Miami Fraudsters Plead Guilty in $48 Million Home Health Care Scheme

Two employees of a Miami home health care company pleaded guilty on Tuesday for their roles in a $48 million home health Medicare fraud scheme, the Justice Department announced.

Elizabeth Monteagudo and Cristobal Gonzalez, both of Miami, worked as patient recruiters for Caring Nurse Home Health Care Corp., according to court documents. Gonzalez also worked for Good Quality Home Health Care, Inc. Both pleaded guilty to one count each of conspiracy to receive health care kickbacks.

Monteagudo also pleaded guilty to receiving kickbacks from a federal health care program. Both charges carry a maximum penalty of five years in prison. Sentencing for both defendants is scheduled for December 2, 2013. 

The two companies the recruiters worked for, Caring Nurse and Good quality, are Miami-based home health care agencies that provide home health and therapy services to Medicare beneficiaries. 

Between January 2009 and June 2011, approximately, Monteagudo and Gonzalez would recruit patients for Caring Nurse and/or Good Quality, court documents indicate, and would solicit and receive kickbacks and bribes from the owners of both companies in return for allowing the agency to bill Medicare on behalf of those recruited patients. 

The Medicare beneficiaries were billed for home health care and therapy services that were either medically unnecessary, or were never rendered, according to the Justice Department. 

Additionally, Monteagudo admitted to being involved with $7 million in fraudulent billings for Starlite Home Health Agency Inc., which she owned and operated. 

Earlier this year in a related case, the owners and operators of Caring Nurse and Good Quality—Rogelio Rodriguez and Raymond Aday—were sentenced to serve 108 and 51 months, respectively. They were sentenced in February following December 2012 guilty pleas to conspiracy to commit health care fraud, after being charged with submitting approximately $48 million in claims for home health services that weren’t medically necessary, or weren’t provided. 

Of those fraudulent reimbursement claims, Medicare actually paid about $33 million. 

The FBI and Department of Health & Human Services-Office of the Inspector General investigated the case, which was brought as part of the Medicare Fraud Strike Force. 

Written by Alyssa Gerace