Two employees of Miami home health and physical therapy companies, ABC Home Health and Florida Home Health Care Providers pleaded guilty today to a home health fraud scheme that cheated Medicare out of $25 million, according to DoJ. Lisandra Alonso and Luisa Morciego, a manager/recruiter and RN respectively, admitted that the two companies where they worked billed Medicare for “medically unneccessary” services and services that were never provided. 17 others, including two doctors who prescribed the services, Jose Nunez and Francisco Gonzalez have also been indicted, are presumed innocent, and await trial. According to DoJ and court documents, patient files were manipulated to appear as if the services were actually necessary when they were not.
“Alonso also taught nurses at ABC how to falsify patient files for Medicare beneficiaries to make it appear that such beneficiaries qualified for home health care and therapy services from ABC. Alonso taught the nurses to do so by, among other things, describing in the nursing notes and patient files non-existent symptoms such as tremors, impaired vision, weak grip and inability to walk without assistance. These symptoms were described to make it appear that the patients qualified for home health care benefits under Medicare.”
Likewise, Morciego — an RN –“falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for home health care and therapy services,” according to DoJ.
“Morciego knew that the beneficiaries did not actually qualify for and did not receive the services. Morciego described in nursing notes and patient files symptoms that were non-existent, such as tremors, impaired vision, weak grip and inability to walk without assistance. Morciego admitted that the files were falsified so that ABC and Florida Home Health could bill Medicare for medically unnecessary services.”
Alonso and Morciego could each spend 10 years in prison for their actions. Unfortunately, such manipulation of the Medicare system in the areas of home health care and physical therapy care as well as abuse of Medicare’s skilled nursing benefit, is becoming all too common. Whistleblowers who are aware of such fraud and come forward and report the fraud may not only help to solve the problem, but they may also be entitled to as much as 25% of the Medicare recovery.