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November 26, 2014

Miami Home Health Agency Owner and Operator Pleads Guilty for Role in Multiple Medicare Fraud Schemes 

WASHINGTON—An owner and operator of a Miami home health care agency pleaded guilty today in connection with a long-running $6.2 million Medicare fraud scheme involving Professional Medical Home Health LLC (Professional Home Health), and similar schemes at two other Miami home health care agencies.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Derrick Jackson of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.

Ernesto Fernandez, 48, of Miami, pleaded guilty to one count of conspiracy to commit health care fraud before U.S. Magistrate Judge Chris M. McAliley of the Southern District of Florida. According to his plea agreement, Fernandez also agreed to forfeit $9,061,867, which represents the proceeds traceable to his criminal conduct. His sentencing is scheduled for Feb. 3, 2015.

According to admissions in his plea agreement, Fernandez was an owner and operator of Professional Home Heath, a Miami home health care agency that purported to provide home health and therapy services. He was also the owner and operator of two other South Florida home health agencies. At each of these companies, Fernandez and his co-conspirators billed the Medicare program for expensive physical therapy and home health services that were not medically necessary or were not provided. Fernandez admitted that he caused patient documentation to be falsified, managed and supervised personnel, and planned, organized and oversaw the submission of fraudulent claims submitted to the Medicare program.

Fernandez also admitted to being a patient recruiter for all three home health agencies. In that capacity, Fernandez recruited patients for the agencies in exchange for kickbacks, knowing that the agencies would bill the Medicare program on behalf of these recruited patients for expensive home health and therapy services that were not medically necessary or not provided.

Fernandez was the eighth defendant to plead guilty in connection with the fraudulent schemes at Professional Home Health. Earlier this month, five other defendants charged in this case also pleaded guilty. Dennis Hernandez, 32, Jose Alvarez, 48, and Joel San Pedro, 44, all of Miami, and Alina Hernandez, 38, of West Palm Beach, each pleaded guilty to one count of conspiracy to commit health care fraud. Juan Valdes, 37, of Palm Springs, Florida, pleaded guilty to one count of conspiracy to defraud the United States and receive health care kickbacks. Sentencing hearings for these five defendants are set for Jan. 29, 2015.

Earlier this year, two additional individuals pleaded guilty and were sentenced in connection with the same scheme. Annarella Garcia, an owner of Professional Home Health, was sentenced to serve 70 months in prison. Annilet Dominguez, an administrator of Professional Home Health, was sentenced to serve 68 months in prison. Both were also ordered to pay $6,257,142 in restitution.

This case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. This case is being prosecuted by Trial Attorney Anne P. McNamara of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.

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