Pinay nurse meted 6 years for illegal Medicare billings

CHICAGO –A Filipina nurse who owned a suburban Schaumburg, Illinois home health company was sentenced last July 26 to six years in prison for scheming to bill Medicare millions of dollars in unnecessary services.

Diana Jocelyn Gumila, 47, manager of Suburban Home Physicians, which did business as Doctor at Home, directed employees to perform home visits to patients who were physically capable of leaving their residences for their medical needs.

Gumila also inflated the costs charged to Medicare by directing employees to bill the treatment at the most complicated levels, even though the visits were typically routine and did not qualify for elevated billing.

Investigators have described the case as the “symbiotic and incestuous relationship that has developed in Cook County between certain home health agencies and the doctors that allow Medicare fraud to flourish.”

A jury in April convicted Gumila, 47, of Streamwood, Illinois, on 21 counts of health care fraud and three counts of making false statements in a health care matter.

In addition to the 72- month sentence, US District Judge Charles Kocoras ordered the defendant to pay $15.6 million in restitution.

But on the day the sentence was handed down by Judge Kocoras, the counsel of the whistleblowers, who stood as complainants in a separate civil suit, was surprised to learn that Gumila was a “mere employee” of two co-accused doctors, whose case was dismissed for “insufficient admissible evidence.”

The counsel for the whistle- blowers – also called “relators” – in a motion asked Kocoras to provide him copy of a letter previously under seal by Gumila addressed to the court stating that “Defendants Naimish and Prashant Patel as the coowners-in-fact of a corporation ( Doctor at Home) that was the principal malefactor in the subject scheme to defraud Medicare.”

The relators are Albert Young, physician assistant; Teresa Dedina, L.P.N.,Vianka Calderon and D’Andre Hooks-Czapansky.

Gumila’s lawyer also argued for a lesser sentence, saying she was “merely a salaried employee of defendant Doctor At Home” and that “defendants Naimish and Prashant Patel, along with Jerry Gumila,” were the true owners of Doctor At Home.

The whistle- blowers are also seeking additional time in a related civil case they filed against the same defendants and “to procure the subject letter by Gumila” from the court to get the full extent of her admissions regarding Naimish and Prashant Patel’s involvement in Doctor at Home.

Gumila is one of several defendants convicted in the federal investigation of Doctor at Home.

Evidence presented at Gumila’s two- week trial included a surreptitious audio recording in which Gumila can be heard telling a new doctor to “paint the picture” of patients so as to make them appear confined to their homes. E- mails from Gumila were also shown to the jury, including one in which she referred to a physician who did not read orders before signing them as “the type of doctor we need ( b) ecause he will just do what we tell him to do.”

The investigation was carried out by the Medicare Fraud Strike Force, which is part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Justice Department and the US Department of Health and Human Services.