A Sacramento registered nurse has been charged in a massive Medicare fraud scheme that cost the federal health care program $31 million in payouts, court documents say.
John Eby, whose Facebook page says he is a nursing care coordinator at Mercy General Hospital, was charged in a two-count information filed in Sacramento federal court Thursday with conspiracy to pay and receive health care kickbacks and receipt of health care kickbacks.
Eby did not respond to a voicemail left for him at Mercy General or to a message left with his wife.
His attorney, William Portanova, said Eby is cooperating with prosecutors.
“The Medicare bureaucracy is a complex one, and mistakes were made,” Portanova said.
The court documents describe a massive conspiracy among individuals and unnamed health care agencies involving more than 8,000 claims made to Medicare “for the cost of home health care and hospice services purportedly provided to Medicare beneficiaries.”
“Based on those claims, Medicare paid the agencies over approximately $31 million in reimbursement,” the court documents say. “Of that amount, Medicare paid the co-conspirator agencies reimbursement of approximately $250,000 for services purportedly provided to beneficiaries John Eby referred to the co-conspirator agencies in exchange for kickbacks.”
The total amount Eby is alleged to receive is not spelled in the court filing.
None of the agencies, co-conspirators or the hospital where Eby worked are named in the seven-page complaint.
A Medicare spokesman in San Francisco said officials would not comment on pending litigation, and a spokeswoman for Dignity Health, which runs Mercy General, had no immediate comment.
The complaint says that Eby worked as a case manager at “Hospital 1,” where he helped patients select post-acute care-providers, including hospices and home health care providers, to care for them after they were discharged from the hospital.
“Although not authorized to do so, Eby was able to and did steer beneficiary referrals to specific providers he selected,” the court documents say.
Medicare is a federal health care program for citizens 65 and older and for other individuals with select disabilities.
Unnamed co-conspirators included home health care agencies in Folsom and El Dorado Hills, a hospice provider in Folsom and a marketer, the court documents say.
The conspiracy allegedly began in September 2015 and continued through November 2018, with Eby and others engaging in a kickback scheme in which conspirators told “Marketer 1” to pay kickbacks and bribes to Eby in exchange for him referring hospital patients to their agencies, the court documents say.
Around Oct. 30, 2018, for instance, a co-conspirator paid the marketer $2,000 in cash in exchange for Eby referring five Medicare patients to a particular home health care provider, the documents say. Two days later, the marketer paid Eby $1,000 in cash, the documents say.
The charges could net Eby up to 10 years in prison and a $250,000 fine.