Corporate Compliance

Patient recruiter pleads guilty in $25 million Medicare fraud scheme

Compliance Monitor, July 27, 2011

Vicente Guerra-Nistal, 54, a patient recruiter for Miami healthcare agencyABC Home Health Care Inc., pleaded guilty for his involvement in a $25 million home health Medicare fraud scheme, according to a Department of Justice (DOJ) press release.

Guerra is the latest ABC employee to plead guilty to participation in agency’s $25 million fraud scheme. Compliance Monitor reported on the guilty pleas of Lisandra Alonso and Luisa Morciego in our last issue.

While working as a patient recruiter for ABC Guerra offered and paid kickbacks and bribes to Medicare beneficiaries in return for those beneficiaries allowing ABC to bill Medicare for home healthcare and therapy services that were medically unnecessary and/or never provided. Guerra admitted that he knew patient files were falsified in order to make it appear that the patients qualified for home healthcare and therapy services so that Medicare could be billed for medically unnecessary services.

Guerra faces 10 years in prison, fines, and terms of supervised release, as well as forfeiture of any property or proceeds derived from his criminal activities.

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