Home Health & Hospice Week

Home care execs are on the hook for alleged fraud.

Home care providers can expect continued fraud and abuse scrutiny in the coming year.

Home health agencies and durable medical equipment providers figured prominently in the HHS Office of Inspector General latest semiannual report to Congress. In the report, the OIG offers a list of HHAs and DME suppliers caught up in OIG enforcement actions this year.

Upcoding: For HHAs, the list includes Colquitt Regional Medical Center's HHA in Sylvester, GA. The agency and its administrators, Coleen Grimsley and James Lowry, allegedly certified and recertified home care patients for medically unnecessary home health episodes, including when patients were not home bound. They also upcoded initial certification diagnoses, the OIG points out. The agency and execs agreed to pay $475,000 to settle the False Claims Act charges.

Impossible visits: The OIG also highlights a case in which a California nurse "who submitted records that purported that she saw 58 patients on a single day, personally made visits that lasted from 30 to 45 minutes each, saw patients every single day during a two-year period, and saw multiple patients in different locations at the same time," the OIG says in the report. LVN Sonia Ogbeni was sentenced to 78 months in prison and ordered to pay $4.2 million in restitution for the fraud scheme.

Fake vaccines: And the fraud watchdog reported the outcomes of two high-profile HHA cases. In 2005 the government filed criminal charges against Iyad Abu El Hawa, owner of Comfort & Caring Home Health in Houston, for his participation in administering bogus flu shots at company-sponsored health fairs as a part of a Medicare fraud scheme (see Eli's Home Care Week, Vol. XIV, No. 40).

El Hawa pled guilty to health care fraud and misbranding of a drug and was sentenced to 46 months in prison and ordered to pay a $15,000 fine, the OIG says. Licensed nurse Martha Gonzales was sentenced to six months' home detention and ordered to pay a $5,000 fine related to the scheme.

"The investigation revealed that over 1,000 fake flu vaccines had been administered to employees of a refinery during a health fair and that senior citizens had been given the fake vaccines at local nursing homes," the report says.

Services not provided: A federal grand jury indicted southwest Virginia-based Homestead Foundational Services owner Rebecca Conyer and bookkeeper Donna Bates on health care fraud, money laundering and mail fraud charges in 2005 (see Eli's HCW, Vol. XIV, No. 31). "Conyer was sentenced to 30 months' incarceration and ordered to pay $923,000 in restitution," the OIG notes. "Bates received a 24-month prison sentence and was held responsible for paying $713,000, a portion of the total restitution amount."

Suppliers' turn: The OIG also lists [...]