Elsa Ruiz, Medicare Fraud, Florida 2023

Florida resident Elsa Ruiz, 45, of Miami pleaded guilty yesterday to her role in a $74 million Medicare fraud scheme. Ruiz, an owner of Professional Home Care Solutions Inc. (Professional Home Care) and an administrator of LTC Professional Consultants Inc. (LTC), a Miami home health care agency, admitted to her participation in the conspiracy to commit health care fraud.

According to court documents, Ruiz and her co-conspirators operated LTC and Professional Home Care for the purpose of billing the Medicare program for expensive physical therapy and home health care services that were not medically necessary and/or were not provided. Ruiz and her co-conspirators paid kickbacks and bribes to patient recruiters, who provided patients to LTC and Professional Home Care, as well as prescriptions, plans of care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries.

Ruiz and her co-conspirators used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for unnecessary home health care and therapy services. From approximately January 2006 to June 2012, LTC and Professional Home Care submitted approximately $74 million in claims for home health care services that were not medically necessary and/or not provided, and Medicare paid approximately $45 million on those claims.

U.S. Attorney Wifredo A. Ferrer commended the outstanding investigative efforts of the FBI and HHS-OIG. The case is being prosecuted by Assistant Chief Joseph S. Beemsterboer of the Fraud Section.

The Medicare Fraud Strike Force, operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 billion. The HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Ruiz’s sentencing is scheduled for October 8, 2014. The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is working to prevent and combat Medicare fraud. To learn more about HEAT, visit www.stopmedicarefraud.gov.