Home Health Care Company Owners Plead Guilty to $8 Million Miami Medicare Fraud By Tod Aronovitz | 08/20/13 | 0 Comment

Married couple Miguel Jimenez, 43, and Marina Sanchez Pajon, 29, of Miami, each pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Ursula Ungaro in the Southern District of Florida, according to Department of Justice officials. Jimenez and Pajon each could be sentenced to a maximum penalty of 10 years in prison for the Miami Medicare fraud scheme. Sentencing is scheduled for October 30, 2013.

From October 2009 through June 2012, Flores Home Health, Inc., was paid approximately $8 million by Medicare for fraudulent claims for home health services.

Court documents reported that the married couple co-owned and operated the now-defunct Miami-based Flores Home Health Care, Inc., for the alleged purpose of billing Medicare for expensive physical therapy and home health care services that were not medically necessary and/or were not provided.

Jimenez’s primary role involved managing the company and its schemes. Both Jimenez and Pajon were responsible for negotiating and paying kickbacks and bribes, interacting with patient recruiters, and coordinating and overseeing the submission of fraudulent claims submitted to the Medicare program.

The couple paid kickbacks to patient recruiters in return for Medicare patients, and bribed co-conspirators in doctors’ offices and clinics in exchange for home health and therapy prescriptions, medical certifications, and other documentation. Jimenez, Pajon, and their co-conspirators used these prescriptions, medical certifications, and other documentation to fraudulently bill Medicare for home health care services that Jimenez and Pajon knew were in violation of federal criminal laws.

How to Report Miami Medicare Fraud
Healthcare or medical billing employees who have inside knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with Miami whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss a case.