Flores Home Health Care Owners Sentenced in $8 Million Health Care Fraud Scheme

December 4, 2013

A married couple from Miami, who co-owned and operated the now-defunct Flores Home Health Care, was sentenced on December 2 for their involvement in an $8 million health care fraud scheme.

Miguel Jimenez, 43, was sentenced to 87 months in prison, while his wife, Marina Sanchez Pajon, 29, was given a 57-month sentence by U.S. District Judge Ursula Ungaro in the Southern District of Florida.  Both pleaded guilty in August to conspiracy to commit health care fraud.

From October 2009 through June 2012, Flores Home Health, Inc. was paid roughly $8 million by Medicare for fraudulent claims for home health services, the U.S. Department of Justice said in a news release.

Jimenez, Pajon, and their co-conspirators pulled off the scheme by paying kickbacks and bribes to patient recruiters, who in return, referred Medicare patients to Flores Home Health for expensive home health and therapy services that were medically unnecessary or not provided.  The couple also paid kickbacks and bribes to co-conspirators in doctors’ offices and medical clinics to get home health and therapy prescriptions, medical certifications, and other documentation necessary to fraudulently bill Medicare.

According to court documents, Jimenez was in charge of controlling Flores Home Health, basically running and overseeing the schemes conducted through the company.  Both Jimenez and Pajon negotiated and paid kickbacks and bribes, interacted with patient recruiters, and coordinated and oversaw the submission of fraudulent claims to the Medicare program.

This case, investigated by the FBI and HHS-OIG, was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.  Since its inception in March 2007, the Medicare Fraud Strike Force has charged more than 1,700 defendants who have collectively billed the Medicare program for more than $5.5 billion.