Miami-Area Woman Sentenced to Over Six Years in Prison for Role in $4.65 Million Medicare Fraud Scheme | OPA

A Miami, Florida-area woman was sentenced to 78 months in prison to be followed by three years of supervised release today for her role in a $4.65 million health care fraud scheme involving three home health agencies that purported to provide home health services to Medicare patients.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.

Margarita Palomino, 54, of Homestead, Florida, was sentenced by U.S. District Judge Jose E. Martinez of the Southern District of Florida.  Judge Martinez also ordered Palomino to pay $4,658,241.00 in restitution and to forfeit $186,650.50.  Palomino pleaded guilty on Oct. 10, 2018 to one count of conspiracy to commit health care fraud and wire fraud.

Palomino worked at Sunshine Home Health Services Inc., Empire Home Health Agency Inc. and Mildred & Marce Home Health Care Services Inc., all in the Miami area.  As part of her guilty plea, Palomino admitted that from approximately January 2010 through approximately January 2014, she accepted kickbacks in return for the referral of Medicare beneficiaries, many of whom did not need or qualify for home health services, to act as patients at the three agencies.  Palomino—who was a physician in Cuba but never licensed in the United States—further admitted that she performed home health care nursing visits and prepared related medical records as if she were a licensed medical professional.  She also admittedly changed claims coding to increase reimbursement by Medicare.

Palomino admitted that, as a result of false and fraudulent claims submitted as part of this conspiracy, Medicare made payments of at least $4.65 million.

Palomino was charged along with Norma Zayas, 29, of Miami, in an indictment returned on June 7, 2018.  Zayas pleaded guilty and is currently awaiting sentencing.

The FBI and HHS-OIG investigated the case, which 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.  Trial Attorney Emily Gurskis of the Fraud Section and Assistant U.S. Attorney Leslie Wright of the District of Massachusetts (previously a Fraud Section trial attorney) are prosecuting the case.

The Fraud Section leads the Medicare Fraud Strike Force.  Since its inception in 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.