Home care director guilty in $27 million Medicare fraud case

The overwhelming majority of patients were not homebound and did not need home health services, according to authorities.

The clinical director of a Boston-area home nursing agency has been convicted for her role in submitting more than $27 million in fraudulent home healthcare claims to Medicare, according to the U.S. District Attorney in Massachusetts.

Janice Troisi, 66, of Revere, Mass., was convicted of conspiracy to commit healthcare fraud and 10 counts of healthcare fraud following a four-day trial, the U.S. District Attorney announced on August 5.

Sentencing is scheduled for Nov. 10.

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Troisi, a registered nurse, was the clinical director of At Home VNA, a home health agency located in Waltham, Mass., which was owned and operated by her co-conspirator, Michael Galatis, also a registered nurse.

From 2006 to 2012, Galatis submitted more than $27 million in fraudulent home healthcare claims to Medicare, according to authorities. Medicare paid more than $20 million of those fraudulent claims.

Troisi joined AHVNA in fall 2009, and by Jan. 1, 2010, she had joined the conspiracy, according to court records.

Troisi and Galatis trained AHVNA nurses to recruit Medicare beneficiaries who lived in senior housing developments or group homes for the disabled. They held "wellness clinics" at these developments, where nurses convinced senior citizens to enroll with AHVNA and have a nurse visit them in their home.

The overwhelming majority of AHVNA's patients were not homebound and did not need home health services, according to authorities. Many worked, took out-of-state vacations, and lived independent lives.

AHVNA's nurses frequently asked Troisi and Galatis if they could stop seeing the patients, because they did not need home health services, but Troisi and Galatis refused these requests, authorities said.

Also, a number of primary care physicians who learned of AHVNA's services complained to Troisi and Galatis and asked them to stop seeing their patients, but their requests were also ignored.

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The home health orders were signed by AHVNA's paid medical director, Dr. Spencer Wilking, who falsely certified to Medicare that these individuals were homebound and needed skilled services, when he never treated or even met the vast majority of AHVNA's approximately 1,400 patients, according to the District Attorney's Office.

In 2011, Medicare passed a new regulation requiring the physician to certify that she or he had a face-to-face encounter with the patient about the need for home health care. Even after this regulation was enacted, Troisi continued to prepare certifications and orders for home healthcare for a doctor to sign despite knowing that the doctor had not examined any of the patients, court records state.

In February, Galatis was sentenced to 92 months in prison on a conviction of conspiracy to commit healthcare fraud, ten counts of health care fraud, and seven counts of money laundering.

Twitter: @SusanMorseHFN