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Guilty Pleas Unfold in Home Health Care Fraud Scheme
Five South Florida residents have pleaded guilty to participating in a home health care fraud scheme, announced the Department of Justice and Health and Human Services. Arturo Fonseca, 47, Isis Torres, 37, Francisco Portillo, 41, Eduardo Romero, 44, and William Madrigal, 56, pleaded guilty to various health care fraud charges in U.S. District Court in Miami.
According to court documents, Arturo Fonseca, owner and operator of Courtesy Medical Group Inc., a purported medical clinic in Miami, admitted to providing prescriptions, plans of care, and medical certifications to Miami-area home health agencies. These agencies would then bill the Medicare program for expensive home health services and therapy for beneficiaries that did not need and in some cases did not receive the purported treatments. As a result, the Medicare program was fraudulently billed approximately $16.6 million for home health services.
Eduardo Romero, 44, a patient recruiter for ABC Home Health Care Inc. and Florida Home Health Care Providers Inc., admitted to soliciting and receiving kickbacks and bribes from the owners of these agencies in return for providing Medicare beneficiaries that the home health agencies could use to bill the Medicare program for unnecessary home health care services. Romero also admitted to paying kickbacks and bribes to the owners and operators of Courtesy in return for the prescriptions for unnecessary home health care services. Medicare was billed approximately $391,593 for purported home health care services that were not medically necessary or were not rendered for the patients recruited by Romero and one of his co-defendants.
Francisco Portillo, 41, and Isis Torres, 37, both nurses, pleaded guilty to conspiracy to commit health care fraud and making false statements in patient files. According to plea documents, Portillo and Torres falsified patient files for ABC and Florida Home Health to make it appear that the patients qualified for home health care services, when in fact they did not qualify and in some instances never received any treatments. Portillo was responsible for approximately $142,000 in fraudulent Medicare billing, while Torres was responsible for approximately $528,400 in fraudulent Medicare billing.
William Madrigal, 56, a Medicare beneficiary, pleaded guilty to conspiracy to commit health care fraud and soliciting and receiving health care kickbacks. According to plea documents, Madrigal admitted that he solicited and received kickbacks and bribes in return for allowing ABC and Florida Home Health to bill Medicare for home health care services for which he did not qualify. As a result, approximately $68,760 was fraudulently billed to Medicare for unnecessary home health care and therapy.
The guilty pleas were announced by Assistant Attorney General Lanny A. [Last Name]. The owners and operators of ABC and Florida Home Health pleaded guilty in a separate case and are awaiting sentencing.
Key Facts
- State: Florida
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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