Former Home Health Administrator Sentenced to Prison for Role in $20M Fraud Scheme

So far, April has already seen two home health industry officials sentenced to a combined 15 years of prison time for their roles in multi-million scams, plus a conviction in the U.S. Department of Justice’s (DOJ’s) biggest health care fraud scheme ever.

On April 4, DOJ announced the former director of nursing and administration of two Houston, Texas-based businesses was sentenced to 10 years in prison for her role in a $20 million Medicare fraud scheme involving false and fraudulent claims for home health services. In addition to the decade-long prison sentence, Evelyn Mokwuah was ordered to pay more than $20.4 million in restitution to Medicare.

Mokwuah — found guilty of one count of conspiracy to commit health care fraud and four counts of health care fraud — previously worked at Beechwood Home Health and Criseven Health Management Corporation. According to evidence presented at her trial, from 2008 to 2016, Mokwuah submitted false claims for home health services that were never provided, not medically necessary — or both.

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Additionally, according to evidence, Mokwuah falsely certified and billed for patients who were not homebound or did not qualify for home health services. Under Medicare rules, a patient can only be considered “homebound” if he or she cannot leave home without “considerable and taxing effort.”

A group of bipartisan lawmakers, including Sen. Susan Collins (R-Maine), recently introduced legislation in the Senate meant to somewhat ease the homebound requirement.

On April 2, DOJ also announced that a former owner and operator of Garland, Texas-based Elder Care was sentenced to five years in prison for his role in a $3.7 million fraud scheme. On top of his prison time, Paul Emordi was sentenced to two years of supervised release and ordered to pay restitution of more than $3.5 million.

Emordi was determined to have operated Elder Care when he was excluded from participating in any federal health care benefit program. Emordi and co-conspirators kept his involvement with the home health provider hidden by using false documents while having others sign bank documents and employee paychecks.

Emordi and co-conspirators — who are still awaiting sentencing — also engaged in a scheme to submit false and fraudulent bills to Medicare for services that were never needed, according to DOJ.

Most recently, DOJ announced that a federal jury found a south Florida health care facility owner guilty for his role in the largest health care fraud scheme ever charged by the department.

Specifically, the scheme involved more than $1.3 billion in fraudulent claims to Medicare and Medicaid for services that were not provided, were not medically necessary or were procured through the payment of kickbacks.

This massive fraud scheme was carried out by Philip Esformes in nursing and assisted living facilities throughout south Florida from January 1998 to July 2016.

“This largest-ever health care fraud conviction highlights the awful toll criminal schemes take on federal health programs,” Shimon Richmond, a special agent in charge for the Health and Human Services Office of Inspector General, said in a statement. “Even beyond the vital dollars lost though, Esformes exploited and victimized patients by providing inadequate medical care and poor conditions in his nursing homes.”

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