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November 2011 Archives

Federal Grant to Combat Health Care Fraud

There are roughly 6.6 million Medicare beneficiaries in Florida. The federal government is now looking to enlist the assistance of that group in uncovering Medicare fraud. The Florida Senior Medicare Patrol was given $400,000 for 2012 by the federal government as part of an anti-fraud campaign. The goal of the campaign is to enlist the assistance of seniors in identifying and avoiding Medicare fraud.

The Success of Medicaid Fraud Control Units

Prosecuting health care professionals and businesses has become big business in Washington D.C. In 2010, the government obtained more than $1.85 billion in Medicaid fraud prosecutions. That is nearly three times the amount they gained just six years prior. The money gained is a reflection of the increase in the money the government now spends investigating and prosecuting health care fraud.

Patient recruiter guilty of Medicare fraud

A recruiter has pleaded guilty for her role in an operation that resulted in more than $25 million in improper Medicare claims. Federal investigators arrested more than a dozen people in connection with the Medicare fraud scheme. The Department of Health and Human Services, along with the Department of Justice and the Federal Bureau of Investigation announced the plea this week as part of their nationwide efforts to target health care providers for improper billing.

Mortgage fraud and organized crime

After conducting raids in Florida, Texas and New Jersey, federal prosecutors charged thirteen people with wire fraud, money laundering, racketeering, securities fraud and making false statements on loan applications. The mortgage fraud case is noteworthy because FBI investigators claim the people charged are members of the mob in Philadelphia. They claim that white collar crimes such as mortgage fraud are replacing the traditional sources of income in organized crime groups.

Medicare fraud and hospice care

Federal investigators might have a new target for Medicare fraud cases: hospice care providers. That industry has created headlines recently as high profile executives have been charged with fraudulent Medicare billing and with using taxpayer money for personal expenses. The entire hospice industry is facing fire for lax standards and insufficient controls on who gets billed and for what. With a large elder population, Florida is likely to be at the forefront of criminal investigations involving Medicare fraud and hospice care.

Doctor receives 11-year sentence for Medicare Fraud

A Houston anesthesiologist was sentenced in federal court last week in connection with the use of her Medicare provider number. The woman's provider number was used to bill more than $29 million in fraudulent Medicare claims. The woman worked for City Nursing Services for a two year period where it was her role to decide which Medicare patients required physical therapy services. The owner of clinic used her provider number during her employment and continued to use it after she left. Last week, he was found guilty of Medicare fraud and received a sentence of 27 years in prison.

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