Home Health & Hospice Week

“We can continue to hold medical providers accountable for their actions when they take advantage of our claimants and program,” says DOL Office of Workers’ Compensation Programs Director Christopher J. Godfrey in the release. “That accountability will reduce future fraud, waste and abuse by other providers,” Godfrey maintains.

AHH self-disclosed some of the case’s information to the HHS Office of Inspector General, the DOJ adds. “In the settlement agreement, the United States acknowledged AHH’s cooperation in this regard,” it says.

Massive Scam Results In Lengthy Prison Terms

But then again, often Medicare fraud is at the crux of high-dollar home health cases.

Big example: Two Florida residents used a complicated scam to bill Medicare for $93 million in fraudulent home health services, and now will serve hefty prison time.

Karel Felipe and Tamara Quicutis conspired with others to submit false claims to Medicare for three home health agencies in Michigan, the DOJ says in a release. Their co-conspirators recruited individuals from Cuba to sign Medicare enrollment documents and appear as the owners of the HHAs to conceal the identities of Felipe, Quicutis, and others involved in the scheme.

Using lists of stolen patient identities, the scammers submitted claims for services that were not rendered, then used dozens of shell companies and hundreds of bank accounts to launder the Medicare fraud proceeds and convert the proceeds into cash at Miami-area ATMs and check cashing stores, the feds proved at trial. Felipe and Quicutis were convicted last October.

Felipe has been sentenced to eight years and four months in prison, and Quicutis five years and 10 months. The court also ordered forfeiture of fraud proceeds. Co-conspirators have already been sentenced in the case, including Jesus Trujillo, who drew a 14-year prison term.