Tucson in-home care operators face Medicare fraud charges

Jan. 20--A federal grand jury has indicted the operators of a Tucson-based in-home health care company on charges of defrauding Medicare.

The indictment filed in U.S. District Court on Jan. 10 says Elvia Lorena Lamont and Stephen Allen Lamont, of Tucson-based Ascension In-Home Medical Care Nurse Practitioner's Group Inc., submitted false claims to Medicare between April 2011 through July 2015.

The couple's purpose was to "fraudulently and unlawfully enrich themselves with money under the custody and control" of the federal Medicare program, the indictment alleges.

The Lamonts say they are innocent.

They are facing 47 federal criminal counts related to Medicare billing, including an accusation that they forged the signatures of Medicare-approved physicians.

Medicare is a government health insurance plan for people over age 65, as well as for people younger than 65 with certain disabilities and people of all ages with end-stage renal disease. There were 1.13 million Arizonans --about 17 percent of the population -- enrolled in Medicare as of 2015, the Kaiser Family Foundation says.

The charges carry the possibility of prison time. Among other offenses, the couple is charged with 10 counts of aggravated identity theft, a charge that has a mandatory minimum federal prison sentence of two years.

They are also facing charges of health care fraud, conspiracy to commit health care fraud, and making false statements relating to a health care matter.

Open for business

The Lamonts are scheduled to be arraigned in federal court on Jan. 26.

The two maintain their innocence and continue to operate the business, their Scottsdale-based lawyer Michael Goldberg said last week.

The federal Centers for Medicare and Medicaid Services (CMS) doesn't revoke billing privileges based on an indictment -- a conviction in a felony case is required, spokesman Jack Cheevers said.

Ascension In-Home Medical Care Nurse Practitioner's (NP) Group Inc. is active and in good standing with the Arizona Corporation Commission, online records say.

The Corporation Commission lists Elvia Lamont as the company's president and director. The federal indictment says both Lamonts own and operate the business. The business operations have included treatment of elderly patients in assisted living facilities or other home settings, court documents say.

Elvia Lamont told the Star in 2007 -- the year the business opened -- that her company had 66 caregivers to serve the Tucson metro area, including companions, health aides, certified nursing assistants, registered nurses, nurse case managers and medication managers. The company has been enrolled as a Medicare provider since 2009, the indictment says.

The company's website says it provides in-home medical care to patients by sending "highly trained doctors, physicians assistants, nurse practitioners, and registered nurses who specialize in geriatrics and chronic conditions to you, and provide quality at home care for you or a loved one."

The website says the business also provides services in Scottsdale, Mesa, Phoenix, Chandler and Tempe.

Allegations

The indictment cites three key ways the couple allegedly was breaking the law on Medicare billing:

1. Upcoding.

The Lamonts were billing for a more complex and expensive level of health care and more extended services than they provided, the indictment says.

2. They said care was provided by a physician or nurse practitioner but it wasn't.

The Lamonts are accused of billing Medicare for medical care provided by a physician or nurse practitioner, yet in reality the services were performed by "auxiliary personnel," such as nurses, medical assistants, technicians or a phlebotomist, the indictment says.

3. Forged signatures.

The Lamonts are accused of forging the signatures, or using signature stamps, of CMS-approved providers without their consent, and without those providers having rendered the medical service.

"These acts of forgery and fraudulent misuse of the provider's signature stamp were committed by the defendants in an attempt to conceal and advance their Medicare (CMS) fraud scheme," the indictment says.

The indictment does not give a total dollar value of the alleged fraud. But it says if the Lamonts are convicted of one or more of the offenses in the indictment, they will have to forfeit any property they acquired from "gross proceeds traceable to the commission of the offenses."

Since 2009, a federal Health Care Fraud Prevention and Enforcement Action Team has filed criminal and civil charges against more than 1,700 defendants who falsely billed the Medicare program for more than $5.5 billion, says a 2014 Congressional Budget Office report, citing data from the U.S. Department of Health and Human Services.

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Contact health reporter Stephanie Innes at 573-4134 or email sinnes@tucson.com. On Twitter: @stephanieinnes

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