Woman Sentenced to 12 Years for Role in $100 Million Home Healthcare Fraud Scheme

A Massachusetts woman was sentenced on January 23, 2025, in federal court for her role in a home healthcare fraud scheme. She received a twelve-year prison sentence, followed by three years of supervised release. Additionally, she was ordered to pay a $250,000 fine and restitution of $99,734,517.

From January 2013 to January 2017, the defendant operated a home healthcare company and conspired with others to defraud MassHealth of at least $100 million. The company, under her direction, billed for services that were never provided. Co-conspirators were instructed to create and submit falsified nursing visit notes. They also paid kickbacks for patient referrals, regardless of medical necessity, and established sham employment relationships with patients’ family members to provide unnecessary home health aide services. Additionally, the company routinely billed for fictitious visits, which the defendant knew had not occurred.

At her direction, the company submitted false claims to MassHealth for services performed by home health aides (HHAs) who lacked the required training and certification. The company failed to provide the mandated 75 hours of training to new hires, instead forging training documents and giving them sham exams with answer keys.

In 2017, after learning that MassHealth had cut off funding to her company, the defendant issued herself and her husband $2 million checks from the company payroll account. Backdating the checks to 2016 to appear as Christmas bonuses, she wrote and cashed them in January 2017.

The defendant was arrested and charged with healthcare fraud in February 2021. In July 2024, she was convicted of one count of conspiracy to commit healthcare fraud, one count of healthcare fraud, and three counts of money laundering. The jury found her not guilty on one count of money laundering conspiracy.

Her co-defendant pleaded guilty to the conspiracy in September 2022, and sentencing for the co-defendant is yet to be scheduled.

Compliance Perspective

Issue

Submitting false or fraudulent claims for payment to Medicare or Medicaid is illegal. This includes falsifying documents related to care, incomplete or inaccurate documentation, failure to provide the documented care, or engaging in other deceptive practices. These actions raise significant concerns about the quality of care provided and the integrity of the healthcare system. Additionally, the Anti-Kickback Statute prohibits offering or paying remuneration to induce referrals of services covered by Medicare, Medicaid, and other federally funded programs. Under both federal and state laws, it is illegal to knowingly offer, pay, solicit, or receive anything of value in exchange for referrals. Kickbacks can take many forms, including bribes, rebates, and other financial incentives. Failing to promptly report a kickback can lead to lawsuits, significant fines, and other severe sanctions.

Discussion Points

    • Ensure your policies and procedures address the prevention of fraudulent billing, falsified documentation, and kickback schemes. These policies should include clear guidelines to detect and prevent billing for services that were not provided, as well as the prohibition of kickbacks for patient referrals. Review and update policies regularly to ensure compliance with current federal and state regulations, and provide clear instructions for staff on how to report suspicious activities.
    • Provide thorough training for all relevant staff on your facility’s policies and procedures, particularly regarding standards of care, accurate documentation practices, and compliance with regulatory requirements. Staff should be trained upon hire and at least annually on their responsibilities to report any concerns of fraud, waste, or abuse of government funds. Additionally, all staff must be educated on federal and state anti-kickback statutes, understanding what constitutes a kickback, and the proper process for reporting suspected violations.
    • Conduct routine audits to ensure staff understand the importance of reporting any suspected kickbacks or fraudulent activities, whether intentional or accidental. Regularly audit medical records, timesheets, and billing documentation to verify that entries are accurate, complete, and timely. Ensure that all entries meet required standards and have not been falsified or erroneously reported.

*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*

You May Also Like