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Home health ploy to defraud Medicare leads to guilty plea

By Kyle Murphy, PhD

A healthcare fraud scheme in Miami has led to a guilty plea for conspiracy to solicit and receive health care kickbacks and to defraud Medicare in Southern District of Florida, according to the Department of Justice. All told, the scheme resulted in more than $6.5 million in submitted claims and $6.1 million being paid out to a now-defunct home healthcare company, Nestor’s Health Services Inc.

Court documents indicate that Euridice Borroto received bribes and kickbacks from Nestor’s Health Services Inc. for her part in recruiting Medicare patients to the home healthcare agency. However, these services were either medically unnecessary or not provided. Details from the case also indicate that Borroto, who awaits sentencing next month, also took part in other attempts at healthcare defraud:

According to court documents, Borroto solicited and received kickbacks and bribes from the owner and operator of Nestor HH in return for recruiting and providing patients to Nestor HH for home health care and therapy services that were medically unnecessary and, in many instances, were not provided.  Nestor HH would then fraudulently bill the Medicare program for home health care services on behalf of the recruited patients, in violation of federal criminal laws. Borroto knew that in many instances the patients she recruited for Nestor HH did not qualify for the services billed to Medicare.

From approximately March 2009 through at least January 2014, Nestor HH submitted more than $6.5 million in claims for home health services. Medicare paid Nestor HH more than $6.1 million for these fraudulent claims before the fraud was exposed.

In documents filed with the court, Borroto also acknowledged her involvement in similar fraudulent schemes at other Miami health care agencies.

Court documents filed in May by US Attorney Wifredo A. Ferrer claim that Borroto received payments of $5,400 and $3,500 in November and December of 2012, respectively, from Nestor’s Health Services Inc.

In May, the DoJ and the Department of Health & Human Services (HHS) revealed details of a nationwide takedown by the Medicare Fraud Strike Force in six cities that led to charges against 90 individuals for approximately $260 million in false billing.

Of the cities target by the Medicare Fraud Strike Force Miami saw the largest number of individuals charged, a total of 50 defendants involved in various schemes adding up to $65.5 million in fraudulent claims for home healthcare, mental health services, and pharmacy.

Two defendants were facing charges for a pharmacy kickback and laundering scheme accounting for largest portion of that amount, an estimated $23 million. Allegedly, the two co-conspirators entered into an agreement with a pharmacy owner to gain access to Medicare beneficiary used to bill for drugs that were never dispensed with kickbacks being paid under a false services contract and laundered through defendant-owned shell companies.

 

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