Michigan woman convicted in $1.6M Medicare home health fraud scheme

A federal jury in Michigan has convicted a home health care agency owner of running a $1.6 million Medicare fraud scheme built on bribery, stolen patient records and falsified claims, the Justice Department announced.

Ruby Scott, 55, of Farmington Hills, was found guilty of operating Delta Home Health Care LLC in a scheme prosecutors said defrauded the federal health insurance program through kickbacks and fraudulent Medicare billing. Scott owned and operated the company and used patient information obtained through illegal referrals and fabricated physician documentation to support false claims, according to court documents and evidence presented at trial.

At the center of the scheme was a relationship Scott cultivated with a discharge nurse at a Detroit hospital, prosecutors said. From 2018 through 2021, Scott paid the nurse more than $130,000 — through CashApp, PayPal, check and cash — to identify Medicare patients and fax their confidential records to Delta without the patients’ knowledge. Scott had originally developed the arrangement at a previous home health company she co-owned, then offered the nurse an additional $100 per patient to induce her to refer patients to the new venture, according to court documents.

Scott paid the nurse approximately $300 for each patient she successfully billed to Medicare, prosecutors said. She then used the stolen patient profiles to submit fraudulent claims, falsely representing to Medicare that physicians had evaluated and certified patients as eligible for home health services, including meeting homebound requirements, when in reality no doctor had evaluated them for those services, evidence at trial showed. In many instances, Scott used the identities of real physicians to fabricate those evaluations and certifications, court documents show, even though those doctors had never met the patients and had no knowledge their information was being used.

The evidence at trial revealed that one patient for whom Delta received thousands of dollars in payments had never actually received any services from the company, a witness testified. Delta also failed to maintain patient files for more than one-third of the patients for whom it submitted claims — patients for whom Medicare paid the company more than $1.2 million, prosecutors said. A witness testified the fraud drains the Medicare trust fund and could impair the program’s ability to pay legitimate claims.

The jury convicted Scott on five counts of health care fraud, one count of conspiracy to defraud the United States and pay illegal health care kickbacks, and four counts of paying illegal health care kickbacks. She faces up to 10 years in prison on each fraud and kickback count and up to five years on the conspiracy count. Sentencing is scheduled for Sept. 24.

The FBI’s Detroit Field Office and the Department of Health and Human Services Office of Inspector General investigated the case.

This article was constructed with the assistance of artificial intelligence and published by a member of The Washington Times' AI News Desk team. The contents of this report are based solely on The Washington Times' original reporting, wire services, and/or other sources cited within the report. For more information, please read our AI policy or contact Steve Fink, Director of Artificial Intelligence, at sfink@washingtontimes.com

The Washington Times AI Ethics Newsroom Committee can be reached at aispotlight@washingtontimes.com.