Fraud Hot Spot

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The Miami area is known as the epicenter of home health fraud. This is not surprising due to the large number of elderly Medicare beneficiaries who live in the South Florida region. The Center for Medicaid and Medicare Services (CMS) has determined that a disproportionate number of home health care agencies exist in Miami as compared to the number of beneficiaries – 1,960 percent higher to be exact. (Some are trying to capitalize on the ”easy money” connected to the multitude of Medicare cards.) The Medicare Strike Force continues to go after criminals in the South Florida area as detailed by a FBI press release concerning the recent conviction of two people in a $48 million health care fraud scheme.

The press release states that over two and a half years, two patient recruiters from a Miami health care company solicited and received kickbacks and bribes from the owners and operators of the business, who then billed Medicare for services on behalf of recruited patients. The services were either medically unnecessary or not provided and resulted in charges of $48 million. Medicare paid approximately $33 million for the fraudulent claims. (Because federal law requires the Medicare program to deliver prompt payment, fraudulent claims are usually not discovered until after payment has been made.)

These two patient recruiters, both in their 30’s, pleaded guilty to one count each of conspiracy to receive health care kickbacks. They both face up to five years in prison. One of the defendants also admitted her involvement in another $7 million of fraudulent billings for a home health care agency she owned and operated. This could get her another five years in prison.

Home health care fraud has become so bad that Federal health officials have placed a temporary ban on new home health agencies in the Miami region to prevent further scams and abuse. This action goes a long way towards stopping the drain on Medicare dollars, so that those who deserve the benefits actually get them.

Source: Today’s ”Fraud of the Day” is a document,”Two Patient Recruiters of Miami Home Health Company Plead Guilty in $48 Million Health Care Fraud Scheme,” issued on September 3, 2013.

WASHINGTON—Two patient recruiters of a Miami health care company pleaded guilty late yesterday for their participation in a $48 million home health Medicare fraud scheme.

Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Special Agent in Charge Michael B. Steinbach of the FBI’s Miami Field Office; and Special Agent in Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG) Office of Investigations Miami Office made the announcement.

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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.