The Office of the Inspector General and other federal entities continue to have a significant local presence when it come to examining Medicare and Medicaid fraud, most especially in home health care. This update on a high profile local arrest comes from Boston attorney and health care compliance expert Paul Shaw, of the law firm Verrill Dana.
On December 3, 2014, following a 15-day trial, a federal jury convicted the owner of At Home VNA of Waltham, MA, Michael Galatis, R.N., for fraudulently billing millions of dollars of services to Medicare and then laundering the proceeds. The jury also found that Galatis used portions of the proceeds of the fraud scheme to purchase a $750,000 house in Natick in 2010. Over the course of 14 months, Galatis purchased the house, and paid off a mortgage, in increments including $50,000 and in excess of $100,000, until he owned it free and clear of a mortgage. The jury’s finding renders Galatis’s home forfeitable. In addition, the jury found that $50,000 contained in two bank accounts related to the fraud scheme is forfeitable.
From 2006 to 2012, Galatis caused At-Home VNA to submit more than $27 million in false and fraudulent home health services claims to Medicare. Galatis, along with his clinical director, trained At-Home VNA nurses to recruit older patients on Medicare who lived in large apartment buildings. Galatis held “wellness clinics” at these buildings where nurses convinced senior citizens to enroll with At-Home and have a nurse visit them in their home. Galatis trained nurses to manipulate the patients’ Medicare assessment forms to make it appear as though the patients qualified for Medicare home health services, when that was often not the case. The home health orders were signed by At Home VNA’s paid medical director, Dr. Spencer Wilking, who has separately pleaded guilty to health care fraud. At no time did the medical director actually examine any patient before signing the order for home health services.
The elderly patients’ primary care physicians were unaware that At Home was sending nurses to see their patients in their homes. A number of primary care physicians complained to Galatis and asked him to stop seeing the patients, but he ignored these complaints. Similarly, At Home VNA’s nurses asked Galatis if they could stop seeing the patients, because they did not need home health services, but Galatis refused these requests as well.
Sentencing in the case is scheduled for February 26, 2015. The health care fraud statutes under which Galatis was convicted provide a sentence of no greater than 10 years in prison, three years of supervised release, a fine of $250,000 or twice the gross gain or loss resulting from the offense, and restitution to the Medicare program.
Attorney Paul Shaw can be reached at (617) 274-2860