Bay Area Home Health Provider Charged in $115M Medicare Scheme; Medicaid Fraud Defendants Plead Guilty

Home Health Provider Charged in Largest Ever Cash-for-Patient Scheme in NorCal

The Bay Area’s largest home health care provider has been charged by federal prosecutors with paying doctors in a Medicare kickback scheme involving millions of dollars of payments in cash, Warriors tickets, designer handbags and more.

Amity Home Health Care paid kickbacks to doctors, marketers and other medical professionals in exchange for the certification or referral of patients, according to charges from the Department of Justice published in a release.

A total of 30 defendants were charged in the $115 million scheme. Others charged include Amity Home Health CEO Ridhima “Amanda” Singh and related hospice care provider Advent Care Inc., as well as dozens of doctors, nurses, marketers and others allegedly involved in the scheme.

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“This is the largest cash-for-patients scheme ever charged criminally in the Northern District of California,” U.S. Attorney David Anderson said in a statement.

Amity’s employees are accused of bribing individuals associated with hospitals, skilled nursing facilities (SNFs) and doctors’ offices to send patients to Amity and Advent. The bribes were usually disguised as payroll but also sometimes came in the form of reimbursements, donations and gifts, such as tickets to Warriors games and designer handbags, according to the DOJ.

“The transition to a home health agency should be based on medical and personal needs – not cash payments or thinly disguised referral bribes as alleged in these cases,” Steven Ryan, special agent in charge for the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG), said in the statement. “We will continue working with law enforcement partners to guard these vital government health programs as patients and taxpayers deserve better.”

It is illegal for a person to solicit, offer or pay a kickback, bribe or rebate for furnishing services under a federal health care program. The individual defendants charged are facing a 10-year prison sentence and a $500,000 fine, the maximum penalties, according to the DOJ. Meanwhile, Amity and Advent are subject to a $1,000,000 fine for each violation.

The news comes on the heels of a recently finalized rule from the Centers for Medicare & Medicaid Services (CMS) designed to keep fraudsters out of Medicare and Medicaid. The rule requires Medicare, Medicaid and Children’s Health Insurance Program (CHIP) providers and suppliers to disclose their affiliations with certain providers. It also gives CMS the authority to deny or revoke a provider’s or supplier’s Medicare enrollment in specified circumstances. The rule goes into effect in November.

Amity and Advent did not respond to Home Health Care News’ request for comments.

Elite Homecare Owner Pleads Guilty to Medicaid Fraud

In Atlanta, the owner and operator of a in-home care provider pleaded guilty to defrauding Medicaid.

The DOJ announced Diandra Bankhead, owner and operator of Elite Homecare, submitted thousands of fraudulent claims for services under the Georgia Pediatric Program (“GAPP”) to Georgia Medicaid. This allegedly took place from September 2015 to April 2018, with Bankhead’s company receiving $1.2 million.

“Bankhead exploited Medicaid-eligible children who suffer from significant physical and cognitive disabilities,” U.S. Attorney Byung Pak, said in a statement from the DOJ. “Her fraud included billing for services never performed and for children never seen. Georgians dependent on these types of services deserve our best, not to be used by someone who is looking to enrich themselves at their expense.”

Bankhead’s sentencing is scheduled to take place on January 28, 2020.

Elite did not respond to HHCN’s request for comments.

Worcester Home Health Agency Owner Gets Probation Following $815K Fraud Scheme

Meanwhile, a Worcester, Massachusetts-based in-home care agency owner was placed on administrative probation in connection to a 2016 Medicaid scheme, according to the Worcester Telegram & Gazette.

Francis Kimaru, the owner of Compassionate Homecare Inc., pleaded guilty to two counts of filing false Medicaid claims and one count of larceny in Worcester Superior Court, the paper reported.

In 2016, Kimaru was indicted for allegations that he stole thousands of dollars from MassHealth, the state’s Medicaid program. From 2011 to 2016, Kimaru allegedly overbilled and falsely billed for services that were not provided to patients. Compassionate Homecare improperly received $815,588, according to MassHealth.

Additionally, the company’s COO Wilberto Rodriguez and its administrator Deborah Giordano received indictments, the paper reported. Rodriguez was charged with two counts of larceny and three counts of filing false Medicaid claims, while Giordano was charged with one count of larceny and two counts of filing false Medicaid claims. Both were placed on a two-year pretrial probation.

There is a restitution hearing scheduled for November 14.

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