January 8, 2018

Florida Home Health Care Owners Plead Guilty for Roles in $8 Million Medicare Health Care Fraud Scheme

Editor’s note: Here’s an interesting blog post from our archives that we thought was worth sharing again. The False Claims Act has enabled whistleblowers to expose fraudulent healthcare fiscal violations, while getting financial rewards for their efforts. We feel this is justice being served indeed.

Miguel Jimenez and Marina Sanchez Pajon, owners and operators of Flores Home Health, a Miami, Florida home health care agency, plead guilty to one count each of conspiracy to commit health care fraud.  This husband and wife team ran the now defunct Flores Home Health agency for the purpose of billing Medicare for expensive physical therapy and home health services that were neither medically necessary nor provided.  Both were responsible for negotiating and paying kickbacks and bribes, interacting with the patient recruiters and coordinating and overseeing the submission of fraudulent claims submitted to Medicare.

The kickback and bribes paid by Jimenez, Pajon and their co-conspirators were in exchange for patients recruiters’ referrals of patients to the Flores Home Health for home health and therapy services that were not medially necessary and/or provided. Kickbacks and bribes were also provided to doctors’ officers and clinics in exchange for home health and therapy prescriptions, medical certifications and other documentation.  Jimenez, Pajon and their co-conspirators used these medical documents to fraudently bill Medicare for home health services that Jimenez and Pajon knew were in violation of federal criminal laws. From approximately October 2009 through June 2102, Medicare reimbursed $8 million to Flores Home Health for services that were not medically necessary and/or provided.

Interested in learning more about False Claims Act repercussions and medical Qui Tam lawsuits? Berg & Androphy has an entire practice area devoted to the subject. Learn more here by visiting this section on our website.