Unprofessional Conduct


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.

Source: Today’s ”Fraud of the Day” is based on the article titled, ”Miami Woman Sentenced in Medicare Fraud,” written by Patricia Borns and published in the Miami Herald on October 23, 2013.

MIAMI – Miami healthcare professional involved in two local companies was sentenced Wednesday to 60 months in prison for participating in a $74 million home health Medicare fraud scheme.

Myriam Acevedo, 63, of Miami, was sentenced by U.S. District Judge Marcia G. Cooke in the Southern District of Florida, after pleading guilty in May to a conspiracy to pay health care kickbacks.

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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.