A man and woman in Florida were convicted for their roles in a conspiracy to defraud Medicare by billing over $93 million for home health therapy services that were never provided.
The conviction was brought down by a federal jury in Miami this week.
The two people convicted — Karel Felipe and Tamara Quicutis — submitted false bills to Medicare for three home health companies located in Michigan from October 2016 to May 2019.
The co-conspirators recruited people from Cuba to sign Medicare enrollment documents and act as the owners of the home health agencies.
Felipe and Quicutis then used a list of stolen patient identities to bill for home health services, according to court documents.
In order to receive the federal funds, Felipe and Quicutis used hundreds of shell companies and bank accounts to launder the money and convert the proceeds into cash at ATMs and check cashing stores in Miami.
Fraud in home health is far from new, especially in parts of Florida.
Researchers at Dartmouth’s Geisel School of Medicine recently discovered that home health agencies that share patients across multiple agencies, and those that had high rates of expenditures across hospital referral regions (HRRs), were more likely to commit fraud than others.
While Medicare spending on home health services naturally grew from 2002 to 2009, the massive increases were highly concentrated in just a few regions of the U.S.
For example, in the Miami region, home health expenditures rose 302% from $802 in 2002 to $3,229 per Medicare enrollee in 2009.
In comparison, home health billing in Los Angeles saw a significantly smaller increase from $782 in 2002 to $861 in 2009.
The jury convicted Felipe and Quicutis on two felony counts: conspiracy to commit health care fraud and wire fraud, and conspiracy to commit money laundering.
They are scheduled to be sentenced at the beginning of 2024 and both face a maximum of 20 years in prison on each conspiracy charge.
A third defendant, Jesus Trujillo, pleaded guilty to one count of conspiring to commit health care fraud and wire fraud and one count of conspiring to commit money laundering.