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$6M Home Health Care Scam Exposed in Miami
Five South Florida residents have pleaded guilty to their roles in a long-running $6.2 million Medicare fraud scheme involving Professional Medical Home Health LLC, a Miami home health care agency. The scheme, which spanned from December 2008 through February 2014, saw the agency bill Medicare for expensive physical therapy and home health services that were not medically necessary or were not provided.
The five defendants, Dennis Hernandez, Juan Valdes, Jose Alvarez, Joel San Pedro, and Alina Hernandez, held positions of influence at Professional Home Health, including owner/operator and manager/supervisor. They admitted to coordinating the submission of fraudulent claims and falsifying patient documentation to make it appear that Medicare beneficiaries qualified for and received home health services that were not medically necessary or not provided.
The defendants also admitted to being patient recruiters for Professional Home Health, soliciting and receiving kickbacks and bribes from other co-conspirators in exchange for recruiting beneficiaries who neither needed, nor in some cases, received services. Dennis Hernandez and Alvarez also admitted to participating in similar criminal conduct at additional Miami-area home health agencies.
The scheme was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force. The case is being prosecuted by Trial Attorney Anne P. McNamara of the Criminal Division’s Fraud Section. Earlier this year, two other individuals, Annarella Garcia and Annilet Dominguez, pleaded guilty and were sentenced to prison for their roles in the same scheme.
The Medicare Fraud Strike Force, operating in nine cities across the country, has charged nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 billion. The HHS Centers for Medicare & Medicaid Services are taking steps to increase accountability and decrease the presence of fraudulent providers.
Sentencing hearings for the five defendants are set for January 29, 2015. The case serves as a reminder of the ongoing threat of healthcare fraud and the importance of vigilance in detecting and preventing such schemes.
In a statement, Assistant Attorney General Leslie R. Caldwell and U.S. Attorney Wifredo A. Ferrer commended the efforts of the investigators and prosecutors involved in the case, stating that the convictions demonstrate the Justice Department’s commitment to protecting the integrity of Medicare and holding accountable those who seek to exploit it.
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Key Facts
- State: Florida
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release ↗
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