately January 2006 through November 2009, Roberto, Olga, Fabian Gonzalez, and their co-conspirators submitted approximately $60 million in false and fraudulent claims to Medicare, and Medicare paid approximately $40 million on those claims.

Written by John Yedinak

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