Ripe for the Picking

200

Florida is known for a lot of fun things including Disney World, the Space Coast, SeaWorld and Miami Beach. Unfortunately, South Florida is not only known for humidity and alligators, it’s also the nation’s capital of healthcare fraud. The incidence of healthcare fraud is so bad in that area that Miami has its own Medicare Strike Force office to handle what the Department of Justice considers to be 20 percent of all healthcare fraud takedowns in America. What a perfect segue into today’s Medicare fraud case which details a Miami, Florida woman’s role in stealing $4.66 million through several home health agencies.

It’s no wonder that today’s fraudster picked South Florida to carry out her scheme that lasted about four years. (Along with the citrus crop, the retiree haven is ripe for the picking.) According to our fraud article, she operated three home health agencies. She kept the clients flowing by paying kickbacks to patient recruiters in exchange for Medicare beneficiary referrals. (Many of them didn’t qualify or need home health services, but that didn’t stop her from submitting bogus claims to Medicare on their behalf.)

In addition to operating the three home health agencies, she became the owner of a nursing agency, which she placed in the name of a nominee owner. (Obviously, to disguise her illegal deeds.) Once again, she paid kickbacks to patient recruiters to supply her new company with clients. Because of her fraudulent claims across all agencies she operated, Medicare paid out $4.66 million.

The 29-year-old from Miami pleaded guilty to Medicare fraud. She received a sentence of 51 months behind bars for her role in the $4.66 million healthcare fraud scheme. In addition to paying restitution of $4,658,241, she must also forfeit $186,650.50. (Let’s not forget the 50 cents because every penny matters.)

Compared to her co-conspirator from Homestead, Florida who received a prison term of 78 months and the same restitution and forfeiture amounts for her part in the scheme, today’s fraudster should be grateful for a shorter prison term. (It looks like the Medicare Strike Force was able to make lemonade out of these two lemons who tried to put the squeeze on the government healthcare program.)

Today’s “Fraud of the Day” is based on a Department of Justice press release, Miami Woman Sentenced to Prison for Role in $4.66 Million Medicare Fraud Scheme,” released on January 28, 2019.  

A woman from Miami, Florida was sentenced to 51 months in prison on Jan. 17 for her role in a $4.66 million health care fraud scheme involving several Miami-area home health agencies, including Sunshine Home Health Services Inc., Empire Home Health Agency Inc., Mildred & Marce Home Health Care Services Inc., and Nursing Care PRN Inc., which purported to provide home health services to Medicare patients.   

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.

SHARE
Previous articleNo Mo’ Money
Next articleNo More Tricks or Treats
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.