Pleads Guilty Medicare fraud
Pleads Guilty Medicare fraud

CHICAGO – A Filipino-American woman, who is an owner of a home healthcare business, pleaded guilty last April 20 before US District Judge Frederick J. Kapala in Rockford, Illinois to healthcare fraud and violation of the anti-kickback statue, it was learned from Assistant US Attorney Scott A. Verseman.

Merigrace Orillo, 45, of Elmhurst, Illinois, co-owner and operator of Chalice Home Heathcare Services Inc. together with her husband, Virgilio Orillo, admitted that she had devised a scheme that defrauded the Medicare program of more than $400,000.[box type=”default” size=”large”] Illinois judge sets sentencing on July 19, 2012 [/box]Chalice has offices in Chicago, Freeport and Morris, Illinois.

Mrs. Orillo pleaded guilty to Count One, which charged her with healthcare fraud, and Count Two, which accused her of aiding and abetting another in paying kickbacks for patient referrals.

In a written plea, Mrs. Orillo admitted that from January 2007 to April 2010, she and her late husband, Virgilio Orillo, falsified documents in order to pad the bills Chalice forwarded to Medicare for payment.

Medicare is a national healthcare program, which provides free or below-cost healthcare to eligible beneficiaries, primarily persons who are 65 years old and older.

Chalice is a healthcare provider enrolled in the Medicare program since 2004.

Chalice’s nurses, nurses’ aides, physical therapists and occupational therapists provided services to patients in their homes. Chalice was paid by the federal government for the services through the Medicare program.

Before submitting a claim with Medicare, the claimant-home healthcare provider is required to assess the health condition of the patient and fill out a Comprehensive Adult Nursing Assessment with Outcome and Assessment Information Set (OASIS) element form.

The OASIS form is used to determine if the patient is homebound. It is also used to determine the severity of patient’s symptoms as well as the reimbursement rate for the home healthcare provider. If after 60 days the patient needs additional home healthcare services, the provider is required to fill out a Recertification/Follow-Up Assessment form (recertification).

The recertification form incorporates OASIS elements and is used to determine if the patient is still eligible for Medicare home healthcare. If so, the rate of reimbursement is also indicated in the form.

The rate of reimbursement determines the amount Medicare pays for the home healthcare of the patient.

This rate was falsified by the Orillio couple after it was submitted to them by the nurses. This resulted in the receipt by Chalice of more than $500,000 in Medicare payments, which it was not entitled to receive.

Assistant US Attorney Randall Samborn, public information officer of the US Attorney’s Office for Northern District of Illinois, said the sentencing of Mrs. Orillo is set on July 19, 2012.

The charges against her husband, Virgilio Orillo, was dropped following his death on Aug. 30, 2011.

A healthcare-fraud offense carries a maximum penalty of 10 years in prison and a $250,000 fine. A kickback charge carries a maximum penalty of five years in prison and a $250,000 fine.

Judge Kapala has an option to modify, increase or decrease the penalty based on the sentencing guidelines.

In a plea agreement, Mrs. Orillo also admitted that she knowingly assisted her husband in paying cash kickbacks to a Chicago doctor. The kickbacks were paid in consideration of the doctor’s referral of patients to Chalice for home healthcare services.

Mrs. Orillo likewise admitted that she had withdrawn cash from Chalice’s bank account and gave the cash to her husband to be used as kickback payments.

The indictment, which was filed on Feb. 15, 2011, charged both Orillo and her husband Virgilio with healthcare fraud.

The filing of charges was part of a nationwide takedown by Medicare Fraud Strike Force. The drive led to the filing of charges against 111 persons  for their alleged participation in Medicare-fraud cases.

Earlier, Alona Bugayong, 38, a Filipino-American employee of another home health firm in Lincolnwood, Illinois, was also sentenced to a 10-month probation after she pleaded guilty to one of two counts of paying $500 kickback to anybody, who referred an elderly patient to Bugayong’s firm.

Meanwhile, US District Judge Jeffrey Cole dismissed without prejudice charges of conspiracy against five Filipino Americans associated with the Goodwill Home Healthcare Inc.

It was alleged that they conspired to violate the federal anti-kickback statute by agreeing to offer or pay or to solicit or receive kickbacks for the referral of Medicare patients for home healthcare services.

Cleared of the charges were Filipino-Americans Marilyn Maravilla, Junjee L. Arroyo, Ferdinand Echavia, Kennedy Lomillo and Baltazar S. Alberto.

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