Fraudster Using Patients as ‘Personal Cash Register’ Sentenced

The woman who once ran home health care company, Doctor at Home, located in Schaumburg, Illinois, has been sentenced to 72 months in prison for performing a $15.6 million Medicare overbilling scheme.

Diana Jocelyn Gumila of Streamwood, Illinois, used patients as “her own personal cash register,” wrote U.S. District Judge Charles P. Kocoras. In April, an Illinois federal jury found her guilty of 21 counts of health care fraud and three counts of making false statements. Gumila was sentenced to prison time on Tuesday and ordered to pay $15.6 million.

Though there were only eight patients found that the government could prove false claims were billed on behalf of, U.S. District Judge Charles P. Kocoras said there was no need to prove each claim due to the numerous emails found, written by Gumila, that proved false bills were part of a larger operation to defraud the government.

In the emails uncovered, Gumila referred to a physician who did not read orders before signing them as “the type of doctor we need because he will just do what we tell him to do.”

Audio recordings were also found in which Gumila was heard speaking to a doctor saying to “paint the picture” of patients to make it appear that they were confined to their homes.

Gumila ignored advice given by doctors after they raised concerns about certain patients who they believed should not have needed home health care or should not have been coded as needing particularly complex or lengthy services, Kocoras said.

The government’s request was for a 10-year sentence, but Kocoras said it was too harsh; however, he agreed with prosecutors that they needed to crack down on this to set an example of what can happen to fraudsters, and hopefully deter other Medicare and Medicaid fraud in and around Chicago.

Chicago has seen many ongoing problems with the home health care industry and has seen a number of Medicare prosecutions in the last few years. Due to the numerous issues, a moratorium was placed in August 2013 preventing new home health care companies from opening in Chicago and other cities that have higher levels of fraud in the industry. The moratorium has been extended a number of times and the most recent extension is through August 2016.

“Home health fraud has become a significant problem nationally and particularly in the Chicago area,” Assistant U.S. Attorney Stephen Chahn Lee said in the government’s sentencing memorandum. “Such fraud cannot happen without people like defendant, who abuse Medicare’s rules and abuse the trust place in them by Medicare and their patients.”

Written by Alana Stramowski