Thursday, April 14, 2011

Houston RN Pleads Guilty ($5.2 Million Medicare fraud scheme--false enrollment)

A registered nurse employed by a Houston health care company pleaded guilty today in connection with an alleged $5.2 million Medicare fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).
Adelma Casas Sevilla, 54, pleaded guilty before U.S. District Court Judge Nancy Atlas in Houston to one count of conspiracy to commit health care fraud.  According to court documents, Family Healthcare Group, a home health care company, purported to provide skilled nursing to Medicare beneficiaries.  According to court documents, Family Group hired co-conspirators to recruit Medicare beneficiaries for the purpose of filing claims with Medicare for skilled nursing that was medically unnecessary and/or not provided.  After the Medicare beneficiaries were recruited, Casas Sevilla, in her capacity as a registered nurse, fraudulently signed plans of care stating that the beneficiaries needed home health care when in fact she knew the beneficiaries were not home-bound and not in need of skilled nursing.
Comment:  "false enrollment" is one of easiest forms of health care fraud to commit.  The system merely relies upon the honesty of the provider who intakes the prospective "patient."  Most, but not, all providers are honest. 

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