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January 18, 2012

Owner of Westlake Home Health Agency Pleads Guilty to Bilking Medicare out of over $5 Million in Health Care Fraud Scheme

Filed under: Uncategorized — fayarfa @ 1:43 pm

LOS ANGELES – A registered nurse who operated a home health agency based in Westlake has pleaded guilty to federal health care fraud charges in a $5 million Medicare fraud scheme involving kickbacks to doctors and patients who did not qualify for in-home health services.

Hee Jung Mun, who often used the name Angela Mun, 50, of Rancho Palos Verdes, pleaded guilty yesterday afternoon before United States District Judge Dean D. Pregerson.

Mun owned Greatcare Home Health, Inc., which was shut down in March 2011 when special agents with the Federal Bureau of Investigation and the Department of Health and Human Services, Office of Inspector General, executed a search warrant at the company’s office. The criminal investigation into Greatcare was prompted by a still-pending “whistleblower” lawsuit filed by a former employee.

In a plea agreement filed in United States District Court, Mun admitted that she orchestrated the scheme that defrauded Medicare in a number of ways: paying illegal kickbacks to doctors for patient referrals, to “cappers” or “marketers” for patient referrals, and to patients to induce them to sign up for home health services; billing Medicare for patients who were not homebound or who otherwise did not quality for home health services, and for services provided by unlicensed individuals or not provided at all; creating bogus medical records to support fraudulent claims to Medicare; and “upcoding” or exaggerating patient conditions to generate larger reimbursements from Medicare.  The scheme targeted elderly, primarily Korean, Medicare beneficiaries.

A nurse who worked at Greatcare also pleaded guilty yesterday afternoon. Ji Hae Kim, 43, of Fullerton, pleaded guilty to conspiracy to commit health care fraud, admitting that she prepared false forms to fraudulently justify that Medicare beneficiaries needed home health services. Kim also falsely claimed to have made patient visits that she knew were either conducted by unlicensed individuals or not conducted at all, leading to $1.1 million in payments from Medicare.

As a result of their guilty pleas this afternoon, Mun and Kim both face statutory maximum sentences of 10 years in federal prison.

Judge Pregerson is scheduled to sentence Mun and Kim on October 1.

Two other people involved in the scheme were charged last week with health care fraud. Seonweon Kim, 46, of Arcadia, and Jung Sook Lee, 51, of Koreatown, are scheduled to make their initial court appearances on January 23.

As part of the investigation, authorities have seized $1.2 million from Greatcare bank accounts.

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