Natick Man and Revere Woman Indicted for $27 Million Home Health Care Fraud Scheme
|U.S. Attorney’s Office September 20, 2013|
BOSTON—A Natick man and a Revere woman were charged today for orchestrating a $27 million home health care fraud scheme.
Michael Galatis, 62, was indicted on charges of conspiracy to commit health care fraud, 11 counts of health care fraud, and seven counts of money laundering. Janie Troisi, 64, was indicted on charges of conspiracy to commit health care fraud and 11 counts of health care fraud.
The indictment alleges that, between 2007 and 2012, Galatis and Troisi conspired to have the Medicare program pay for home health care services that, by and large, the beneficiaries did not need nor want. Galatis, a registered nurse, owned and operated At Home VNA (AHVNA), a home health agency located in Waltham. Troisi, also a registered nurse, was the clinical director for AHVNA. The Medicare program pays for home health services under specified conditions, including that a physician has certified that the patient is homebound and needs the services and that the services were provided to the Medicare patient. Galatis and Troisi had AHVNA bill Medicare, and Medicare paid AHVNA, millions of dollars for home health services that it should not have paid because the patients were not homebound, did not request nor need the services, and/or skilled services were not provided.
Galatis and Troisi trained AHVNA nurses to recruit Medicare beneficiaries who lived in residential facilities for senior citizens. They trained AHVNA nurses to hold “wellness clinics” where they would take residents’ blood pressure and vital signs. During these “clinics,” Galatis and Troisi trained the nurses to recruit the senior citizens by asking if they were Medicare beneficiaries, and if so, if they would like to have a nurse visit them in their home. Galatis and Troisi trained the nurses to manipulate the patients’ initial assessments to make it appear as though the patients qualified for home health services pursuant to Medicare’s guidelines, when that was often not the case. The home health prescriptions and plans of care were then signed by AHVNA’s paid medical director, who certified that the patients were homebound and in need of skilled services. In fact, the overwhelming majority of AHVNA’s patients were not homebound and did not need home health services: many of the patients worked, took out-of-state vacations, and lived independent lives. AHVNA’s nurses frequently complained to Galatis and Troisi that the patients did not want AHVNA’s services, were not home when they visited and/or were independent and did not need the services. Galatis and Troisi regularly refused the nurses’ requests to discharge the patients, ordering them to keep visiting the patients, or they simply assigned the patient to a new nurse.
Even though the AHVNA medical director certified that the patients were homebound and needed skilled services, he never treated or even met these patients. This was true even after 2011 when a new Medicare regulation required as a condition of payment that the patient have a face-to-face encounter with a physician demonstrating that the home health services were medically necessary. In fact, the patients’ primary care physicians were almost always unaware that the patients were receiving home health services. When some of the patient’s primary care physicians discovered that their patients were receiving home health services, they instructed AHVNA to terminate these services. In many instances, AHVNA continued to bill Medicare notwithstanding these complaints.
During the course of the conspiracy, AHVNA submitted more than $27 million in false and fraudulent claims to Medicare, and Medicare paid AHVNA more than $20 million. The vast majority of these claims should not have been paid because the patients were not homebound, did not need skilled services, and/or were not provided with skilled services
Galatis is separately charged with money laundering. The indictment alleges that Galatis spent a portion of the proceeds from the AHVNA fraud scheme to pay for a $750,000 house in Natick. Galatis withdrew and/or transferred funds from the AHVNA business bank account into his personal bank account, which he immediately used for a down payment for this house and then to pay off a $450,000 mortgage on the property in just 16 months.
If convicted, Galatis faces up to 10 years in prison, three years of supervised release and a $250,000 fine on each count. If convicted, Troisi faces up to 10 years in prison, three years of supervised release and a $250,000 fine on the conspiracy count and each health care fraud count.
United States Attorney Carmen M. Ortiz; Susan J. Waddell, Special Agent in Charge of the Department of Health and Human Services, Office of Inspector General, Office of Investigations; Vincent B. Lisi, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division; and John Collins, Acting Special Agent in Charge of the Internal Revenue Service’s Criminal Investigation in Boston, made the announcement today. The case is being prosecuted by Assistant U.S. Attorneys David S. Schumacher and Lisa A. Schlatz of Ortiz’s Health Care Fraud Unit.
The details contained in the indictment are allegations. The defendant is presumed to be innocent unless and until proven guilty beyond a reasonable doubt in a court of law.