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Whistleblower Brings Down Multi-Million Dollar Healthcare Scam

Misha Kim was a receptionist for Greatcare Home Healthcare, a Los Angeles based home health care company, started by nurse Hee Jung Mun (a.k.a. Angela Mun) and Dr. Wan Sihl Kim (a.k.a. Victoria Kim, no relation to Misha). According to Misha, once she began working there, she realized that nearly the entirety of the organization was built on fraudulent practices. She felt obligated to blow the whistle on the complex scheme of fraudulent behavior.

Angela Mun had set up a system of doctors, including Victoria Kim, and other employees who would falsify paperwork making it seem as those she was providing services to elderly people who had never actually received them. She paid patients $300 each to sign up for her services. She also paid doctors between $100 – $300 per patient to create files and falsify paperwork referring these ‘patients’ for home healthcare services. She then charged Medicare more than $5 million in fees for services that were never provided.

According to the Department of Justice, the Federal Bureau of Investigations, and the Office of the Inspector General of the U. S. Department of Health and Human Services, Medicare paid approximately $5.1 million to Greatcare for fraudulently documented home health services to patients. Those reimbursements stemmed from forms that had been falsified by Mun and her staff. The forms made it appear that patients’ medical conditions and lack of willing caregivers made them eligible for home health services. She also falsified daily route sheets and skilled nursing notes to make it appear as though she had visited patients whom she had never visited, and possibly had never even met.

Mun was sentenced to 57 months in federal prison for her role in the scam. After being indicted by a federal grand jury, she pled guilty as part of a plea deal in 2012. The 52-year-old Rancho Palos Verdes resident paid illegal kickbacks to doctors, patients and those known as “cappers” or “marketers” who recruited patients. She also billed Medicare for patients who were not homebound, did not qualify for services, were seen by unlicensed representatives or who never received services at all.

Dr. Jong Shin was another member of the group of indictees. He was charged with receiving kickbacks for referring patients to GreatCare and signing false certificates of medical necessity. He was ordered to pay more than $217,000 in civil penalties for his role in the scheme.

A physical therapist, Seonweon Kim pled guilty to healthcare fraud and admitted that he had falsified physical therapy notes, indicating that he had provided services to patients which he had never seen. He was ordered to pay $205,000 in penalties as part of his sentence.

The aforementioned Dr. Victoria Kim was herself sentenced to spend one year and one day in prison, and pay over $1 million in civil penalties. She pled guilty to receiving kickbacks and participating in the fraudulent scheme.

Of course, as mentioned earlier, this entire scheme was brought down by the actions of Misha Kim, the whistleblower how first reported, and assisted in the investigation and prosecution of the cases against Mun and her accomplices.

According to her attorney, Misha felt that she had to report the fraud because it was so blatant that she was concerned that she might also go to prison once (not if) the truth ever came out. “It was so blatant, it was almost a joke,” she said.

Misha should be entitled to thousands (if not hundreds of thousands) of dollars for her part in bringing the scheme to an end, as part of the recovery sharing provisions of the False Claims Act.

If you have information that your employer is engaged in some sort of fraudulent or illegal activity and wish to report it to the proper authorities, contact the offices of Stephen Danz & Associates at (877) 789-9707 or use the Contact Form on our website BEFORE you take any steps to gather evidence or report the issues. Stephen has more than 30 years of experience defending the employees of California against the unlawful acts of their employers and in representing civic minded employees in bringing whistleblower actions and protecting them from retaliation. His cases have been citied in whistleblower handbooks and he is a recognized expert in employment law. He will guide you through the turbulent waters of whistleblower actions and make sure that your rights to share in the recovery are protected.