Feds Go After Patient Recruiters in Home Health Kickback Schemes

Federal authorities took action against a handful of individuals and companies last month for their roles in multimillion-dollar home health fraud schemes.

On Feb. 15, a Michigan woman pleaded guilty for her role as a patient recruiter in a scheme involving about $1.2 million in fraudulent Medicare claims for home health care procured through kickback payments. Ghalia Savaya — first indicted in June — admitted to receiving illegal kickbacks in exchange for referring Medicare beneficiaries to Franklin Health Care LLC from April 2015 to November 2017.

Medicare paid over $1.25 million for claims related to beneficiaries referred by Savaya, which included claims for beneficiaries who were not eligible to receive home health care services, according to the U.S. Department of Justice (DOJ).

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Also last month, a federal jury found another patient recruiter who operated in southern Florida guilty for her role in a scheme involving roughly $600,000 in Medicare claims for home health care services procured through kickback payments. Yamilet Diaz was convicted of one count of conspiracy to defraud the United States and receive health care kickbacks and four counts of receiving health care kickbacks.

From October 2012 to June 2013, Diaz received kickbacks in return for referring Medicare beneficiaries to Good Friends Services Inc., a now-defunct home health agency located in Hialeah Gardens, Florida, according to DOJ. The evidence established at the trial found that Diaz personally benefited to the tune of at least $306,800.

The largest health care fraud development in February revolved around the sentencing of a home health services company owner and co-conspirator — both Miami residents — for their roles in a $8.6 million scheme.

Alexander Ros Lazo, the owner of TLC Health Services of Miami, was sentenced to serve 87 months in prison. Misleady Ibarra, who performed home health therapy services without a license, was sentenced to serve 24 months in prison. A judge ordered Ros Lazo to pay $8,603,859 in restitution and to forfeit the same amount — and for Ibarra to pay restitution in an amount to be determined.

Ibarra and Ros Lazo initially pleaded guilty in December 2018 to one count of conspiracy to commit health care fraud. Both defendants were charged in an indictment returned on June 21, 2018.

As part of his guilty plea, Ros Lazo admitted that he paid kickbacks and bribes to his co-conspirators in exchange for home health services prescriptions and the referral of Medicare beneficiaries to TLC Health Services. Ros Lazo additionally admitted that he and Ibarra agreed with their co-conspirators to commit health care fraud by billing Medicare for physical therapy services performed by Ibarra on behalf of licensed therapists despite knowing she was not appropriately licensed.

Medicare paid $8.6 million in benefits that it otherwise would not have as a result of the fraud, according to DOJ.

Lastly, Miami-area medical clinic owner Juliette Anais Tamayo pleaded guilty Feb. 20 for her role in a scheme to defraud Medicare by submitting fraudulent billings from the clinic and by supplying patients to three home health agencies that submitted fraudulent bills for home health services. The clinic operated under the name Sunshine Medical Care Group Inc.

A superseding indictment alleged that the losses to Medicare as a result of the scheme were about $3.7 million.

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