The owner of two Texas-based home healthcare service business will spend 60 months in prison after her conviction for charges related to a $10 million Medicare fraud scheme, the U.S. Department of Justice announced Aug. 16.
Naomi Moore, owner of Friend’s Place and Metro Health Services, was convicted of committing and conspiracy to commit healthcare fraud for the scheme, which involved billing Medicare using the names of beneficiaries who weren’t patients of either facility and did not even need home health services. Using fake documents created with the beneficiaries’ information, Moore then billed Medicare for roughly $10.7 million worth of “purported home health services,” of which she received almost $6.8 million, the DOJ states.
Due to the amount of money involved, U.S. District Judge Charles Eskridge sentenced Moore to the maximum 60 months of prison time, which will be followed by three years of supervised release.1
Last Week’s Other Key Enforcement Actions
Other major enforcement actions involving the healthcare industry announced last week include:
Aug. 9: Two Pennsylvania-based skilled nursing facilities and five people were indicted by a federal grand jury for various healthcare fraud charges, including conspiracy to defraud the United States. The charges relate to two alleged schemes. In the first scheme, high-level employees of the two facilities—Mt. Lebanon Rehabilitation and Wellness Center and Brighton Rehabilitation and Wellness Center—are alleged to have either provided or instructed others to provide fake staffing records to the Pennsylvania Department of Health “during federally mandated surveys,” according to the DOJ. In the second scheme, the facilities’ co-owner and other employees are alleged to have made false statements relating to resident assessments in order to increase reimbursements from Medicaid and Medicare, the DOJ states.2
Aug. 9: Continuing the trend of increased enforcement actions relating to telemedicine fraud, a nurse practitioner from Georgia was sentenced to 87 months in federal prison and ordered to pay $1.6 million for her part in a telehealth fraud scheme. In the massive kickback scheme, which involved in excess of $3 million in charges to Medicare, the nurse practitioner ordered unnecessary orthotic braces “for patients she never examined or spoke to,” said David H. Estes, U.S. Attorney for the Southern District of Georgia, in the DOJ release. The nurse practitioner was then paid by companies for her fake orders, which they used to get reimbursed by Medicare, according to the DOJ.3
Aug. 10: A long-term care and skilled nursing services provider in Indiana settled False Claims Act allegations for just over $5.5 million. In a complaint brought forth in a whistleblower lawsuit, the provider, American Senior Communities, L.L.C., was alleged to have falsely billed Medicare for therapy-related services provided to patients placed on hospice. However, those services should already have been covered by those beneficiaries’ Medicare hospice coverage, the DOJ states.4