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Miami Healthcare Facility Pleads Guilty to Medicare Fraud

The federal government is getting tough on healthcare fraud. In Miami specifically the owner and administrator of a home health care company pleaded guilty earlier this week to participating in an elaborate $74 million healthcare fraud scheme. This woman pled guilty to charges that she had submitted false medical claims for unnecessary home health care services during the time periods between January 2006 and 2012. Medicare ended up paying around $45 million in order to satisfy these claims. Health care fraud cases are typically subject to federal law, especially in the case of the Miami administrator, because she was using Medicare, a federal program, to perpetuate her fraud and other crimes.

What is Health Care Fraud?

The recent Medicare fraud case in Miami represents a textbook example of health care fraud. Health care fraud is a white collar crime within which inaccurate or false health care claims are filed in order to receive some benefit or profit. Health care fraud can be perpetrated by and against healthcare providers including physicians, hospitals, and other entities. Health care fraud can also be perpetrated by and against private citizens. The Office of the Inspector General, The Federal Bureau of Investigation and the U.S. Postal Service are the government organizations responsible for investigating potential cases of health care fraud. Typical types of health care fraud include:

  • Obtaining subsidized/insurance-covered prescriptions that are not needed and then reselling such medications on the black market;
  • Billing medical professions for services and care that was never actually received, or not necessary when conducted;
  • Altering the description and/or dates of medical services rendered;
  • Altering medical records and billing records;
  • Intentionally reporting incorrect procedures or diagnosis in order to maximize the amount of reimbursement to be received;
  • Billing non-covered services as covered under insurance or other medical benefits:
  • Submitting false information when applying for health care services and programs;
  • Selling/forging prescription medications;
  • Using/loaning another person’s insurance account; and
  • Utilizing transportation benefits for non-health care-related reasons.

The Medicare Fraud Strike Force

The recent prosecution of a Miami health care provider is part of a broader campaign being led by the Medicare Fraud Strike Force (MFSF). The MFSF is part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT), which is an initiative being led by the Department of Health and Human Services (DHHS) and the Department of Justice (DOJ). Since 2009, HEAT has been focused specifically on preventing and deterring white collar fraud in the U.S. This year alone, the initiative led a nationwide crackdown on Medicare fraud in six cities in the U.S in order to investigate and prosecute those believed to be participants in an assortment of Medicare fraud schemes that involved around $260 million in false medical care billings. By the end of the investigation process, 90 people were charged with Medicare fraud, including 16 doctors. The success of this campaign can be attributed to the multi-agency cooperation between local, state and federal investigators, totaling almost 400 law enforcement professionals.

If you are facing healthcare fraud charges, contact the criminal attorneys at Jeffrey S. Weiner, P.A., in Miami, Florida. We can provide you with a personalized defense depending on the specifics of your case.

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