A Texas home health company owner was sentenced to serve three years and nine months in prison and pay more than $1 million in restitution after a conviction of conspiracy to commit health care fraud, according to a Department of Justice release on April 13, 2023.
 
Miguel Angel Contreras, 44, of McAllen, pleaded guilty April 14, 2016.
 
Contreras was an owner and administrator for Sambritt Home Health LLC. As part of his plea, he admitted he submitted false and fraudulent claims to Medicare for reimbursement of home health services that were not provided, that a physician had not authorized and/or were not medically necessary, according to the DOJ release.
 
The false and fraudulent claims Contreras submitted to Medicare totaled $724,056.02. As a result of the false and fraudulent claims, Medicare paid approximately $1,037,353.78.
 
Contreras further admitted he paid illegal kickbacks in exchange for patient information, including patient Medicare numbers. He and/or his co-conspirators would then use the fraudulently obtained Medicare numbers to submit claims to Medicare in order to receive reimbursements, according to the DOJ.    
 
As part of his plea, Contreras admitted he forged and/or caused others to forge the signatures of physicians on the referral forms or 485 forms, knowing the physicians did not authorize the need for home health services and/or that the beneficiaries did not need or qualify for home health services. Contreras directed employees to create “ghost notes” for patient files which were intended and calculated to make the fraudulent claims submitted to Medicare appear legitimate. Contreras also admitted he directed employees and/or co-conspirators to bill Medicare for home health services with 485 forms which were missing physician signatures.