Therapist and Patient Recruiters Tied to Miami Health Care Fraud By Tod Aronovitz | 12/18/13 | 0 Comment

Ruben Busquets, a former licensed mental health counselor at the now defunct Health Care Solutions Network Inc. (HCSN), recently pleaded guilty to a charge of one count of conspiracy to commit health care fraud. The pleading came as part of a larger Miami health care fraud racket in which HCSN billed Medicare and the Florida Medicaid program approximately $63 million for purported Partial Hospitalization Program (PHP) services from 2004 through 2011.

The 50-year old from Miami faces a maximum penalty of 10 years in prison and will be sentenced on February 20, 2014, the U.S. Department of Justice said.

Court records show Busquets was aware that HCSN-FL personnel were routinely falsifying patient medical records to support false and fraudulent billings to government health care programs. Busquets, who was employed as a licensed therapist, also signed the fabricated PHP therapy notes and other medical documentation, which sometimes was created weeks or months after patients were admitted for PHP treatment.

Busquets was one of 20 in a string of arrests related to the HCSN scheme, as we previously posted on our ARONOVITZ Blog on September 4.

In a separate case, two patient recruiters for Miami health care companies were sentenced for their roles in a $48 million home health Medicare fraud scheme.

Elizabeth Monteagudo, 33, and Cristobal Gonzalez, 39, both of Miami, recruited for Caring Nurse Home Health Care Corp.  Gonzalez also worked for Good Quality Home Health Care Inc.  The two Miami home health care agencies—owned and operated by Rogelio Rodriguez and Raymond Aday—supposedly provided home health and therapy services to Medicare beneficiaries.

The Justice Department reported that Monteagudo was sentenced to 70 months, followed by three years of supervised release, and ordered to pay $3.5 million in restitution jointly with co-defendants.  Gonzalez was sentenced to 46 months of jail time, followed by two years of supervised release, and ordered to pay $2 million in restitution jointly with co-defendants.  Each pleaded guilty in September to one count of conspiring to receive health care kickbacks.

According to court documents, Monteagudo and Gonzalez recruited patients, and solicited and received kickbacks and bribes in return for allowing Caring Nurse and/or Good Quality to bill Medicare on behalf of the recruited patients, charging for services that were medically unnecessary and/or not provided. Their participation in the scheme occurred from about January 2009 through June 2011.

Monteagudo also admitted to her involvement with $7 million in fraudulent billings for Starlite Home Health Agency Inc., which she owned and operated.

In a related case earlier this year, Caring Nurse and Good Quality owners Rogelio Rodriguez and Raymond Aday were sentenced to serve 108 and 51 months, respectively, following their 2012 guilty pleas of one count of conspiring to commit health care fraud.

The indictment charged that from January 2006 through June 2011, the two agencies submitted approximately $48 million in claims for home health services that were not medically necessary and/or not provided.  Medicare actually paid approximately $33 million for these fraudulent claims.

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.