Twenty individuals and one corporation in Louisiana are being indicted for allegedly claiming over $30 million in a home health Medicare fraud, according to an announcement by U.S. Attorney Kenneth A. Polite. Some charges relate to money distributed after the Deepwater Horizon oil spill in 2010.
Lisa A. Crinel, one of those indicted, was the owner and operator of a home health company known as Abide. Through her operation of Abide, Crinel and her daughter Wilneisha Harrison Jakes, as chief administrative officer, allegedly hired “House Doctors” to sign orders and plans of care for Medicare beneficiaries who had no legitimate medical necessity for home health services.
The House Doctors allegedly falsely signed home health orders regardless of the beneficiary’s needs, homebound status, or diagnoses, according to the indictment. In return, the doctors allegedly received monthly payments fraudulently characterized as medical consultant or director fees for which they provided no services other than fraudulently certifying Medicare beneficiaries for unnecessary home health services. The wife of one of the doctors was hired by Abide and allegedly received her husband’s fees for fraudulent certifications in the form of an inflated salary.
The company also allegedly employed marketers to drive referrals, which should come from health care professionals. And registered nurses engaged in wrongdoing after they were assigned to go to the homes of Medicare beneficiaries to complete assessments that determined the necessary level of care required for the beneficiary and the reimbursement rate for the claims made by Abide, the authorities contend.
“When [the nurses] completed these assessments, they routinely and fraudulently included a group of diagnoses that were unrelated to the needs of the beneficiaries and included items suggesting the need for assistance with different activities of daily living in order to falsely inflate the reimbursement rates paid by Medicare to Abide,” Polite’s office said in a statement. Those nurses also allegedly fraudulently included other items in the assessment to falsely document the beneficiary’s homebound status.
Crinel also faces wire fraud charges related to claims that she filed false applications for wage relief after damage to the Deepwater Horizon oil rig caused a catastrophic oil spill in the Gulf of Mexico. Authorities claim that this part of the fraud netted Crinel and others at the home care company more than $37,000 from British Petroleum, which reimbursed lost wages due to the oil spill.
If convicted, the defendants face between five and 270 year maximum terms of imprisonment, and for each count for which any defendant is convicted, they are subject to a $250,000 fine.
The company faces millions in fines. The indictment also charges forfeiture of property including real estate, bank and life insurance accounts, and jewelry purchased with the proceeds of health care fraud.
The 26-count indictment returned against the defendants shows they charged approximately $30,052,295 in Medicare fraud.
Charged in the conspiracy were Lisa A. Crinel, age 51; Wilneisha Harrison Jakes, age 28; Henry Evans, age 70; Threasa Adderley, age 63; Michael Jones, age 45; Paula Jones, age 44; Shelton Barnes, age 61; Cary Payton, age 60; Evelyn Odoms, age 63; Sheila Mathieu, age 46; Suprenia Washington, age 58; Erica Edwards, age 30; Zellisha Dejean, age 36; Caren Battaglia, age 48; Sheila Hopkins, age 62; Verinese Sutton, age 62, all of New Orleans.
Also charged were Jonathon Nora, age 27, of River Ridge; Eleshia Williams, age 44, of Harvey; and PCAH, INC. a/k/a Priority Care At Home, Inc. d/b/a Abide Home Care Services, Inc., a Louisiana corporation.
All entities were indicted for conspiracy to commit health care fraud, conspiracy to defraud the United States and to receive and pay health care kickbacks, and health care fraud.
Clara Aitch, age 39, of New Orleans, and Wendy Ervin, age 41, of Laplace, were indicted for conspiracy to commit wire fraud along with Crinel and Jakes. Crinel is also charged with wire fraud.
Written by Cassandra Dowell