Miami Woman Bilks Medicare Out of $74 Million in Home Health Fraud Scheme

A Miami resident who owned a home health care company and was the administrator of another pleaded guilty for her involvement in a $74 million Medicare fraud scheme.

Elsa Ruiz, 45, pleaded guilty before U.S. District Judge Marcia G. Cooke to one count of conspiracy to commit heath care fraud.

According to court documents, Ruiz was the owner of Professional Home Care Solutions Inc. and an administrator of LTC Professional Consultants Inc., Miami agencies that provided home health services to Medicare beneficiaries.

Ruiz and her co-conspirators operated Professional Home Care and LTC “for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided,” according to a written statement released by the U.S. Department of Justice.

From about January 2006 to June 2012, Professional Home Care and LTC submitted approximately $74 million in claims for these home health care services, and Medicare paid an estimated $45 million on the claims.

In another recent case, an Illinois couple was arrested and charged with several counts of health care fraud after allegedly bilking Medicare for more than $800,000 and paying kickbacks for referrals of Medicare patients.

Ruiz’s sentencing is scheduled for Oct. 8.

Written by Emily Study