Crossing the Line

5

Unfortunately, a lot of health care fraud occurs in the State of Florida. One reason for the high rate of fraud is because the Sunshine State has a very large pool of Medicare and Medicaid beneficiaries to victimize. An article posted on NBCMiami.com tells the story of a recent raid on a Florida health care company and 11 employees that may have gone beyond state and national borders to recruit victims for their alleged $25 million health care scam. (Perhaps the alleged perpetrators thought that the crime would be harder to track down if the victims were from another country.)

The story states that the alleged perpetrators recruited people living in the Dominican Republic and Nicaragua to apply for Medicare and Medicaid benefits, stating that they were Florida residents. Both government programs made payments to the Florida health care company based on claims submitted by the fraudulent Florida residents.

The article also says that according to the federal indictment, the Florida Medicaid program paid Medicare premiums and deductibles for multiple beneficiaries who did not actually live in Florida. (It is also alleged that co-conspirators included primary care doctors who saw the patients and provided diagnoses for the defendants so they could bill Medicare.)

It is important to remember that the 11 defendants, who are charged with a number of counts of health care fraud, are innocent until proven guilty in a court of law. No matter the outcome of the case, this recent raid proves that law enforcement officials in Florida are serious about battling health care fraud no matter the location – whether local or across state and even national borders. The government will continue to go after those people who cross the line by threatening the country’s health care system and the beneficiaries who rightfully deserve assistance.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”11 Charged in Medicare/Medicaid Fraud Scheme,” posted on NBCMiami.com on November 19, 2014.

Federal agents raided Florida Healthcare Plus in Coral Gables Wednesday for allegedly running a more than $25 million Medicare, Medicaid, and wire fraud scheme.

Authorities said eleven people were involved in the schemed to defraud the government. According to the federal indictment, Florida Healthcare Plus (FHCP) was authorized by Medicare and Medicaid to offer plans to the beneficiaries, which was then allegedly taken advantage of by the defendants.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.