White Collar Criminal Defense Group

Hospice Eligibility Remains A Focus For Federal Prosecutors – Philadelphia Nurse Convicted In Hospice Healthcare Fraud

On February 8, a federal jury convicted Patricia McGill, a Philadelphia registered nurse, on four counts of healthcare fraud.  The charges arose out of her service as Director of Professional Services for Home Care Hospice (HCH), a for-profit hospice service provider for patients in nursing homes and private residences.  The charges against McGill related to her authorization and supervision of the admission of inappropriate and ineligible patients for hospice services, which contributed to HCH submitting millions of dollars in fraudulent claims to Medicare.

According to the government, HCH billed Medicare for approximately $9,328,000 in hospice services purportedly provided by HCH nurses and health aides.  With the jury’s verdict, however, the government’s evidence established that many HCH patients did not meet Medicare criteria for hospice care and that HCH billed Medicare for hospice care that was not provided to patients.

According to a report by Philly.com, the owners of HCH, identified in other reports as Matthew Kolodesh and Alex Pugman, were tried separately, convicted and sentenced to prison terms last year.  According to the same report, several nurses who worked under McGill’s direction have also been tried and convicted of charges arising out of the same case.

Ms. McGill is scheduled to be sentenced before U.S. District Court Judge Eduardo C. Robreno on May 24, 2016. According to the government, McGill faces a potential advisory sentencing guideline range of 33 to 41 months in prison.

Kickbacks And Falsification Of Records At Center Of $20 Million Home Healthcare Fraud Conspiracy

Last Tuesday Miami physician Henry Lora pled guilty to federal criminal charges arising out of a $20 million healthcare fraud conspiracy.  In entering the plea, Lora admitted that as the medical director of Merfi Corporation, a Miami-area clinic, he accepted kickbacks and bribes.  He also acknowledged that he, along with co-conspirators, wrote prescriptions for home healthcare and other services for Medicare beneficiaries, when those services were either not medically necessary or not provided.

Lora entered a plea of guilty to one count of conspiracy to commit healthcare fraud and one count of conspiracy to defraud United States, receive healthcare kickbacks and make false statements relating to healthcare matters.  The fraudulent conduct for which he pled guilty included the falsification of patient records, which was done to make it appear as if the beneficiaries qualified for the services.

As a result of his plea of guilty to both counts, Lora faces a maximum combined sentence of 25 years.  In 2014, the owner of Merfi, Isabel Medina, was sentenced to nine years in prison for her conviction of conspiracy to commit healthcare fraud.