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.
In 1995, there was no criminal law concerning Medicare fraud. The problem was either considered too minor to address or it had not occurred to legislators that such a thing could exist. It is difficult to explain how something could go from being of no concern to being at least a $100 billion per year issue. Medicare and Medicaid and the ways in which those programs are managed may explain why health care fraud has become so common. Some doctors and hospitals contend that the reimbursement rates offered by those programs are too low for hospitals serving large numbers of eligible patients to survive. Moreover, the billing and reimbursement policies have encouraged questionable billing practices.
The Miami office of the Federal Bureau of Investigation and the U.S. Justice Department announced that two more people have pleaded guilty in connection with the Health Care Solutions Network Inc. health care fraud scheme. The two people, a licensed therapist and clinic director, along with a registered clinical social worker intern, entered guilty pleas to single counts of conspiracy to commit health care fraud.
Miami and South Florida remain a central focus area in the FBI's war against healthcare fraud. A new press release from the FBI explains how it has relied on well-funded multi-office task forces to investigate and prosecute defendants here in Miami. That approach is working so well here that the authorities are expanding around the nation with similar teams.
The Medicare Fraud Strike Force, along with other federal authorities, is focusing increased attention on HIV infusion therapy clinics in Florida and throughout the country. Authorities often allege that infusion therapy clinics charge Medicare for either unnecessary treatments or care that they did not actually provide to HIV patients.
Federal authorities are very serious about healthcare-related fraud. As a result, the penalties in these cases can be very severe. Even defendants who participated only on the edges of a scheme can face hefty prison sentences.
As another indicator of the government's aggressive focus on Medicare and Medicaid fraud, federal investigators seized 92 people across the country. The defendants, including 34 people from Miami, will face federal fraud charges. Overall, the government says that these cases represent $432 million in fraud.
A federal judge sentenced a Miami-area psychiatrist to 10 years in prison this week. The defendant must also repay more than $51.9 million as restitution. The sentence concludes a massive health care fraud conspiracy prosecution.
Earlier this year, a Miami couple pleaded guilty to Medicare fraud in a deal with prosecutors. Based on the plea deal, a federal judge sentenced the couple to prison last week. Prosecutors accused the couple of committing health care fraud by submitting $45 million in false claims.
The U.S. attorney's office struck a deal with a Miami defendant this week, reducing his prison sentence in exchange for cooperation in a larger fraud prosecution. The defendant pled guilty to laundering funds as part of a massive health care fraud network.