Nurse Fraudster Pleads Guilty in $45 Million Home Health Scheme

Following a months-long investigation of three, Illinois-based home health agencies, a nurse who helped run the companies has pleaded guilty to her role in a Medicare fraud scheme totaling $45 million, according to court documents.

Administrator and director of nursing at Donnarich Home Health Care Inc., Pathways Home Health Services LLC and Josdan Home Health Care Inc., Sharon Gulla admitted that she instructed nurses to falsely certify patients for in-home skilled nursing to reap millions in insurance reimbursements.

Since 2008, Gulla has worked for the three companies and coached nurses to fill out health assessment forms to make it look as though the patients required the care as well as performed “patient recycling” in which patients were released from home care but later re-enrolled, according to court documents.

During a part of her employment with Pathways, Gulla served as lead administrator. After she took over, the company collected $3.5 million in fraudulent reimbursements.

Gulla was among more than a dozen people indicted in a scheme prosecutors say stole $45 million in Medicare reimbursements by overstating patients’ need for high-priced home care.

Others who were involved included Avelina Fiel, the former director of nursing at Pathways Home Health Services, who admitted guilt in the scheme, as well as Richard Tinimbang and his wife, Maribel Tinimbang who co-owned the three home health agencies and were indicted for the fraud scheme. The Tinimbangs are described as the leaders of a six-year plot run through the three companies to bilk millions from Medicare.

The Tinimbangs and their staff paid nurses kickbacks to recruit patients to use in their scheme, according to court documents. In some cases, they paid patients to accept the unnecessary care. They also would sometimes forge doctors signatures on certifying forms for their Medicare claims, or take them to at least one doctor who was paid to sign them.

Richard Tinimbang was also charged with immigration fraud for falsifying visa application paperwork for a woman he brought to the United States from the Philippines. He said the woman was going to work as a business analyst for his companies, but she actually worked as an unpaid housekeeper and nanny for his family and others, according to the indictment.

The Tinimbang’s along with Gulla and others are scheduled to go to trial in February. Six of the people who were named in the indictment, including Gulla, have pled guilty. Of the group there were several nurses, a patient recruiter and Fiel, the former director of nursing.

Written by Alana Stramowski