Home Health Agency Wins Payment Fight With CMS in ZPIC Audit

A home health agency will be paid for services following a court win that prevents the Centers for Medicare & Medicaid Services (CMS) from withholding and recouping payments—at least temporarily. A judge granted the home health agency’s temporary restraining order motion in the case, Family Rehab., Inc. v. Azar, which will temporarily ensure payments are not […]

Fraud Watch: Michigan Agency Owner Guilty in $8 Million Fraud Case

Michigan Agency Owner Pleads Guilty in $8 Million Fraud Scheme Zahir Shah, 48, of West Bloomfield, Michigan, pleaded guilty to fraud charges for his role in a scheme involving approximately $8 million in fraudulent Medicare claims for home health services procured through illegal kickbacks, according to the Department of Justice (DOJ). Shah pleaded guilty to […]

Top Payment Scrutiny Areas in Hospice Care

As more government agencies leverage data analysis and tracking to monitor billing in the home health and hospice space, providers are seeing heightened scrutiny across billing practices. From time to time, everyday mistakes in documentation and challenges with compliance can lead to bigger problems—even when providers think they are doing everything right. In 2015, hospice […]

Fraud Watch: Miami Home Health Owners Indicted in Scheme

Three Miami Home Health Agency Owners Charged in Fraud Scheme Three Miami-area home health care agency owners were charged in an indictment for their alleged participation in a health care fraud scheme involving a now-defunct business, the Department of Justice (DOJ) announced in March. Ailin Consuelo Rodriguez Sigler, 39; Ziola C. Rios, 57; and Thomas […]

U.K. Home Care Startup Accused of Posting Fake Reviews Online

Since launching in 2016, U.K. home care startup Cera Care, which pairs patients with in-home caregivers, has locked in more than $4 million in venture funding and garnered widespread praise. But now, it’s being accused of crafting fake reviews online and lying about key health partnerships, Bloomberg Technology reported Thursday. Citing “three people with knowledge of […]

Texas Home Health Care Owners Make OIG’s Most Wanted List

The Office of Inspector General (OIG) has named a former owner of a Texas-based home health care company, Ebong Aloysius Tilong, among its “most wanted fugitives.” Tilong was indicted on charges of conspiracy to commit health care fraud, health care fraud, conspiracy to pay kickbacks, payment of kickbacks and conspiracy to commit money laundering in […]

Fraud Watch: Doctor’s Conviction Overturned

New Orleans Doctor’s Fraud Conviction Overturned A New Orleans-based doctor and owner of a home health care company will likely be released from federal prison after an appeals court overturned the original conviction. Dr. Pamela Ganji and Elaine Davis were convicted of health care fraud and conspiracy to commit health care fraud in 2017. Ganji […]

Texas Mayor Involved in $150 Million Home Health Fraud Scheme

Francisco Pena, mayor of Rio Bravo, Texas, has been indicted alongside three other individuals for his alleged role in a $150 million home health care fraud and money laundering scam, according to a memo released by the U.S. Justice Department. Pena, 82, of Laredo, Texas, was charged in an 11-count indictment with co-conspirators Rodney Mesquias, […]

Fraud Watch: Miami, Detroit Sentencing and Conviction

Two Miami Home Health Agency Owners Sentenced in Separate Fraud Schemes The owner of two Miami home health care agencies, now defunct, has been sentenced to 80 months in prison for her role in a $74 million conspiracy to defraud the Medicare program, the Department of Justice (DOJ) announced in late November. Sila Luis, 59—who pleaded […]

Home Health Owner Gets 80 Years in Prison for Medicare Fraud

The co-owner of a Houston home health agency was sentenced to a lengthy prison sentence for his role in a $13 million Medicare fraud scheme and for filing false tax returns. U.S. District Judge Melinda Harmon of the Southern District of Texas ordered Ebong Tilong, 53, to spend 80 years behind bars, according to the U.S. […]