Excluded, Concealed Co-Owner of Texas Home Health Provider Sentenced in $3.7 Million Healthcare Fraud Scheme
One of two co-owners of a Texas home healthcare provider, both of whom had been previously excluded from Medicare and Medicaid programs, was sentenced by a U.S. District Judge to five years in prison after being convicted of conspiracy to commit healthcare fraud. He was also sentenced to two years of supervised release and required to pay restitution in the amount of $3,559,154.22.
Three other co-conspirators were also each convicted in the same trial of one count each of conspiracy to commit healthcare fraud, and two of the three were convicted of two counts each of making false statements in connection with a healthcare benefit program.
Evidence during the trial exposed the two co-owners as not being eligible to participate in any federal healthcare benefit program due to their being previously excluded. Their identities as the owners were concealed and false documents were signed, indicating that no one associated with the home healthcare company was excluded from Medicare and Medicaid. Instead, another individual was listed as being the owner. Along with concealing the ownership, the defendants engaged in a scheme to submit false claims for services that were not necessary.
Compliance Perspective
Concealing the identity of owners who have been excluded from participation in Medicare and Medicaid and knowingly submitting claims for unnecessary services is healthcare fraud.
Discussion Points:
- Review policies and procedures regarding non-association with excluded vendors and healthcare providers.
- Train staff to be aware of the policies and procedures that disallow a facility’s association with excluded vendors and healthcare providers, and how to view data bases that list excluded vendors and healthcare providers.
- Periodically audit the facility’s vendors and healthcare providers, including licensed staff, to determine if any have been excluded from Medicare and Medicaid.
