Miami Woman Sentenced to Prison for Role in $4.66 Million Medicare Fraud Scheme

A woman from Miami, Florida was sentenced to 51 months in prison on Jan. 17 for her role in a $4.66 million health care fraud scheme involving several Miami-area home health agencies, including Sunshine Home Health Services Inc., Empire Home Health Agency Inc., Mildred & Marce Home Health Care Services Inc., and Nursing Care PRN Inc., which 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.

Norma Zayas, 29, of Miami, was sentenced by U.S. District Judge Jose E. Martinez of the Southern District of Florida.  Judge Martinez also ordered Zayas to pay $4,658,241.00 in restitution and to forfeit $186,650.50.  Zayas pleaded guilty on Oct. 22, 2018 to one count of conspiracy to commit health care fraud. 

As part of her guilty plea, Zayas admitted that from approximately January 2010 through approximately January 2014, she operated Sunshine, Empire, and Mildred & Marce Home Health and paid kickbacks to patient recruiters in return for the referral of Medicare beneficiaries, many of whom did not need or qualify for home health services.  Zayas further admitted that she became the true owner of Nursing Care PRN, which she placed in the name of a nominee owner.  She also paid kickbacks to patient recruiters who referred Medicare beneficiaries to Nursing Care PRN.

The defendant admitted that, as a result of false and fraudulent claims submitted as part of this conspiracy, Medicare made payments of nearly $4.66 million.  Zayas was charged along with Margarita Palomino, 54, of Homestead, Florida in an indictment returned on June 7, 2018.  Palomino was sentenced in December 2018 to a term of 78 months in prison and ordered to pay over $4.65 million in restitution, as well as to forfeit $186,650.50.

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.  Former Fraud Section Trial Attorney and current Assistant U.S. Attorney Leslie Wright prosecuted the case; the case is now being handled by Trial Attorney Emily Gurskis of the Fraud Section.

The Criminal Division’s 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.