https://www.law360.com/articles/873613/more-nurses-plead-guilty-in-45m-medicare-fraud-scheme
Registered nurses Mary Mendoza and Ronald Malalis, along with office manager Janet Guerrero entered plea bargains in the alleged scheme run by the owners of Lincolnwood-based Pathways Home Health Services LLC, Donnarich Home Health Care Inc. and Josdan Home Health Care Inc. The owners of the three home health companies, Josephine, Richard and Maribel Tinimbang, are the alleged ringleaders, with help from staff.
In their time participating in the Tinimbangs’ scheme, Mendoza and Malalis allegedly made patients out to be sicker than they were, in order to gain a higher payout from the Medicare program. The nurses allegedly falsified patient care paperwork known as the Outcome and Assessment Information Set, or OASIS form.
“Defendant understood that the sicker the patient appeared to be on the OASIS form, the more the company was paid by Medicare,” Malalis’ plea bargain said. “Defendant also understood the patients he assessed were insured by Medicare, and that such patients were only eligible for home health care if they were homebound. Yet most of the beneficiaries defendant and others enrolled in home health care at Josdan and Pathways were not homebound.”
Mendoza’s plea bargain is similar, admitting she learned how to fraudulently fill out OASIS forms from a supervisor named Monette Mojares and an unnamed person referred to as “Supervisor B.”
“Defendant acknowledges that over the course of approximately two and a half years as a start-of-care nurse, defendant certified non-homebound beneficiaries for home health care more than 150 times, causing Medicare to pay Pathways more than $400,000 but not more than $500,000,” according to the Mendoza’s plea. Malalis’ plea included a similar statistic.
Both Mendoza and Malalis allegedly were pressured to fill out OASIS forms incorrectly in sweeping fashions, prescribing one ailment to many patients.
“Defendant’s supervisors told him to mark all women as incontinent because women have babies,” Malalis’ plea deal said. “Defendant’s supervisors also told him that he should not state on OASIS forms that a beneficiary had scores of ‘zero,’ indicating an ability to independently complete daily activities like walking.”
Both Malalis’ and Mendoza’s plea deals carry a maximum sentence of 10 years in prison and a top fine of $250,000.
In the case of Janet Guerrero, Thursday’s plea said Guerrero acknowledged that during her time as office manager of Josdan, she enrolled patients in home care services they did not need at the instruction of Josephine Tinimbang. Guerrero would aggressively contact Medicare beneficiaries who were referred to Donnarich and Josdan, according to her plea.
“The beneficiaries Guerrero spoke with often refused services or told her that they were driving, working, or otherwise able to leave the home regularly and without difficulty,” Guerrero’s plea said. “However, Guerrero was supervised by Josephine Tinimbang, and Tinimbang did not accept that beneficiaries who did not want, need, or qualify for services should not be enrolled. Tinimbang insisted that Guerrero and others make repeated attempts to persuade unqualified beneficiaries to accept the companies’ services, and Guerrero in fact did so.”
In total, 15 people who worked at or with the three companies were indicted as part of a wider crackdown by the Medicare Fraud Strike Force that the government announced in 2015 had swept up 243 individuals in 17 federal districts for Medicare fraud totaling $712 million.
The three Tinimbangs are scheduled to be tried in February, while some of the other Tinimbang health care agencies’ defendants have been given a September trial date. To date, four registered nurses and a president of one of the recruitment companies that sent patients to the agencies have also pled guilty.
Representatives from no parties could be reached for comment on Friday.
Mendoza is represented by Michael Falconer, attorney at law.
Malalis is represented by Gal Pissetzky of Pissetzky & Berliner and Michael Schmiege of the Law Offices of Michael P. Schmiege PC.
Guerrero is represented by MiAngel C. Cody of the Federal Defender Program.
The government is represented by Assistant U.S. Attorney Brooke Harper.
The case is USA v. Tinimbang, et al., case number 1:14-cr-00732, in the U.S. District Court for the Northern District of Illinois.
— Additional reporting by Diana Novak Jones and John Kennedy. Editing by Ben Guilfoy.
More Fraud Charges Added Over $45M Home Health Scheme
Four more counts of health care fraud have been added to the charges faced by a Chicago couple and others who allegedly paid doctors kickbacks in a $45 million scheme to falsely certify that Medicare beneficiaries needed in-home physical therapy, according to a fourth superseding indictment filed Thursday in Illinois federal court.
Alleged Leader Of $45M Medicare Fraud Blames ‘Dictator’ Mom
One of the alleged ringleaders of a $45 million scheme to defraud Medicare is pinning the blame for the operation on his fugitive mother, who was accused at the opening of an Illinois federal trial Monday of being a “dictator” who left her son at the mercy of federal prosecutors.
Home Health Care Exec Cops To Role In $45M Fraud
The former director of nursing of a home health company caught up in a massive $45 million fraud scheme pled guilty Monday to falsifying medical records to make it appear as if Medicare patients were homebound when they were not.
Chicago Couple Charged In $45M Medicare, H-1B Visa Frauds
A Chicago couple has been charged with paying doctors kickbacks in a $45 million scheme to falsely certify Medicare beneficiaries needing in-home physical therapy and lying to get an H-1B visa for a Filipino woman they forced to work as their maid, federal prosecutors said Monday.
Latest News
HHS Asks Justices Not To Review Medicare Billing Suit
The government has urged the U.S. Supreme Court to reject a bid for review of a determination that a Florida ophthalmology clinic connected to criminal charges against U.S. Sen. Robert Menendez, D-N.J., overbilled Medicare by nearly $9 million by extracting multiple doses of a macular degeneration drug from a single-dose vial.
16 Texans Charged In $60M Medicare Fraud Scheme
Sixteen Texas residents were charged with participating in a $60 million Medicare fraud scheme that involved improperly putting patients into hospice care and giving some of them unnecessary doses of morphine and other drugs, the U.S. Department of Justice announced Tuesday.
Alleged Leader Of $45M Medicare Fraud Blames ‘Dictator’ Mom
One of the alleged ringleaders of a $45 million scheme to defraud Medicare is pinning the blame for the operation on his fugitive mother, who was accused at the opening of an Illinois federal trial Monday of being a “dictator” who left her son at the mercy of federal prosecutors.
Feds Blast Drug Return Co.’s ‘Puffery’ Defense In $116M Fraud
Statements from Guaranteed Returns’ promotional materials used while the company allegedly stole $116 million in refunds from pharmaceutical manufacturers can show it engaged in fraud and are not simply “puffery,” Pennsylvania federal prosecutors argued Monday.
1st Circ. Affirms Conviction In $19.9M Mass. Medicare Fraud
The director of clinical services at a Massachusetts home health services agency knew that she was assisting a $19.9 million Medicare fraud by falsifying paperwork to make patients wrongly seem eligible for services, the First Circuit affirmed Friday.
Ex-Clinic Owner Given 5 Years In $70M Medicare Scheme
The co-owner of three New York health clinics was sentenced in a New York federal court on Friday to five years in prison for running a $70 million Medicare and Medicaid fraud in which he paid indigent people to undergo unnecessary medical tests and then billed the government.
South Texas Woman Convicted In $2.5M Medicaid Fraud
A federal jury convicted a woman who formerly operated a durable medical equipment company in McAllen, Texas, on all 18 counts of defrauding Medicaid through $2.5 million in fraudulent billing for incontinence supplies, the U.S. Department of Justice announced on Friday.
Medical Supply Co. Owner Gets 27 Years In $3.5M Fraud
A 55-year-old man who was involved in a $3.5 million scheme to defraud Medicare and Medicaid by filing false claims for powered wheelchairs and scooters was sentenced Thursday in San Antonio, Texas, to 27 years in prison, the U.S. Department of Justice announced.
‘Puffery’ Isn’t Fraud, Says Drug Return Co. In $116M Case
Guaranteed Returns on Wednesday urged a Pennsylvania federal court to tell a jury that puffery or sales talk is not fraud, in the midst of a trial alleging that the company — which helps the government and providers return expired drugs — stole $116 million worth of refunds from pharmaceutical manufacturers.
Gov’t Fights Health Care Cos.’ Evidence In $45M Fraud Case
Fraud in Chicago’s home health industry is so widespread that executives accused of a $45 million Medicare fraud shouldn’t be able to present a jury with examples of other companies’ billing practices, the federal government said Wednesday.
Clinic Manager Cops To Role In $70M Medicare Fraud Scheme
The manager of two New York health care clinics pled guilty Monday to taking part in a $70 million scheme to defraud Medicare and Medicaid by paying beneficiaries to undergo medically unnecessary tests for which the clinics could then bill the government.
The Missing Key To 3rd-Party Litigation Funding
Unlike other forms of commerce and unlike in other nations, litigation investment and funding in the U.S. is largely unregulated with few disclosure requirements. Where darkness exists, ignorance and mistrust breed. Disclosure and transparency in litigation investment and funding is the first and proper step to better understand this opaque dynamic in the U.S. civil justice system, says Tripp Haston of Bradley Arant Boult Cummings LLP.
Ex-Chicago Contractor Pays $20M To End Bribery Suit
Chicago Mayor Rahm Emanuel said Monday that a former city contractor will pay $20 million to end claims it paid bribes to secure $126 million in contracts to install red-light cameras at city intersections, allegations that sent a former official and the company’s onetime CEO to jail.
MaryGSykes.com 
Reblogged this on Justice for Everyone Blog.
Wow! “Mark all women as incontinent because all women have babies???” I can’t begin to state how many things are wrong with that statement! I believe that everyone at http://www.byrdadatto.com/ would agree.
Thanks for the comment. That’s how corruption works. All the elderly need hospice and until then all women are incontinent and need more services. It’s nothing but fraud, waste and mismanagement. Why does it take the US govt years to prosecute tho?