On December 2, 2014, a 54-year-old Florida man was sentenced to an eleven-year prison term and was ordered to pay $14,424,856 in restitution after pleading guilty on February 3, 2014 to conspiracy to commit health care fraud and making a false statement relating to health care matters that involved Medicare fraud between 2005 and 2009. The man and his co-conspirators had billed approximately $28,347,065 in fraudulent reimbursement claims to Medicare, for which they received about $14,424,865 in payments.
The Medicare fraud scheme involved a holding company controlled by the man that was used to purchase comprehensive outpatient rehabilitation facilities and outpatient physical therapy providers in Florida that led to the man and his co-conspirators controlling the rehabilitation facilities’ Medicare provider numbers that were used to bill Medicare for reimbursement for therapy services that were not legitimately prescribed and not provided. The Medicare fraud scheme involved the creation of false and forged patient records.
Additionally, the man and his co-conspirators paid illegal kickbacks to obtain stolen personal identifying information of Medicare beneficiaries. They also obtained the unique identifying information of physicians to create and submit false claims to Medicare through the rehabilitation facilities owned by the holding company.
The owners of other Florida outpatient rehabilitation facilities were recruited into the Medicare fraud scheme by offers to pay them 80% of the Medicare reimbursements received as a result of false reimbursement claims (the man and his co-conspirators kept 20% of the illegal reimbursements).
In an effort to distance themselves from their Medicare fraud activities, the man and his co-conspirators would enter into sham sales of the rehabilitation facilities owned by the holding company, using straw purchasers who were recent immigrants with no background or experience in the heath care industry.
Since 2007, the Medicare Fraud Strike Force that operates in nine U.S. cities (Baton Rouge, Louisiana; Brooklyn, New York; Chicago, Illinois; Dallas, Texas; Detroit, Michigan; Houston, Texas; Los Angeles, California; Miami –Dade, Florida, and Tampa Bay, Florida) has charged nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 billion. In October 2012, Medicare Fraud Strike Force operations in seven cities led to charges against 91 individuals (including doctors, nurses, and other licensed medical professionals) for their alleged participation in Medicare fraud schemes involving approximately $432 million in false billing.
Individuals who report Medicare fraud may be eligible for a reward of up to $1,000 if: the Medicare fraud reported is substantiated as potential fraud by the Centers for Medicare & Medicaid Program Safeguard Contractor or the Zone Program Integrity Contractor and is formally referred to the Office of Inspector General for further investigation as part of a case; the person reporting Medicare fraud is not an “excluded individual” (such as someone who participated in the fraud); the person reporting the Medicare fraud does not qualify for another reward under another government program; the person or organization reported is not currently under investigation by law enforcement; and, the report leads to the direct recovery of at least $100 of Medicare money.
If you or a loved one may be the innocent victim of medical negligence in the United States, you should promptly seek the legal advice of a medical malpractice attorney in your state who may investigate your medical malpractice claim for you and represent you in a medical malpractice case, if appropriate.
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