Miami Home Health Fraudster Sentenced for $74 Million Medicare Scheme

The owner and administrator of two Miami home health agencies was sentenced Wednesday to serve 80 months in prison for her participation in a $74 million Medicare fraud scheme. 

Elsa Ruiz, 45, of Miami, owned and operated Professional Home Care Solutions, Inc. and was an administrator of LTC Professional Consultants Inc., both of which claimed to provide home health and therapy services to Medicare beneficiaries. 

Admissions during Ruiz’s plea hearing revealed that she and her co-conspirators operated LTC and Professional Home Care 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 or were not provided. 

Ruiz’s primary role in the scheme, according to her admission, was to negotiate and pay kickbacks to patient recruiters and to otherwise oversee the schemes operating out of LTC and Professional Home Care.

Specifically, Ruiz and her co-conspirators paid kickbacks to recruiters for the referral of patients and for the provision of prescriptions, plans of care and certifications for medically unnecessary therapy and home health services to bill Medicare.

From January 2006 to June 2012, Ruiz’s companies submitted approximately $74 million in claims for these services that were either not rendered or considered medically unnecessary. Of that total amount, Medicare paid approximately $45 million on those claims.

Ruiz pleaded guilty in July 2014 to one count of conspiracy to commit health care fraud. In addition to her prison sentence, Ruiz was ordered to pay $45 million in restitution. 

Written by Jason Oliva

Jason Oliva