The Medicare billing system is complicated. In an effort to stop overpayment and find those guilty of Medicare fraud, the federal government pays companies or individuals known as "recovery audit contractors" to search through Medicare claims to find improper claims. If an RAC finds a claim considered suspect, the solution can either e to order the money be paid back or to withhold that amount of Medicare reimbursement from later claims by the doctor or hospital. Despite being paid by the government to spot improper claims, RACs incorrectly identify proper claims as potentially fraudulent on a regular basis. According to the American Hospital Association, 72 percent of the claims that are investigated after being withheld by the federal government on the advice of an RAC are later overturned and delivered to the provider.
The massive crackdown that led to charges against 89 different people included four Tampa area clinics. Among the claims laid out by the U.S. Attorney General were charges that four fake health care clinics, purportedly based in Tampa, filed more than $2.5 million in Medicare claims for procedures that were not performed. The claims involved varicose vein procedures. Each of the four clinics listed the identical address of 2137 W. Dr. Martin Luther King Jr. Boulevard.
The U.S. Attorney's Office announced Wednesday that two Florida residents had been sentenced in a mortgage fraud and tax evasion case. The couple, Rudolf Straat and Maria Gudelis, pleaded guilty in December and January to charges of conspiracy and tax evasion. They were accused of mortgage fraud for presenting false information in order to obtain mortgage loans to buy homes in Florida and Nevada. The purchases totaled more than $10 million. The couples' activities took place between 2004 and 20012.
The government conducted a nationwide crackdown on people suspected of health care fraud this week. In total, the Department of Justice charged 89 people across 8 cities, including Miami, with health care fraud. This marks the sixth nationwide crackdown conducted by the government since 2010. The 89 people were accused of filing fraudulent claims to the tune of $223 million. The U.S. Attorney General, Eric Holder, took the opportunity to suggest that upcoming fiscal cutbacks could lead to a reduction in these types of operations. According to Mr. Holder, the sequestration cuts will have cost the DOJ $1.6 billion in funding by September 30.
A three-year operation by the Federal Bureau of Investigation led to the arrest of four Florida residents last month. The three, Jim Sotolongo, Ramara Garrett, Stephanie Musselwhite and Christopher Mencis were indicted last week in Orlando on charges that they conducted a mortgage fraud scheme over a period of years. Mr. Sotolongo has prior experience with federal prosecutors. In 1995, he entered into a plea agreement on drug charges and money-laundering charges. He was facing up to 33 years in prison. Instead, he cooperated with government officials and received five years of probation.