The clinical director of a Massachusetts home nursing agency, along with the agency's co-conspiring owner and doctor who served as the agency's medical director, have been sentenced in U.S. District Court in Boston for healthcare fraud and other charges in a multi-million dollar Medicare fraud scheme, the FBI and U.S. Attorney's office announced in a Dec. 22 statement.
According to the FBI, Janie Troisi, 66, of Revere, Massachusetts is a registered nurse and was the clinical director of At Home Visiting Nurse Association. She has been sentenced to three years in prison and three years of supervised release after being convicted of conspiracy to commit healthcare fraud and 10 counts of healthcare fraud.
Her co-conspirator Michael Galatis, who owned the agency and is also a registered nurse, was convicted of conspiracy to commit healthcare fraud, as well as 10 counts of healthcare fraud and seven counts of money laundering. He was sentenced in February to a little more than seven-and-a-half years in prison.
Dr. Spencer Wilking, At Home's in-house medical director, pleaded guilty to healthcare fraud and was sentenced to one year of home confinement and fined $7,500.
Authorities said the scheme spanned three years, from 2009 to 2012, during which time Troisi and her co-conspirators ignored a Medicare requirement whereby home health care is only covered under particular conditions, including that a physician has certified that the patient is homebound and requires skilled services.
Authorities say Troisi ignored that requirement, and trained AHVNA nurses to recruit healthy people with Medicare coverage who lived in "large apartment buildings" where she would then hold "wellness clinics." Troisi and her nurses convinced senior citizens to sign up with AHVNA to have a nurse visit them in their homes.
Furthermore, Troisi and Galatis trained their nurses to alter the patient's Medicare assessment forms so that it appeared the patient qualified for home health services, when frequently they did not, the FBI and U.S. Attorney's Office said.
Troisi and Galatis worked with Dr. Wilking, who was paid to sign the home health care orders, despite never having examined most of AHVNA's patients. In 2011, Medicare enacted a new requirement that a physician must certify that a face-to-face visit with a patient took place prior to home health care. Even so, Dr. Wilking continued to sign home health orders without examining patients and Troisi continued to "cause the submission" of millions of dollars in false claims to Medicare, said the FBI and U.S. Attorney's Office.
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Authorities said the illegal operation was raising red flags along the way. A number of primary care physicians who had not referred their patients for home health services with AHVNA and were unaware nurses were visiting their patients at home, complained to Troisi once they found out. However, she ignored their complaints, authorities said.
Additionally, some of the agency's nurses themselves told Troisi some patients did not require home health services. But the FBI and U.S. Attorney's office said Troisi would not discharge these patients and continued to cause Medicare to be billed fraudulently.
All told, $27 million in false claims were submitted to Medicare over the course of the scheme, according to the Department of Justice.
Twitter: @BethJSanborn