Federal investigators had a busy month of October shining a light on major fraud schemes throughout the home health industry — and November appears to be more of the same.
A federal jury on Friday found a patient recruiter guilty for her role in a scheme involving roughly $1.1 million in fraudulent Medicare claims for home health care services procured through kickbacks.
Sophia Eggleston, 56, of Detroit, was convicted of one count of conspiracy to receive health care kickbacks and two counts of receipt of health care kickbacks following a three-day trial. Sentencing has been scheduled for Feb. 6, 2019 before U.S. District Judge Bernard Friedman of the Eastern District of Michigan.
From 2009 to 2012, Eggleston and others engaged in a kickback scheme to defraud Medicare of approximately $1.1 million through fraudulent home health claims, according to the U.S. Department of Justice (DOJ). Specifically, Eggleston solicited and received kickbacks in exchange for referring Medicare beneficiaries to serve as patients at a home health agency owned by co-conspirators. In turn, the co-conspirators submitted Medicare claims for home health services that were purportedly provided to those beneficiaries.
The FBI, U.S. Health and Human Services Office of Inspector General and a division of the IRS investigated the case.
DOJ also announced recently that four Pennsylvania residents were charged in federal court with conspiracy to defraud the Pennsylvania Medicaid program of tens of millions of dollars.
Pittsburg residents Travis Moriarty, 37, Tiffhany Covington, 41, Autumn Brown, 31, and Brenda Lowry Horton, 48, were charged in separate but related criminal informations with one count of conspiracy to commit health care fraud.
An information is a formal criminal charge which begins a criminal proceeding.
According to the informations filed in their respective cases, the defendants were employees of one or more of four related entities operating in the home health care industry: Moriarty Consultants, Inc.; Activity Daily Living Services, Inc.; Coordination Care, Inc.; and Everyday People Staffing, Inc.
All four entities were approved under the Pennsylvania Medicaid program to offer certain services to qualifying Medicaid recipients, including personal assistance services, service coordination and non-medical transportation. Similar to many home care agency offerings, personal assistance services included meal preparation, bathing, dressing and light cleaning.
From January 2011 to April 2017, collectively, Moriarty Consultants, Activity Daily Living Services, Coordination Care and Everyday People Staffing received more than $87 million in Medicaid payments based on claims submitted for services.
During that time, services documented on claims were never actually provided, according to DOJ. Instead, office employees would fraudulently fabricate time sheets to suggest care was given. Additionally, certain in-house employees stopped using their own names as the attendant on time sheets and instead used the names of “ghost employees.”
As alleged, some of the “ghost employees” allowed their names to be used in exchange for a portion of the resulting salary payments derived from Medicaid disbursements.
In some cases, according to DOJ, Medicaid claims were submitted for personal assistance services that purportedly occurred while consumers were hospitalized, incarcerated or deceased. The informations filed against the four Pittsburg residents further allege that co-conspirators — including Moriarty, Covington, Brown and Horton — paid kickbacks to consumers in exchange for their participation in the submission of fraudulent time sheets in support of Medicaid claims.
Several other alleged wrongdoings also took place, according to DOJ.
Defendants each face a maximum total sentence of not more than 10 years in prison, a fine of $250,000 — or both.
These two recent fraud schemes in Michigan and Pennsylvania just a few weeks after DOJ highlighted another multimillion-dollar conspiracy in October.
Written by Robert Holly