The Justice Department is hot on the trail of Medicare fraud scams across the United States. In the last several years, prosecutors have indicted hundreds of healthcare professionals and recovered billions of dollars from wrongdoers. Unfortunately, although the statistics sound impressive, Medicare is able to recover a small percentage of the overall fraud. The FBI claims that Medicare fraud may cost taxpayers as much as $80 billion per year.
In the last several years we have seen an uptick in the amount of Medicare fraud involving home health agencies. A recent indictment in Chicago is indicative of how some people think they can outsmart prosecutors.
According to an indictment unsealed last month, the government has indicted the owners of a Chicago area home health care agency and several others.
Miquel and Estrellita Duquilla were charged with multiple counts of healthcare fraud and criminal conspiracy. Prosecutors claimed the two were the masterminds of a scheme to pay kickbacks to employees and patient recruiters who in turn referred people for home healthcare services that were either never provided or medically unnecessary.
According to the indictment, the Duquillas owned HCN Home Healthcare Inc. Their scheme allegedly netted $6 million of taxpayer money.
The indictment alleges the kickbacks and bribes ranged between $500 and $6175. Nurses and others that worked at HCN would be paid to either refer actual patients or receive permission to use their Medicare ID information.
Several nurses that worked for the couple were charged with filling out phony nursing assessments so that the patients would qualify for home services. Unless someone is unable to care from him or herself, Medicare usually doesn’t pay for services in the patient’s home.
Staff would alleged to have doctored records to show home visits when none occurred.
The indictment suggests that the husband of one of the nurses and an outside patient recruiter were also paid to help round up non-eligible “patients” for home services.
Two things stand out in the indictment. First, the conduct occurred between 2008 and 2012. That is important because many would be whistleblowers are reluctant to come forward and report fraud thinking their information is too old. Generally the statute of limitations on a federal False Claims Act case is 6 years.
The lesson here is simple. If someone committed Medicare fraud and stole taxpayer money, Uncle Sam wants to know.
The other takeaway is the existence of patient recruiters. Although not per se illegal, we rarely see a legitimate healthcare operation that needs to pay for patients. Kickbacks and bribes are simply illegal and prosecutors will often prosecute both the recruiter and the provider.
Medicare Fraud and the False Claims Act
Whistleblowers are the government’s best weapon in the war on Medicare fraud. The False Claims Act pays whistleblowers up to 30% of whatever the government recovers from wrongdoers.
To obtain a whistleblower award, one must file a lawsuit in federal court (state court in Medicaid fraud cases) and possess inside or original source information.
If you have information and are interested in receiving a large cash award, call us. Reporting fraud to a Medicare hotline does not earn you a big award.
For more information, contact attorney Brian Mahany at or by telephone at (414) 704-6731 (direct). See also our homecare fraud page.
MahanyLaw – America’s Whistleblower Lawyers