Clinical Director of Home Care Agency Sentenced in Medicare Fraud Scheme
BOSTON—The clinical director of a home nursing agency was sentenced yesterday in U.S. District Court in Boston in connection with her role in a multi-million dollar scheme to defraud Medicare.
Janie Troisi, 66, of Revere, was sentenced by U.S. District Court Judge Douglas P. Woodlock to three years in prison and three years of supervised release. In August 2015, Troisi was convicted following a five-day trial of conspiracy to commit health care fraud and 10 counts of health care fraud.
Troisi, a registered nurse, was the Clinical Director of At Home VNA (AHVNA), a home health agency located in Waltham, which was owned and operated by her co-conspirator, Michael Galatis, also a registered nurse. From 2009 to 2012, Troisi conspired with Galatis to submit more than $3.5 million in fraudulent home health care claims to Medicare.
The Medicare program only pays for home health services under certain conditions, including that a physician has certified that the patient is homebound and needs certain skilled services. Troisi ignored these requirements and trained AHVNA nurses to recruit healthy individuals with Medicare insurance who lived in large apartment buildings. Troisi held “wellness clinics” at these buildings where nurses convinced senior citizens to enroll with AHVNA and have a nurse visit them in their home. Troisi and Galatis trained AHVNA nurses to manipulate the patients’ Medicare assessment forms to make it appear as though the patients qualified for Medicare home health services, when that was often not the case. Troisi also worked in concert with Dr. Spencer Wilking, AHVNA’s in-house Medical Director, who was paid to sign the home health care orders, even though Dr. Wilking did not examine the vast majority of AHVNA’s patients.
The patients’ primary care physicians did not refer the patients to AHVNA and were unaware that AHVNA was sending nurses to see their patients in their homes. A number of primary care physicians who learned of AHVNA’s services complained to Troisi, informing her that the patients did not need a visiting nurse, but Troisi ignored these complaints. Similarly, AHVNA’s nurses frequently informed Troisi that the patients did not need a visiting nurse, but Troisi refused to discharge the patients and continued to cause Medicare billing.
In 2011, Medicare passed a new requirement that a physician certify that she or he had a face-to-face encounter with the patient about the need for home health care. Even after this regulation was enacted, Troisi continued to cause the submission of millions of dollars of Medicare claims for home health care even though Dr. Wilking continued to sign each order without examining any of the patients.
Galatis was convicted of conspiracy to commit health care fraud, 10 counts of health care fraud, and seven counts of money laundering. He was sentenced in February 2015 to 92 months in prison. Dr. Wilking pleaded guilty to health care fraud and sentenced to one year of home confinement and a fine of $7,500.
United States Attorney Carmen M. Ortiz; Philip Coyne, Special Agent in Charge of the U.S. Health and Human Services, Office of Inspector General, Office of Investigations; Harold H. Shaw, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division; and William P. Offord, Special Agent in Charge of the Internal Revenue Service’s Criminal Investigation in Boston, made the announcement today. Assistance was also provided by the New England Benefit Integrity Support Center, a fraud contractor for the Medicare program. The case was prosecuted by Assistant U.S. Attorneys Lisa Asiaf Schlatz and David S. Schumacher of Ortiz’s Health Care Fraud Unit.