8 Nurses Heading to Prison for Medicare Fraud

Eight Miami-area nurses were sentenced to prison and ordered to pay hundreds of thousands of dollars in restitution after pleading guilty to their role in an $18.7 million Medicare home healthcare fraud scheme, the Department of Justice said.

The nurses were originally indicted in July 2010, along with Jorge Dieppa, MD, who awaits trial on charges of healthcare fraud, and making false statements related to Medicare payments.

According to prosecutors, the Miami-based healthcare agencies ABC Home Health Inc. and Florida Home Health Care Providers Inc. were owned by the nurses, and allegedly referred Medicare beneficiaries to Dieppa for prescriptions, medical certifications and care plans for therapy and home health services. ABC and Florida Home Health billed Medicare $18.7 million for services that were either medically unnecessary or never provided. 

The eight nurses each previously pleaded guilty to one count of conspiracy to commit healthcare fraud and were sentenced in US District Court:

• • • Diana Sanabia, 36, RN, was sentenced to 30 months in prison, three years of supervised release and ordered to pay $594,000 in restitution;
    • Daisy Santos, 43, RN, was sentenced to 30 months in prison, three years of supervised release and ordered to pay $699,000;
    • Roberto Rodriguez, 44, RN, was sentenced to 30 months, three years of supervised release and ordered to pay $603,900;
    • Marlene Magadan, 36, RN, was sentenced to 24 months, three years of supervised release and ordered to pay $334,200;
    • Maria Perez, 49, RN, was sentenced to 18 months, three years of supervised release and ordered to pay $180,600;
    • Alberto Alvarez, 55, RN, was sentenced to 15 months, three years of supervised release and ordered to pay $101,800;
    • Yanisley Chao, 32, LPN, was sentenced to 5 months, two years of supervised release and ordered to pay $66,800;
    • Leonardo Malagon, 40, LPN, was sentenced to 5 months, two years of supervised release and ordered to pay $65,900.

 According to plea documents, Perez and Chao worked for Florida Home Health; Santos, Magadan and Malagon worked for ABC; and Sanabia, Rodriguez and Alvarez worked for both ABC and Florida Home Health. They falsified patient files for Medicare beneficiaries to make it appear that the beneficiaries qualified for services from Florida Home Health or ABC that were prescribed by Dieppa. In fact, the nurses knew that the services were not medically necessary and /or were not rendered, DOJ said.

Sanabia and Santos also recruited Medicare beneficiaries for the agencies and received kickbacks for the recruitments, even though the pair knew that the beneficiaries they recruited did not qualify for the home health services, DOJ said.

Co-defendant Alfredo Zayas, 76, a Medicare beneficiary who pleaded guilty to one count of conspiracy to commit healthcare fraud, was also sentenced to two years of probation. Zayas solicited and accepted kickbacks and bribes for allowing his Medicare number to be used to bill Medicare for the bogus treatments, DOJ said.

Sanabia, Santos, Magadan, Perez, Rodriguez, Alvarez, Chao, Malagon and Zayas were responsible for fraudulently billing to Medicare the following approximate amounts, respectively: $594,000, $699,000, $381,100, $180,600, $603,900, $101,800, $66,800, $65,900 and $23,800, DOJ said.

The sentences were imposed by U.S. District Court Judge Ursula Ungaro in Miami.

Since their inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 850 individuals who collectively have falsely billed the Medicare program for more than $2.1 billion, DOJ said. 

OIG recently posted a 'Most Wanted' list of Medicare fraudsters.