Health Care Fraud: Texas Hospice CEO Gets 15 Years Jail Time; Florida Businesswoman Faces 13 Years Prison Sentence

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The CEO of Merida Group, a health care company operating dozens of hospice, nursing homes, and group homes in Texas, was sentenced to 15 years in prison for committing health care fraud and money laundering scheme, according to the U.S. Department of Justice (DOJ).

In Flordia, the Justice Department said a businesswoman pleaded guilty to criminal health care fraud and tax fraud and is facing a maximum penalty of 13 years in federal prison.

Merida Group CEO Henry McInnis supervised a  $154 million health care fraud

In November 2019, Merida Group CEO Henry McInnis was convicted by a federal jury of six counts of health care fraud. The jury also found him guilty of one count each of conspiracy to commit health care fraud, conspiracy to commit money laundering, and obstruction of justice.

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Rodney Mesquias, the owner of Merida Group, was also convicted of six counts of health care fraud. He was also found guilty of one count each of conspiracy to commit health care fraud, conspiracy to commit money laundering, conspiracy to pay and receive kickbacks, and obstruction of justice.

The jury convicted Merida Group’s medical director Francisco Pena of one count of health care fraud, obstruction of health care investigations,  one count of false statements,  and one count of conspiracy to pay and receive kickbacks.

In December 2020, Mesquias was sentenced to 240 months or 20 years in prison. Pena is awaiting sentencing.

In a statement, the DOJ’s Criminal Division Acting Attorney General Nicholas McQuaid, said McInnis directly supervised the “reprehensible criminal scheme” involving the submission of more than $150 million in fraudulent bills, falsification of patients’ medical records, and payment of kickbacks.”

McQuaid added, “McInnis preyed upon some of the most vulnerable members of our society, including many who suffered from diminished mental capacity and who were falsely and cruelly told by co-conspirators that they had only months to live. Today’s significant sentence demonstrates the department’s continued commitment to pursuing individuals, at all levels of corporate management, who engage in criminal schemes that prioritize profits over patient care.”

On the other hand, FBO San Antonio Field Office Special Agent in Charge Miranda Bennett said, “McInnis and his co-conspirator’s reprehensible and deceitful actions to defraud Medicare weren’t without harm:  vulnerable beneficiaries were unnecessarily enrolled in hospice care, preventing them from accessing needed curative care.”

Florida businesswoman Kelly Wolfe pleads guilty, agrees to pay $20.3 million

Meanwhile, Kelly Wolfe, a businesswoman in Largo, Florida, pleaded guilty to conspiracy to commit health care fraud and filing a false tax return. She is facing a maximum penalty of 13 years in federal prison.

Wolfe is the owner and operator of Regency Inc., durable medical equipment (DME) billing and consulting company.

The Justice Department filed a lawsuit against Wolfe and her co-conspirator used Regency to create dozens of DME supply companies as fronts. They placed the DME fronts in the names of straw owners.

By concealing their true ownership, Wolfe and her co-conspirators collectively submitted more than $400 million in illegal DME claims to Medicare and the Civilian Health and Medical Program of the Veterans Affairs (VA).

Wolfe admitted that she purchased numerous personal items and services using Regency’s funds and falsely declared them as business expenditures for the tax year 2017.

Wold and her company reached a civil settlement with the Justice Department and agreed to pay up to $20,332, 516 to resolve allegations that they violated the False Claims Act.

In a statement, DOJ Civil Division Acting Assistant Attorney General Brian Boynton said, “The department is committed to ensuring that federal health care program providers do not place their own financial gain over patients’ clinical needs. When medical professionals and companies knowingly commit fraud to maximize their profits, we will hold them accountable for their unlawful conduct.”

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