By JOSEPH G. LARIOSA
CHICAGO (JGL) – A Filipina nurse who owned a suburban Schaumburg, Illinois home health company was sentenced last July 26 to six years in prison for scheming to bill Medicare millions of dollars in unnecessary services.
Diana Jocelyn Gumila, 47, manager of Suburban Home Physicians, which did business as Doctor at Home, directed employees to perform in-home visits with patients who were physically capable of leaving their residences and did not need in-home treatment.
Gumila also inflated the costs incurred by Medicare by directing employees to bill the treatment at the most complicated levels, even though the visits were typically routine and did not qualify for the elevated billing.
The case has been described by investigators as the “symbiotic and incestuous relationship that has developed in Cook County between certain home health agencies and the doctors that allow Medicare fraud to flourish.”
A jury in April convicted Gumila, 47, of Streamwood, Illinois, on 21 counts of health care fraud and three counts of making false statements in a health care matter. In addition to the 72-month sentence, U.S. District Judge Charles P. Kocoras ordered the defendant to pay $15.6 million in restitution.
But on the day the sentence was being handed down by Judge Kocoras, the counsel of the whistle blowers, who stood as complainants in a separate civil suit, was surprised to learn that Gumila was a “mere employee” of two co-accused doctors, whose case was being dismissed for “insufficient admissible evidence.”
The counsel for the whistle blowers also called Relators in a motion asked Judge Kocoras to provide him copy of a letter previously under seal by Gumila addressed to the Court that “Defendants Naimish and Prashant Patel as the co-owners-in-fact of a corporation (Doctor at Home) that was the principal malefactor in the subject scheme to defraud Medicare.”
The Relators are Albert Young, Physician Assistant; Teresa Dedina, L.P.N., Vianka Calderon and D’Andre Hooks-Czapansky.
Aside from making the letter a matter of public record, Gumila’s lawyer also argued for a lesser sentence because she was “merely a salaried employee of Defendant Doctor At Home whereas Defendants Naimish and Prashant Patel, along with Jerry Gumila, were the true owners of Doctor At Home and therefore made most of the money (the Patels making even more due to their financial investment in the enterprise).”
The whistle blowers are now seeking additional time in a related civil case they filed against the same defendants and others “to procure the subject letter by Gumila from this Honorable Court so that the full extent of her admissions regarding Naimish and Prashant Patel’s involvement in Doctor at Home can be utilized in responding to their motion to dismiss” prior to the ruling on their motion to dismiss.
The other defendants in the civil case include Home Life Healthcare Corp., Medex Home Healthcare Incorporated, Medex Home Services Agency, Inc., Nelson K. Hodogbey, Physicians Preferred Home Care, Inc., Felicia Hayes, Tosheta Brown Greenfield, Comet Home Healthcare, Inc., Miranda Home Healthcare, Inc., Vivian Nwakah, Jessica Nwakah, Christopher Theopilus aka Christopher Nwakah, A & Z Home Health Care, Inc., Felix I Omorogbe, Patricia Omorogbe, Bestmed-Care Services, Ltd., Adonis, Inc., Akpevwe S. Olidge Pro Vita Home Care, LLC, Elmerson Villa, Felicito Sugay, Maria Alferez, Christeen Rosales, Rodel Bugayong, Govvas Health Care Services, Inc., Valentine Akpata and Gloria Akpata.
“Home-health fraud has become a significant problem nationally and particularly in the Chicago area,” Assistant U.S. Attorney Stephen Chahn Lee argued in the government’s sentencing memorandum. “Such fraud cannot happen without people like defendant, who abuse Medicare’s rules and abuse the trust placed in them by Medicare and their patients.”
Gumila is one of several defendants convicted in the federal investigation of Doctor at Home. The prior convictions include ALAN NEWMAN, a physician from Chicago, and JAMES ADEMIJU, a nurse from Matteson, Illinois who operated two nursing agencies. In a plea agreement, Newman admitted falsely certifying patients for nursing services even when he knew the patients did not need such care. Newman admitted causing approximately $2.6 million in losses to Medicare, according to his plea agreement. Ademiju pleaded guilty to billing for unnecessary services that were improperly authorized by physicians from Doctor at Home, and he acknowledged making illegal payments for patient referrals.
Evidence presented at Gumila’s two-week trial included a surreptitious audio recording in which Gumila can be heard telling a new doctor to “paint the picture” of patients so as to make them appear confined to their homes. Emails from Gumila were also shown to the jury, including one in which she referred to a physician who did not read orders before signing them as “the type of doctor we need [b]ecause he will just do what we tell him to do.”
Gumila’s conviction was announced by Zachary T. Fardon, United States Attorney for the Northern District of Illinois; Lamont Pugh III, Special Agent-in-Charge of the Chicago Region of the U.S. Department of Health and Human Services Office of Inspector General; Michael J. Anderson, Special Agent-in-Charge of the Chicago Office of the Federal Bureau of Investigation; and Kristie Osswald, Special Agent-in-Charge of the Chicago Office of the Railroad Retir,ement Board Office of the Inspector General.
The investigation was carried out by the Medicare Fraud Strike Force, which is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Justice Department and the U.S. Department of Health and Human Services to prevent fraud and to enforce anti-fraud laws around the country. Dozens of defendants have been charged in numerous fraud cases since the strike force began operating in Chicago in 2011.
The government is represented by Mr. Lee and Assistant U.S. Attorney Vikas Didwania.