According to a Department of Justice press release issued December 15, 2016, Raciel Leon was convicted after a two-week jury trial of one count of conspiracy to commit health care fraud and wire fraud and one count of conspiracy to defraud the United States and pay and receive health care bribes and kickbacks. The convictions stem from Leon’s administration of a $2.5 million Medicare home health care fraud scheme.
According to evidence presented at trial, between approximately October 2014 and June 2015, Leon was the manager of Mercy Home Care Inc. (Mercy) and a billing employee for D&D&D Home Health Care Inc. (DDD), both of which were home health agencies in Miami-Dade County, Florida. The evidence showed that Leon and his co-conspirators used the companies to submit false claims to Medicare that were based on services that were not medically necessary, not actually provided and for patients that were procured through the payment of illegal kickbacks to doctors and patient recruiters. In an attempt to support the false claims, Leon’s co-conspirators forged prescriptions and other medical records, and Leon submitted claims to Medicare based on the falsified documentation.
The case against Leon is a criminal case. However, under the qui tam provisions of the False Claims Act, whistleblowers with information about similar fraud against the government may bring a civil case on behalf of the United States. If successful, the government can recover up to three times the amount the defendants fraudulently billed the government. The whistleblower, who originally filed the case, is entitled to 15-30% of the government’s recovery as well as their attorney’s fees.
To learn more about home health fraud, click here.