Patient Recruiter Convicted Of Conspiracy To Commit Health Care Fraud

By: John A. Schwab

On September 15, 2010, Antonio Ochoa was convicted by a federal jury in the U.S. District Court of the Southern District of Florida of one count of conspiracy to commit health care fraud and three counts of soliciting and receiving kickbacks and bribes.  Mr. Ochoa was a home health patient recruiter for home health agencies, including ABC Home Health Inc. and Florida Home Health Care Providers, Inc., which provide physical therapy and home health services to Medicare beneficiaries.  According to evidence at trial, Mr. Ochoa received approximately $1,300 per Medicare beneficiary from the home health agencies who, in turn, billed Medicare on behalf of the beneficiaries which Mssrs. Ochoa and Romeo recruited.

Evidence also indicated that the services for which Medicare was billed were unnecessary and often never provided, including twice daily nursing visits for diabetic insulin injections as well as home health aide visits and therapy.  Mr. Ochoa faces a maximum of ten years in prison for the count of conspiracy to commit health care fraud and five years in prison for the three kickback counts. He is presently scheduled to be sentenced later this year before U.S. District Judge Adalberto Jordan in Miami.

The announcement of Mr. Ochoa’s conviction follows remarks made in August by Attorney General Eric Holder and U.S. Department of Health and Human Services Secretary Kathleen Sebelius at the Health Care Fraud Prevention Summit in Los Angeles.  Participants in the summit discussed innovative ways to eliminate fraud within the health care system and included law enforcement officials such as Assistant Attorney General Lanny A. Breuer of the Criminal Division and other consumer experts, providers, beneficiaries, and key government agencies.

“[O]ur health care system is under siege – exploited by criminals intent on lining their own pockets at the expense of American taxpayers, patients, and private insurers,” stated Attorney General Holder.  He also said, “[T]he Affordable Care Act provides new resources and includes tough penalties to help stop and prevent health care fraud.  We will continue to work vigorously with our law enforcement and private sector partners to punish those who steal from taxpayers, patients, seniors and other vulnerable Americans.”

Secretary Sebelius remarked, “The steps we are taking today provide us with additional tools to support our continuing efforts to reduce Medicare fraud by helping ensure that only appropriately qualified suppliers are enrolled in the program…. [T]here are those who look for any opportunity to take advantage of beneficiaries and Medicare, including sham operations that are not legitimate businesses.”

Both speakers focused on the Affordable Care Act which provides tools and resources to fight fraud in the health care system by providing an additional $350 million over the next ten years through the Health Care Fraud and Abuse Control Account.  As Attorney General Holder noted in his comments at the summit, anti-fraud efforts in FY 2009 returned $2.51 billion to the Medicare Trust Fund and over $441 million in Medicaid money returned to the U.S. Treasury.

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