Zenia Chavez, 45, owner of El Paso, Texas-based Nursemind Home Health, which providers hospice care, has been arrested on fraud and kickback charges. Her nephew and Nursemind employee Raul Alejandro Fuentes, 23, was also arrested in connection with the scheme.
According to the U.S. Department of Justice, Chavez and Fuentes enrolled patients into Nursemind’s hospice program who did not have a terminal illness or were otherwise ineligible for the benefit. Chavez is also charged with offering kickbacks for patient referrals to Nursemind.
“The defendants sought out people in boarding homes and senior living facilities for enrollment in a Nursemind hospice program although they did not need hospice care or have a terminal illness,” the Justice Department alleged in a statement. “The defendants then created false and fraudulent medical records for the individuals, forged health personnel signatures, and submitted fraudulent claims to Medicare.”
The FBI and the U.S. Department of Health & Human Services Office of the Inspector General (OIG) investigated the case. Both of those agencies in recent years have increasingly scrutinized hospice providers for compliance with anti-fraud measures. Many organizations have come under legal and regulatory attention related to medical necessity complaints under the False Claims Act.
FCA cases often hinge on the question of whether live discharges from hospice care were the result of deliberate fraud or occurred because of the inherent difficulty of predicting a patient’s life expectancy.
A report from Bass, Barry, and Sims shows that a leading cause of fraud involves hospices billing Medicare for services for which patients were not eligible. This resulted in several multi-million dollar settlements during 2020, with amounts ranging from $1 million to $5.25 million.
Chavez and Fuentes are each charged with one count of conspiracy to commit health care fraud and 14 counts of health care fraud. Chavez is also charged with one count of conspiracy for illegal remunerations regarding a federal health care program and 11 counts of illegal remunerations regarding a federal health care program.
Assistant U.S. Attorneys Chris Skillern and Debra Kanof are prosecuting the case. The two defendants face as many as 10 years in prison if convicted of the fraud charges. Chavez could see an additional five years for the kickback charges.