Five with Physician Home Visit and Health Care Companies in Dallas Plead Guilty in Health Care Fraud

[nitpicker]

https://www.justice.gov/usao-ndtx/pr/five-affiliated-physician-home-visit-and-health-care-companies-dallas-plead-guilty

Department of Justice
U.S. Attorney’s Office
Northern District of Texas

FOR IMMEDIATE RELEASE
Tuesday, November 29, 2016

Five Affiliated with Physician Home Visit and Health Care Companies in Dallas Plead Guilty in Health Care Fraud Conspiracy

Defendants Face up to 10 Years in Federal Prison

DALLAS – A Dallas woman who was among those charged last year as part of a nationwide sweep led by the Medicare Fraud Strike Force for her alleged participation in Medicare fraud schemes pleaded guilty today, announced U.S. Attorney John Parker of the Northern District of Texas.

Myrna S. Parcon, a/k/a “Merna Parcon,” 63, pleaded guilty to one count of conspiracy to commit health care fraud. She faces a statutory penalty of up to 10 years in federal prison and a fine of up to $250,000 or twice the pecuniary gain to the defendant or loss to the victim. Restitution may also be ordered. In addition, according to the plea agreement, she will be excluded from Medicare, Medicaid and all federal health care programs.

Last week, two of Parcon’s co-defendants, Oliva A. Padilla, 57, of Garland, Texas, and Ben P. Gaines, 56, of Plano, Texas, pleaded guilty to a conspiracy count, and each faces a maximum statutory penalty of five years in federal prison and a $250,000 fine.

Co-defendants Ransome N. Etindi, 56, of, Waxahachie, Texas, pleaded guilty earlier this year to conspiracy to commit health care fraud; he faces a maximum statutory penalty of 10 years in federal prison and a fine of up to $250,000 or twice the pecuniary gain to the defendant or loss to the victim. Lita S. Dejesus, 70, of Allen, Texas, pleaded guilty to a conspiracy count and faces a maximum statutory penalty of five years in federal prison and a $250,000 fine. The one defendant charged in the case who has not pleaded guilty, Noble U. Ezukanma, 57, a physician from Fort Worth, Texas, is set to go to trial in January 2017, before U.S. District Judge Jane J. Boyle.

According to documents filed in the case, from approximately January 2009 through June 9, 2013, Parcon and the other five defendants conspired to defraud Medicare by making materially false and fraudulent representations and promises in connection with health care services, namely physician house call visits and home health care.

Parcon owned US Physician Home Visits (USPHV) and managed its operations. USPHV, located on Viceroy Drive in Dallas, provided physician home visits to Medicare beneficiaries. It also certified and recertified Medicare beneficiaries for home health services, and it provided medication to Medicare beneficiaries. It became a credentialed Medicare provider in May 2009.
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Once USPHV established a new patient and Ezukanma, Etindi or others conducted a home visit, USPHV, at the direction of Ezukanma, Parcon and Dejesus submitted billings for fraudulent claims for services not rendered.

USPHV submitted claims as if Ezukanma provided the services to Medicare beneficiaries, regardless of who actually performed the service; this caused Medicare to pay a higher reimbursement rate. Then, beginning in January 2013, the majority of claims for USPHV were submitted as if Etindi provided the services, regardless of who actually did perform the services. Ezukanma, Parcon and Dejesus submitted reimbursement claims for physician home visits that falsely represented to Medicare that Ezukanma and Etindi conducted comprehensive patient exams and prolonged service patient exams, when they did not. At the defendants’ directions, the majority of the claims fraudulently claimed that Ezukanma or Etindi spent a minimum of 90 minutes of face-to-face time with a patient, when in fact, most visits took a total of 15-20 minutes.

Ezukanma and Etindi signed Medicare Form 485s certifying the Medicare beneficiaries for home health services even if the beneficiary was ineligible to receive the benefits. They also signed and certified Form 485s regardless of the homebound status of the patient and often without any knowledge of the patient or the patient’s medical condition.

More than 97% of USPHV’s Medicare patients received home health care – whether they needed it or not. As a result of these false Form 485 certifications, Medicare paid more than $40 million in fraudulent home health services.
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[KatyMan]

1. The real Medicare/caid fraud

in this country is done by doctors, providers and insurance companies rather than the people who actually use the services. Sad.