Provider of Home Health Care Services Sentenced for Medicaid Fraud

NORFOLK, VA—Janice W. Holland, 42, of Suffolk, Virginia, was sentenced today to 51 months in prison for health care fraud and alteration of records and a mandatory consecutive sentence of 24 months in prison for aggravated identity theft, for a total sentence of 75 months. She was also ordered to pay restitution to the Virginia Medicaid program in the amount of $630,339.30.
Neil H. MacBride, United States Attorney for the Eastern District of Virginia, and Virginia Attorney General Ken Cuccinelli made the announcement after sentencing by Senior United States District Judge Robert G. Doumar.
Holland pled guilty on September 18, 2012. According to court documents, Holland owned and operated A Caring Hand Home Health Care Services Inc., a business located in Suffolk that was authorized to provide respite care to Medicaid recipients. Respite care is designed to provide temporary, substitute care for a Medicaid recipient that is normally provided by the family or another unpaid primary caregiver of the recipient. These services are provided on a short-term basis because of the emergency absence or need for routine or periodic relief of the primary caregiver. Between January 2008 and October 2011, Holland filed approximately 939 false and fraudulent claims with the Virginia Medicaid program, representing that respite care had been provided by her company to 30 Medicaid recipients, when, in fact, no such care had been provided. She filed these claims using, without authority, the recipients’ names, dates of birth,and Medicaid identification numbers. As a result, Holland obtained health care benefit payments in the approximate amount of $630,339.30, to which she was not entitled. She also altered and falsified her office records to conceal and cover up her false billings.
This case was investigated by the FBI and the Office of the Virginia Attorney General, Medicaid Fraud Control Unit. Assistant United States Attorney Alan M. Salsbury and Special Assistant United States Attorney David W. Tooker prosecuted the case on behalf of the United States.
A copy of this press release may be found on the website of the United States Attorney’s Office for the Eastern District of Virginia at http://www.justice.gov/usao/vae.

Home Health Care Agency Operator Charged with Health Care Fraud

MINNEAPOLIS—Yesterday in federal court, the operator of Lucky Home Health Care Inc., a home health care agency in Minneapolis, was charged with defrauding Medicaid. On January 8, 2013, Abshir Mohammed Ahmed, age 40, of Minneapolis, was charged via an information with one count of health care fraud.
Allegedly, from January 2008 through June 2011, Ahmed defrauded Medicaid, a federal health care benefit program, out of more than $400,000 by submitting fraudulent billings. Ahmed submitted claims that falsely represented that home health care services were purportedly provided by identified Personal Care Assistants (PCA) that were not, in fact, provided by those PCAs.
For example, a claim for reimbursement submitted on July 16, 2009, billed Medicaid $1,330.56 for PCA services allegedly, but not actually, provided by the identified PCA.
The Medicaid program provides medical care and services to low-income people who meet certain income and eligibility requirements. Home health care, provided by PCAs, is one of the services reimbursed by Medicaid.
If convicted, Ahmed faces a potential maximum penalty of 10 years in federal prison. All sentences will be determined by a federal district court judge.
This case is the result of an investigation by the Federal Bureau of Investigation. It is being prosecuted by Assistant U.S. Attorney David M. Genrich.
The U.S. Attorney’s Office participates in a task force with the Medicaid Fraud Control Unit at the Minnesota Attorney General’s Office that focuses on home health care fraud trends. The task force includes the U.S. Department of Health and Human Services-Office of Inspector General, the FBI, the Internal Revenue Service, and other federal, state, and local law enforcement partners.
As a result of federal convictions for health care fraud, defendants are excluded from participating in federal health benefit programs, including Medicare and Medicaid. Exclusion determinations are made by the U.S. Department of Health and Human Services. Nationwide, more than 3,000 individuals were excluded from program participation in fiscal year 2010 based upon criminal convictions or patient abuse or neglect, license revocations, or other factors.
For more information, visit http://www.stopmedicarefraud.gov.
A defendant, of course, is presumed innocent until he or she pleads guilty or is proven guilty at trial.