The owner of an Illinois home healthcare company is facing conspiracy and fraud charges after being indicted in an alleged kickback scheme that defrauded Medicare for at least $450,000. Jacqueline Tuanqui, 53, the owner of Hexagram Home Health Care LLC, allegedly paid kickbacks to an outside marketer in exchange for elderly patient referrals for unecessary treatment funded by Medicare, the FBI said in a statement.
According to that statement, the scheme involved Tuanqui and Susie Avellanose, 57, who owns Elgin-based Allied Care Services, and started in November 2012 continuing until approximately April 2014. During that time, the defendants are said to have signed written contracts about their partnership, hoping to conceal their alleged operation. The contracts showed Avellanosa would refer a certain number of patients to Hexagram per month, but fraudulently stated she would be paid by the hour for her services, with no mention of any additional compensation.
The FBI said the alleged bribes were paid even though some of the elderly patients didn't qualify for the in-home treatment Tuanqui's company provided, and the hundreds of thousands of dollars in Medicare payments Hexagram received were for those treatments, all the result of kickbacks.
This latest indictment follows a trend in home healthcare fraud. In 2014, the Office of the Inspector General reporter that the federal government recovered $186 million in 2014 from civil fraud Medicaid cases involving home healthcare agencies. They also said home health care aides led the list of having the largest number of fraud convictions. Of the $1.9 billion in recovered that year in civil judgments and settlements, the largest single chunk, $186 million, was recovered from home health care agencies total, the OIG said.
Experts have commented that home health care is an industry that is tough to regulate because care is rendered in a person's home with much less official scrutiny, as opposed to care delivered in a typical healthcare facility.
Tuanqui and Avellanosa, have pleaded not guilty to conspiracy and fraud charges. The kickback and conspiracy charges are punishable by up to five years in prison and a $250 thousand fine. Their next court appearance is scheduled for January 28, 2016.