Home Care Director Admits Guilt in $45 Million Fraud Scheme

A former home health care executive has pleaded guilty for her part in a fraud scheme worth $45 million that involved falsifying medical records of Medicare beneficiaries.

Avelina Fiel, the former director of nursing of Illinois-based Pathways Home Health Services LLC, pled guilty this week to a single count of conspiracy to commit health care fraud, Law360 reported. Fiel’s actions directly led to at least $1.5 million in false payments to the home health agency.

She admitted that she pressured at least one employee to falsify medical records to make it appear patients were sicker than they really were during her time at Pathways—between 2012 and 2014. Field also said she told quality assurance supervisors to not adhere to physicians’ recommendations when they refused to certify patients as homebound. Instead, patients were sent to a second physician who was unaware of the first physician’s refusal.

“I was fully aware that most of our patients weren’t homebound,” she said at a hearing this week, Law360 reported.

In addition to falsifying records, Pathways would recycle patients by billing patients for six month cycles before decertifying them for home health care. Weeks later, the company would put that back into the home health billing cycle again. She believes 80% of the company’s patients were recycled in this way, Fiel noted, while many patients received just a check up during home health visits.

The business was owned by Josephine Tinimbag, mother to Richard Tinimbang. Rich Tinimbang and his wife Maribel Tinimbang were indicted for their participation in the scheme earlier this year, which also involved Patients First Physical Therapy Inc., a business which purported to provide in-home therapy services to three home health care companies—Pathways, Donnarich Home Health Care Inc. and Jordan Home Health Care Inc. The couple reportedly spent millions of dollars on personal expenses to sustain their lavish lifestyle in the Chicago suburbs.

A total of 15 people involved with the three companies were indicted by the Medicare Fraud Strike Force, as part of a larger crackdown in 2015 that included 243 people in $712 million of Medicare fraud in 17 district, according to Law360. So far, two registered nurses and a president of a recruitment that sent patients to the home health agencies have also pled guilty for their respective roles in the scheme.

The Tinimbangs’ trial dates are set for February.

Written by Amy Baxter