Registered Nurse Defrauds Medicare for $17M in Home Healthcare Scheme

False Claims Act , Healthcare Fraud

A registered nurse based out of Texas was found to have utilized two separate home healthcare clinics to swindle the federal Medicare program for $17 million over the course of the seven-year scheme. The nurse, a resident of Fort Bend, Texas, owned and operated Preferred Health Services Inc. and Deligent Health Services Inc., both based out of Houston. From August 2009 to March 2016, he filed extensive claims that certified his patients as eligible for home health services, though many did not meet the federal requirements for such treatment.

Medicare has strict limitations regarding beneficiary qualifications for the services rendered under such providers; the program offers home healthcare services solely to those who are found to necessitate skilled nursing services and are medically diagnosed with a homebound status, signifying that they are unable to acquire reasonable transportation to medical appointments and thus require in-home services to be provided.

Over the course of the scheme, the nurse in question cooperated with two physicians licensed by the state of Texas in order to submit falsified claims that certified patients as meeting these eligibility requirements; oftentimes, these two practitioners would report that patients were under their care, when they had not been seen by either. In return, the nurse would offer payments to Southwest Total Medical Inc., the medical center which employed the two doctors. The federal report goes on to further denote that the three would regularly attest to the fact that patients were homebound, which was later discovered to be a deliberate misrepresentation of their true status.

Through the two clinics, the nurse was able to unlawfully bill Medicare for a total of $12,744,784.20; it was reported that the healthcare program reimbursed $17,195,899.10 for the jointly submitted claims, the majority of which was then diverted to the nurse’s personal account and offered to the participating physicians.

In his testimony, the RN showed considerable remorse for his role in the scheme, alleging that he did not intend to defraud Medicare; though this may be the case, the uncovering of such blatant fraudulence and the subsequent recovery of government funds is vital to the continuance of programs such as Medicare.

In a 2016 study released by the Office of the Inspector General, it was shown that home healthcare fraud is rising, with an estimated $10 billion in reimbursements for fraudulent claims being paid annually to home health agencies (HHAs) alone. It additionally cited that over 500 of these agencies, along with 4,502 standalone physicians who provide such services, presented characteristics that imply dishonest practices. Though the report identified a “relatively small number” of outliers, with those figures representing only 1% to 5% of the nation’s home health providers, the study lends itself to the ever-present issue of healthcare fraud as a whole and clearly illustrates the necessity of reporting such activity.

Whistleblower Justice Network Can Help You

Whistleblower Justice Network partners with potential whistleblowers in a noble attempt to restore order and integrity to healthcare programs that are currently being defrauded. Together, we seek to expose those who commit Medicare fraud for personal and financial gain in efforts to recover funding intended for those in need.

If you have meaningful information regarding home health fraud that you believe is in violation of the False Claims Act, Whistleblower Justice Network can help. Working alongside world-class legal counsel, we will ensure you are protected to the fullest extent of the law and that you receive credit for the information you bring to the U.S. government. Partnering with whistleblowers is all we do. Visit us at www.whistleblowerjustice.net, or call us at 844-WJN-4ALL.

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