Three Sentenced in Miami For Medicare Fraud

This week in Miami, three individuals related to a home therapy and care service were sentenced to prison, after having been convicted of conspiracy to commit health care fraud last year. The individuals, who operated Nany Home Health Inc were, according to court records, responsible for over fifty million in Medicare Fraud.

The defendants, Robert Gonzalez, Olga Gonzalez, and Fabian Gonzalez were sentenced to 120, 87, and 87 months in federal prison respectively, as well as 36 months of probation after their release. They were also fined forty million dollars, which is expected to be paid as a single fine for all co-defendants.

The owners of this home healthcare business plead guilty to a single count of conspiracy to commit healthcare fraud earlier and, as part of their plea agreement, admitted to attempting to defraud the US Federal Government. They admitted their role in utilizing patient recruiters, who were paid illegal kickbacks for providing Medicare patients to use their service. This included not just physical therapy, but also prescription drug fraud and unneeded medical services.

One interesting difference between this and some of the other common Medicare scams that involve recruiters is that, allegedly, the Gonzalez’s used staffing agencies located in Miami to help provide patients.

Prosecutors contend that many of the patients that received home healthcare services from the Gonzalez’s company were not qualified to receive these Medicare benefits, allegedly falsifying patient records to include symptoms that the Medicare recipient did not actually have.

The Medicare fraud is alleged to have taken place between 2006 and 2009, receiving almost forty million dollars from fraudulent claims they submitted to Medicare.

Nany Home Health is based in Florida and provided services to those on Medicare, including physical therapy and general home healthcare. According to public records, Nany Home Health Inc, which has a Miami address, has been in business for over 15 years, with tax records going back to 1995. Court records indicate that Roberto Gonzalez was the president, Olga Gonzalez was the vice-president, and Fabian Gonzalez was more closely tied to general operations.

Florida Home Medical Business Owners Plead Guilty to Medicare Fraud

The owners and operators of Serendipity Home Health Inc, a physical therapy and home medical care company located in Miami Florida, plead guilty this week to a single count of conspiracy to commit health care fraud, which allegedly was related to around $20 million in fraudulent Medicare Billings. The fraud, according to prosecutors, took place during 2007 to 2009 and they received approximately $15 million in reimbursement from Medicare.

Allegedly, Reynaldo Navarro and Ariel Rodriguez, who are listed in court documents as the owners of Serendipity Health, paid illegal kickbacks to those who referred Medicare recipients to their home healthcare business. In turn, they were, as per their plea agreements, using this information to bill Medicare for services that were not medically required, including physical therapy. Reynaldo Navarro is 41 years old and Ariel Rodriguez is 37 years old.

According to statements made in court, the patient recruiters also sometimes provided certificates of medically necessity, which are used by Medicare to justify reimbursement for things like wheelchairs or other durable medical equipment, in addition to prescribing unneeded medications that would also be billed to Medicare illegally.

Ariel Rodriguez is listed as the president and registered agent of Serendipity Home Health Inc., which was established in 2006 and is currently listed as Inactive in Florida’s Division of Corporations. Their last annual report was from 2009 and they list a Miami Florida business address in the 33135 zip code.

In addition to Ariel Rodriguez and Reynaldo Navarro, two other employees of Serendipity’s Home Medical Services, Melissa Rodriguez and Ysel Salado, have also been implicated in this case of Medicare fraud. Melissa Rodriguez, who is 24, plead guilty to conspiracy to commit health care fraud last week, on the 28th of March. Salado, who is 26 years old, plead guilty with Reynaldo Navarro and Ariel Rodriguez to the same charge.