December 31, 2013
December 31, 2013 — Each year, whistleblowers collaborate with the U.S. Justice Department to help the government recover millions of dollars that would otherwise be squandered on phony Medicare claims. The federal False Claims Act’s qui tam provisions give health care insiders the tools they need to help combat fraudulent health care claims. In return for filing a whistleblower claim on the government’s behalf, insider informants retain a portion of any recovery from the suit.
Two Florida health care clinic owners have been sentenced for their roles in an $8 million Medicare fraud scheme involving a now-defunct home health care agency. Miami residents Miguel Jimenez and Marina Sanchez Pajon were the husband-and-wife owner/operators of Flores Home Health Care Inc. The company purportedly was a provider of home health and physical therapy services to patients eligible for Medicare.
Between October 2009 and June 2012, Flores Home Health received around $8 million from Medicare in payment for phony home health services that either were not medically necessary or had not been provided, or both.
According to the U.S. Department of Justice, Jimenez and Pajon used Flores Home Health to bill Medicare for the unnecessary and nonexistent services. Jimenez controlled the company and oversaw the Medicare fraud schemes operated through the company. Both Jimenez and Pajon negotiated kickbacks and bribes, directed patient recruiters who participated in the scams and coordinated the filing of false claims to Medicare.
In running the scam, Jimenez and Pajon paid bribes and kickbacks to patient recruiters in exchange for the recruiters assistance in finding Medicare beneficiaries for whom Flores Home Health could submit phony claims for services. The couple also paid kickbacks and bribes to health care workers in clinics and doctors’ offices in return for prescriptions and other documentation needed to support the bogus Medicare filings, all of which Jimenez and Pajon recognized to be a violation of federal law.
Jimenez and Pajon both pleaded guilty in August 2013 to conspiracy to commit health care fraud. A federal judge in Florida has sentenced Jimenez to 87 months in prison and Pajon to 57 months.
Health care employees are ideally situated to uncover False Claims Act violations like the ones in this case involving fraudulent Medicare claims. Informants willing to collaborate with the government need to understand the process before moving forward. The qui tam lawyers at Waters & Kraus offer health care insiders the aggressive legal representation they deserve. Contact us by email or phone our False Claims Act attorneys at 855.784.0268 to learn more about what makes our whistleblower practice so successful.
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