Administrator and Employee of Miami Home Health Companies Pleads Guilty to Role in $74 Million Health Care Fraud Scheme

WASHINGTON—A Miami resident who was an administrator of a home health care company and was the employee of another home health care company pleaded guilty today for her participation in a $74 million home health Medicare fraud scheme, announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations, Miami Office.

Myriam Acevedo, 63, pleaded guilty before U.S. District Judge Marcia G. Cooke in the Southern District of Florida to one count of conspiracy to pay health care kickbacks and two counts of payment of kickbacks in connection with a federal health care benefit program.

Acevedo was an administrator of LTC Professional Consultants Inc. and an employee of Professional Home Care Solutions Inc., Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries. According to court documents, Acevedo and her co-conspirators operated LTC and Professional Home Care for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

According to court documents, Acevedo’s primary role in the scheme was to pay kickbacks and bribes to patient recruiters at LTC and Professional Home Care. Specifically, Acevedo conspired with patient recruiters and others for the purpose of billing the Medicare program for unnecessary home health care and therapy services. Acevedo and co-conspirators paid kickbacks and bribes to patient recruiters, who provided patients to LTC and Professional Home Care, as well as prescriptions, plans of care (POCs), and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Acevedo and her co-conspirators used these prescriptions, POCs, and medical certifications to fraudulently bill the Medicare program for home health care services, which Acevedo knew was in violation of federal criminal laws.

From approximately September 2007 to June 2012, LTC and Professional Home Care submitted approximately $41 million in claims for home health services that were not medically necessary and/or not provided, and Medicare paid approximately $27 million on those claims.

At sentencing, scheduled for July 24, 2013, Acevedo faces a maximum penalty of five years in prison for each count.

This case is being prosecuted by Assistant Chief Joseph S. Beemsterboer of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with 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.