Over just a two-year period, a Miami home health care agency, Serendipity Home Health Inc., filed $20 million in false claims against Medicare. Medicare paid $14 million of the fraudulent claims before the scheme was uncovered and stopped. Serendipity owners Ariel Rodriguez and Reynaldo Navarro and employees Melissa Rodriguez and Ysel Salado have pleaded guilty of conspiracy to commit health care fraud for their part in the scam.
According to the Justice Department, the owners paid bribes and kickbacks to patient recruiters. In return, the patient recruiters provided Serendipity with patients, plans of care, prescriptions, and certifications for medically unnecessary home health services and therapy. Serendipity’s owners then allegedly used the certifications, plans of care and prescriptions to knowingly commit Medicare fraud.
The two employees involved in the case admitted to facilitating the kickbacks by cashing checks from Serendipity and returning the case to the owners to be used in the kickback scheme.
After patient recruiters identified Medicare beneficiaries for Serendipity, the home health care agency’s nurses and staff would falsify patients’ medical records so it would appear that the patients qualified for therapy and home health care services. The owners knew, however, that these Medicare beneficiaries did not in fact qualify for these services, that the services were medically unnecessary, and that the services were not received by the patients. Nevertheless, Serendipity fraudulently billed Medicare for these services.
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