After serving five years for drug smuggling and money laundering, a Miami man turned his attention to the health care business. He now faces charges stemming from more than $7 million in fraudulent Medicare claims. He established his wife as the corporate officer of record to obtain a Medicare provider number and avoid any concerns about his criminal record.

The husband and wife are facing charges of conspiracy to commit healthcare fraud, money laundering, and paying kickbacks to individuals who recruited new patients for their business. In this case, the Medicare claims were for diabetes treatments the prosecutors are claiming were not needed or were not given at all. The couple faces significant criminal penalties if found guilty.

Medicare fraud is a hot-button issue in Washington D.C. and in Florida these days. The man at the head of the national anti-fraud movement is Peter Budetti. He claims situations such as these are being addressed with stricter screening and advanced software designed to detect fraudulent claims before they are paid. The changes will likely have a disparate impact on South Florida, which the FBI has identified as the unofficial capital of healthcare fraud.

It is a common practice to use the identities of family and friends to obtain Medicare provider numbers. It is also common to establish “straw men” to obscure who is actually running a healthcare business. This is one way that people with criminal backgrounds get around the screening process. In some cases, a criminal background is no obstacle. A felony record can only be used to deny an applicant if the conviction came within the last 10 years.

Source: The Miami Herald, “Former Miami drug trafficker now an accused Medicare scammer,” Jay Weaver, 28 July 2011

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