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Medicare Fraud Indictment Results in More Guilty Pleas in $25 Million Health Care Fraud Scheme

In a press release issued September 27, 2011, the United States Department of Justice, the Department of Health and Human Services, and the FBI announced that two Miami-area residents pled guilty for their roles in a $25 million home health Medicare fraud scheme. Both defendants pled guilty to conspiracy to commit health care fraud, which carries a maximum prison sentence of 10 years.

Maritza Vidal and Richard Diaz admitted their participation in a scheme to bill Medicare for expensive physical therapy and home health care services that were prescribed by doctors but were medically unnecessary and never provided. According to court documents, Vidal and Diaz worked for ABC Home Health Inc. or Florida Home Health Providers Inc., two related Miami home health care agencies, which purported to provide home health and therapy services to Medicare beneficiaries, but allegedly existed only to defraud Medicare.

Vidal and Diaz both admitted to recruiting Medicare beneficiaries who would allow ABC and Florida Home Health to bill Medicare for home health care and therapy services that were medically unnecessary and/or never provided. The defendants also solicited and received kickbacks and bribes from the owners and operators of the home health agencies in return for allowing the companies to bill on behalf of the recruited patients.

Vidal also admitted that she and other co-defendant nurses falsified patient files for Medicare beneficiaries by describing non-existent symptoms such as tremors, impaired vision, weak grip and inability to walk without assistance in an attempt to make it appear that the patients qualified for home health benefits.

Vidal and Diaz were originally charged in a February 2011 indictment, which included numerous other defendants. Including Vidal and Diaz, seventeen people have pled guilty for their roles in the fraud scheme.

This case was investigated by the FBI and HHS-OIG, and was brought as part of the Medicare Fraud Strike Force. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,140 individuals who collectively have falsely billed the Medicare program for more than $2.9 billion.

These recently announced guilty pleas bear out the advice that we have been delivering to clients, namely that the health care enforcement landscape is evolving and thus it is even more imperative to ensure that providers take pro-active steps to mitigate the likelihood that they will become subjects of the government’s more robust initiatives to prevent health care fraud
For more information regarding healthcare litigation and how to avoid becoming a government target, please contact Robert S. Iwrey, Esq. or Alan G. Gilchrist, Esq., for more information regarding healthcare fraud and abuse and how to properly structure business ventures, please contact Adrienne Dresevic, Esq., Carey F. Kalmowitz, Esq. or Esq., and for information regarding healthcare compliance, please contact Abby Pendleton, Esq. at (212) 734-0128 or at (248) 996-8510 or visit the HLP website.

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