Preventing Fraud in Miami

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The Medicare Strike Force is at it again…this time in Miami – the Nation’s capital for Medicare fraud. With a higher percentage of older beneficiaries residing in the metropolitan area, this haven for retirees is a gold mine for health care fraud. The Department of Justice reports in a recent press release that another pair of fraudsters has been taken down by the task force, putting an end to an $8 million scheme.

The press release states that a married couple owned and operated a Miami-based home health care agency that claimed to provide home health and physical therapy services to Medicare beneficiaries. In reality, the business operated primarily for the purpose of billing Medicare for pricey physical therapy and home health care services that were not medically necessary or actually provided. (This is a common practice in health care fraud.)

The husband was responsible for running the company and overseeing the scheme. Along with his wife, he negotiated and paid kickbacks and bribes to recruiters, who provided patients to the business. (Just another case where a couple’s vows should have included a commitment to love, honor and fraud together.) The pair of fraudsters also paid co-conspirators in doctors’ offices and clinics in return for prescriptions authorizing therapy services and medical certifications. (How inclusive…everyone had a role.) This documentation was used by the couple and other co-conspirators to bill Medicare. Over approximately three years, the company received $8 million for the fraudulent claims.

The two health clinic owners pleaded guilty to conspiracy to commit health care fraud for their involvement in the scheme. The husband was sentenced to 87 months in prison, while the wife will be required to serve 57 months.

Congratulations to the Medicare Fraud Strike Force for another successful bust. Since its inception in 2007, more than 1,700 defendants who have billed the Medicare system for more than $5.5 have been charged, putting the money back where it belongs – in the pockets of those Medicare recipients who justly deserve the benefits.

Source: Today’s ”Fraud of the Day” is based on a press release titled, ”Health Care Clinic Owners Sentenced for Role in $8 Million Health Care Fraud Scheme,” issued by the Department of Justice on December 2, 2013.

Two health care clinic owners were sentenced today in connection with an $8 million health care fraud scheme involving the now-defunct home health care company Flores Home Health Care Inc.

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 B. Dennis of the U.S. Department of Health and Human Services 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.