Home Health Care Fraud on the Rise

In February 2015, two Florida doctors and their spouses paid $1.13 million to settle allegations that they received kickbacks in exchange for home health care referrals. Drs. Alan Buhler and Craig Prokos hired their wives as “marketers,” and referred patients for home care services. The settlement will resolve the allegations brought by a relator under the qui tam provisions of the federal False Claims Act, which allows private parties to bring suit on behalf of the United States government to recover funds paid by the government based on false claims. The relator is entitled to a share of the settlement amount.

Home health care is an area of continuing and rising fraud. Fraudulent conduct has become part of a number of companies’ business plans. Some businesses view making a settlement payment a cost of doing business, knowing that the settlement will be only a fraction of the money they have fraudulently received. Often, though, criminal charges are also brought against the fraudster.

An unlicensed Detroit doctor, Wilfred Griffith, was convicted on criminal charges in a $4.69 million fraudulent Medicare scheme. Griffith treated Medicare beneficiaries and used the pre-signed prescription pads of another physician. Griffith was found guilty of one count of conspiracy to commit health care fraud and one count of conspiracy to solicit and receive healthcare kickbacks.

In a third case, Alexander Lara, the owner of a Miami home health company, pleaded guilty for his role in a $13 million fraudulent Medicare scheme. Lara paid kickbacks and bribes to Medicare beneficiaries, doctors’ offices, and clinics to increase his patient referrals, and issued fraudulent prescriptions to support fraudulent billing to Medicare. Lara was charged with conspiracy to commit health care fraud.

Tagged: False Claims Act (FCA), Whistleblower Laws (Federal)