By Christina Jewett
A Southern California doctor has been sentenced to a year in prison after pleading guilty to accepting $30,000 in kickbacks to fabricate Medicare claims for home health care services for seniors.
The sentencing of Dr. Whan Sil "Victoria" Kim of Hancock Park last week is the latest in a series of prosecutions targeting the Los Angeles Greatcare Home Health clinic, which the prosecutor in the case says was "almost a wholly fraudulent endeavor."
Greatcare's owner, Hee Jung "Angela" Mun, a nurse, pleaded guilty to orchestrating the scam. Her plea says the clinic bribed Medicare patients to sign up for home care they didn't need and paid doctors to document $5 million worth of care, much of which was not provided.
The case is one in a growing number of fraud cases exploiting Medicare's home health care program, which is meant to pay for skilled nursing or physical therapy for homebound seniors. In 2010, Medicare spent $19.5 billion on care rendered by more than 11,000 certified home health care agencies.
Authorities learned of the case when the receptionist at Greatcare's Westlake-area clinic exposed the operation.
Whistle-blower Misha Kim "felt she was going to go to prison unless she reported it," said Philip Cohen, the attorney representing her. "It was so blatant, it was almost a joke."
Cohen's civil whistle-blower case entitles Misha Kim, who is not related to Victoria Kim, to thousands of dollars recovered under laws that reward insiders who come forward to expose fraud against the government. The civil case is proceeding in federal court as the U.S. Department of Justice pursues criminal charges against Mun and other nurses and doctors accused of defrauding Medicare.
Mun, who is expected to be sentenced in March, signed a guilty plea that outlines the scheme. She paid Medicare patients $300 each to sign documentation used as proof that they needed home health care. Doctors got $100 to $300 per patient to fabricate medical files claiming that patients needed home health care, according to court documents.
Attorneys for Mun and Victoria Kim could not be reached for comment. Victoria Kim filed a reply to the civil whistle-blower lawsuit in April, denying the allegations and saying her actions were reasonable, proper and legal.
Documents show Greatcare Home Health employed nurses, but they mainly handled paperwork; unlicensed staff performed some home visits to patients, even though they were not qualified to render care reimbursed by Medicare.
Greatcare staff entered exaggerated or false information into a Medicare billing system, reaping $5 million in payments from 2008 to 2011, documents show.
Kristen A. Williams, an assistant U.S. attorney on the case, said patients who participate in fraud expose themselves to potential identity theft. She said some health care fraudsters sell patients' personal information to others. She also said patients could be injured if they submit to treatment from unqualified staff.
"Many times, beneficiaries chosen (to be part of fraud) don't speak English well, they're not familiar with the Medicare system or they don't understand how the system is supposed to work," Williams said. "They wind up being used in ways that aren't appropriate at all."
Prosecutors around the U.S. have gone after home health care operators suspected of fraud.
In October, U.S. Attorney General Eric Holder announced the arrest of a Dallas-area physician accused of signing off on about $100 million in false or unneeded claims for home health care, some purportedly completed while he was traveling overseas. That doctor, Dr. Joseph Megwa, 58, was indicted on charges of conspiracy and health fraud.
This week, two owners of Miami home health care agencies pleaded guilty to a $48 million fraud scheme. Rogelio Rodriguez, 43, and Raymond Aday, 48, paid recruiters to send patients to Caring Nurse Home Health Corp. and Good Quality Home Health Inc. Prosecutors said nurses and other staff at the agencies falsified patient files to make it appear as though they needed home health care services.
In August, the U.S. Department of Health and Human Services' inspector general reported that Medicare spent $5 million in 2010 on home health care bills [PDF] submitted for times when patients were in a hospital or nursing home or after the patient's death.
The report showed California ranked third among states with the most home health care agencies with questionable billing, behind Texas and Florida. The report says 281 California firms reported unusually high billing amounts or numbers of home health visits in 2010.
The inspector general recommended that Medicare increase monitoring of home health care agency payments.