April has proved a successful month for the Department of Justice (DOJ). The agency has already had two successful prosecutions against local leaders in the Home Health Care industry accused of health care fraud crimes.
Both will serve prison time for their alleged crimes. The cases serve as a reminder for those accused of health care crimes to take the allegations seriously. The DOJ can and will pursue serious penalties, including imprisonment.
Case #1: DOJ accuses director of submitting false and fraudulent claims to Medicare.
The first case involved a director of nursing and administration for two Texas home care facilities. The DOJ accused the woman of submitting false and fraudulent claims to Medicare for reimbursement for home health services from 2008 through 2016 as part of a health care fraud scheme. The court found the accused guilty of criminal charges for conspiracy to commit health care fraud and commission of health care fraud. The court ordered her to pay $20.4 million dollars in restitution to Medicare for her role in a $20 million health care fraud scheme and serve a 10 year prison sentence.
Case #2: DOJ accuses owner of elder care facility of health care fraud.
In a separate case, the DOJ accused an owner and operator of an elder care facility of obtaining false documents to hide his involvement in the facility. This was an issue as he was forbidden from participating in any home health care benefit program, likely due to previous, similar allegations.
The court found the man guilty and sentenced him to a 5 year prison term and a required restitution payment of $3.5 million.