A federal jury in New Orleans convicted the owner of a Louisiana home health care company and a doctor for their roles in a $34 million Medicare home health care fraud scheme. Elaine Davis, the owner of Christian Home Health Care Inc. and Dr. Pramela Ganji, both of New Orleans were each convicted of one count of conspiracy to commit health care fraud and one count of health care fraud on Thursday, March 17. Dr. Godwin Ogbuokiri, another doctor indicted in scheme, was acquitted on all charges.
According to a Department of Justice press release, evidence introduced at trial showed that Davis and Ganji caused Christian Home Health Care to bill Medicare for home health care services that were not needed and/or were not provided. To accomplish this fraudulent scheme, Davis paid employees to recruit new home health patients from communities in Southeast Louisiana, primarily around New Orleans and Hammond, Louisiana. The company then sent the new patients’ Medicare information to doctors, including Dr. Ganji, to falsely certify that the patients qualified to receive home health care services. The evidence introduced at trial showed that Dr. Ganji often never examined these patients to assess their eligibility for home health services. The false certifications allowed Christian Home Health Care to fraudulently bill Medicare for home health services and to conceal that the services were unnecessary. This scheme was in effect from 2007 to June 2015, when the defendants were indicted. Throughout this time period, Christian Home Health Care submitted more than $34.4 million in claims to Medicare. A large number of these claims were fraudulent because the patients did not actually qualify to receive home health care. Due to the concealment of this fraud, Medicare paid Christian Home Health Care approximately $29.6 million for these claims.
This case is an example of criminal prosecution of health care fraud. However, health care fraud, including home health fraud can also be prosecuted in civil court through the qui tam provisions of the False Claims Act. To read more about the conditions necessary for a patient to be qualified for Medicare home health services, visit the Home Health page.
To report healthcare fraud contact Frohsin & Barger.