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Thursday, May 11, 2017
Six Convicted in Home Health Medicare Fraud Scheme
Posted by Pamela Egan of Wellness and Anti-Aging Clinic

Four Doctors, Two Others Convicted in $13.6 million Medicare Home Health Care Fraud Scheme

By: Peter Egan

NEW ORLEANS, LA - Six people including four doctors were convicted Tuesday, May 09, on charges stemming from a home health care fraud scheme that netted $13.6 million in Medicare reimbursements that were fraudulent in nature.

The four doctors and two business executives all worked for or with Abide Home Care Services, which according to federal prosecutors regularly falsified diagnoses in order to artificially inflate Medicare reimbursements. Abide was also accused of falsifying medical records that called for medically unnecessary home health care services.


Abide Home Care

The company was owned by Lisa Crinel, a New Orleans businesswoman who in 2015 pleaded guilty along with Sheila Mathieu, mother of NFL star Tyrann Mathieu.

The guilty verdicts followed a month-long trial. Among the six found guilty are Dr. Henry Evans, Dr. Michael Jones, Jones' wife Paula Jones, Dr. Gregory Molden, Dr. Shelton Barnes - all from New Orleans and Jonathan Nora of River Ridge, LA.

The allegations involved a scheme in which the doctors ordered medically unnecessary services in exchange for kickbacks/bribes, that were disguised as consulting and/or director fees.

While Crinel and Mathieu pleaded guilty in 2015 along with Theresa Adderley and Rhonda Maberry, the other six opted to go to trial and were all found guilty. Charges ranged from health care fraud, conspiracy to commit health care fraud, conspiracy to defraud the United States, conspiracy to pay and receive health care kickbacks, and obstruction of a federal audit.

Sentencing guidelines range from a maximum $250,000 fine and between a maximum of 15 years (Paula Jones) to 170 years (Dr. Shelton Barnes). The other sentences fall within the range of the aforementioned two.

Medicare fraud has been a serious problem in the United States, which cannot afford to pay out funds for services that were either never rendered or were unnecessary. A new reimbursement model has been implemented for home health care payments, in part to make it more difficult to fraudulently bill Medicare for unneeded services.

As in any other industry, there are a vast majority of companies that do not break the law and actually provide much needed services at a far lower cost than at an in-patient setting. The quality of this care varies, but is tracked by Medicare's "Home Health Compare," which rates and evaluates home health agencies' quality of care using dozens of categories, and comparing each company's score/rating to both the state and national average. There are also highly-reputable private organizations that evaluate home health companies such as Joint Commission.

Between Medicare's "Home Health Compare," knowing whether or not a home care agency is Joint Commission accredited and knowing the answers to a dozen or so questions can help one determine whether an agency is legitimate and if so, how their quality of care ranks compared with other agencies within the area. A good list of questions to ask when choosing a home care provider can be found here: http://eganhealthcare.com/2017/05/questions-to-ask-when-choosing-a-home-health-or-hospice-provider/.

The New Orleans-based agency Abide Home Care does not appear to still be in business. A Google search did reveal a home care company operating by that name, however that company is based in the United Kingdom and appears to have to ties to the New Orleans-based company.

For the record, there is a company in the United Kingdom that goes by the same exact name as the Abide Home Care Services described in this article, however the two companies are in no way related.

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