The word professional refers to someone who is skillful, competent, proficient and qualified to serve in a certain area or role. The word unprofessional describes someone who is an amateur or exhibits behavior contrary to an accepted code of conduct. The Miami Herald reports on a woman, who was employed by two different companies having the word professional in the corporate name; however, her behavior was far from it. In fact, her deceptive actions resulted in a $74 million Medicare fraud scheme.

The story follows a Miami healthcare professional who was an administrator of LTC Professional Consultants Inc. and an employee of Professional Home Care Solutions Inc. The 63-year-old defendant, in conjunction with co-conspirators, operated the companies with the intent to falsely bill Medicare for medically unnecessary physical therapy and home health care services that were not provided. (In contrast to the corporate names, their missions were hardly professional at all.)

The fraudster’s main role in the scheme was to compensate patient recruiters of both companies with kickbacks and bribes in exchange for bringing in patients, prescriptions, plans of care and certifications for treatments and services that were not needed. She then billed Medicare for the medically unnecessary health care services. The article states that over nearly a five-year period, the woman submitted approximately $41 million in claims, of which, Medicare paid about $27 million. Overall, the scheme was credited with billing more than $74 million in fraudulent claims.

The fraudster, who was investigated by the Medicare Strike Force, pleaded guilty to a conspiracy to pay health care kickbacks. She’ll be forced to adhere to a totally different code of conduct while serving out her five-year prison sentence. This former healthcare professional will have plenty of time to ponder her unprofessional behavior. Let’s hope that after her experience in jail, she’ll profess to never committing a crime again.

  1. The article does not indicate if the companies, through which the Medicare Fraud was facilitated, was controlled or incorporated by the fraudsters.
    Were the patients recruited from the same specific areas.
    Was there any commonality among the patiens as to age, gender, etc?

    Was there any pattern toward the timing of the billing to medicare.
    I deal specifically in the area of financial crimes that have a tax results. However, medicare fraud hsa a tremendous effect on our economy; therefore, it is area that has peaked my interest toward aking a transition into this area of fraud.
    Keep the articles coming

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