FLORIDA — A Miami resident who owned a home health care company and was the administrator of another home health care company pleaded guilty Wednesday for her participation in a $74 million Medicare fraud scheme, federal officials said.
Elsa Ruiz, 45, plead guilty in U.S. District Court to one count of conspiracy to commit health care fraud. Her sentencing is scheduled for Oct. 8.
From about January 2006 to June 2012, LTC Professional Consultants Inc. and Professional Home Care Solutions Inc. submitted approximately $74 million in claims for home health care services that were not medically necessary and/or not provided, and Medicare paid approximately $45 million on those claims.
According to court documents, Ruiz was an owner of Professional Home Care and an administrator of LTC, Miami home health care agencies that purported to provide home health and therapy services to Medicare beneficiaries.
Ruiz and her co-conspirators operated LTC and Professional Home Care for the purpose of billing the Medicare program for, among other things, expensive physical therapy and home health care services that were not medically necessary and/or were not provided.
Also according to court documents, Ruiz ran and oversaw the schemes operating out of LTC and Professional Home Care.
Ruiz and co-conspirators paid kickbacks and bribes to patient recruiters, who provided patients to LTC and Professional Home Care along with prescriptions, plans of care and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries.
Ruiz and her co-conspirators used these prescriptions, plans of care and medical certifications to fraudulently bill the Medicare program for unnecessary home health care and therapy services.