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Florida Woman’s Guilty Plea in $74 Million Medicare Scam
Elsa Ruiz, a 45-year-old Miami resident, pleaded guilty to conspiracy to commit health care fraud in a $74 million Medicare scheme. Ruiz owned home health care company Professional Home Care Solutions Inc. and was the administrator of LTC Professional Consultants Inc., two agencies that purported to provide home health and therapy services to Medicare beneficiaries.
According to court documents, Ruiz and her co-conspirators operated the agencies to bill the Medicare program for unnecessary services such as physical therapy and home health care services. The scheme involved paying kickbacks and bribes to patient recruiters, who provided patients to the agencies along with prescriptions, plans of care, and certifications for medically unnecessary therapy and home health services.
The agencies 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. The scheme operated from January 2006 to June 2012.
The case was investigated by the FBI and the HHS Office of Inspector General, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.
Ruiz’s sentencing is scheduled for October 8, 2014. The Medicare Fraud Strike Force has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 billion since its inception in March 2007.
The Health Care Fraud Prevention and Enforcement Action Team (HEAT) is working to increase accountability and decrease the presence of fraudulent providers. To learn more about HEAT, visit http://www.stopmedicarefraud.gov.
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Key Facts
- State: Florida
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release ↗
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