In May the U.S. Department of Justice revealed that it had conducted a nation-wide sting of individuals who had defrauded the Medicare system to the tune of over $260 million dollars. Of the 90 people caught in the fraud operation, 50 of them are residents of Miami. One group in particular, operating in Miami, is suspected of filing claims with the government for $65.5 million dollars. The Miami crew is accused of filing falsified claims related to the home and mental health care and other pharmacy services they supposedly gave to their patients.
Just days after the DOJ announce of the sting, Florida Senator Bill Nelson, and his colleagues, introduced a bill aimed at reducing the amount of Medicare fraud nationwide. The bill’s focus is to eliminate potential fraudsters from the ranks of trusted Medicare providers organized by The Centers for Medicare & Medicaid Services. The proposed bill would grant the CMS greater powers in identifying the personal histories of people who own interests in companies that submit bills to them.
As the law currently stands, a person who has previously been caught for defrauding the system through one company could simply change the name of the company and get a fresh start. The new law would essentially keep convicted conmen from returning to the Medicare business. People with even minor interests in companies caught facilitating fraud could be discovered using the new law. It is hoped that the fraudster’s identities would be revealed by using a series of databases and other background checks with the goal of preventing the wide-scale abuses found in the Miami cases.
People accused of Medicare fraud should know that every criminal defendant has a right to challenge the evidence and testimony used against them. They should also know that the prosecution has the duty to prove each of the charges against them beyond a reasonable doubt.
There are also other paths available to defendants in lieu of trial. Sometimes the prosecution will allow a defendant to plead guilty to lesser offenses, reduced jail time and fines in return for their admission of guilt.
Source: insurancenewsnet.com, “Legislation aims to curb Medicare scams” Laura Green, May. 27, 2014