Given the sheer size and scope of government health care programs such as Medicare and Medicaid, coupled with the progressively growing number of people relying upon their services, it is hardly unsurprising that health care fraud is an acute focus of federal and state law enforcement officials.
A TV entrepreneur was denied bail by federal judge in Miami this week. The man stands accused of Medicare fraud for his role as titleholder of Trust Care Health Services. The company has been charged collectively for obtaining some $223 million in Medicare payments through illegal invoices. The Justice Department stated that the man and his wife filed more than $20 million in false Medicare invoices and received more than $15 million in improper payments.
The past two years have seen a tremendous surge in the number of providers and suppliers who have been banned from billing Medicare for services rendered. The number coincides with a sharp increase in the legal actions taken against doctors and medical suppliers in cases of Medicare fraud. According to the Department of Health and Human Services, revocations in the last two years were approximately 250 percent higher than the two-year period that preceded it. That number is nationwide. In some areas, revocations are up nearly 400 percent.
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.
In 2007, the government set up a law enforcement group known as the Health Care Fraud Prevention and Enforcement Action Team, shortened to HEAT. The group now has branch offices in nine cities, including Miami. Since its inception, HEAT Task Force agents have charged nearly 1,500 people with health care fraud totaling $4.8 billion. More than 50 percent of the fraud cases identified by HEAT were originated from the Miami office. Law enforcement has repeatedly labeled Miami as the epicenter of all health care fraud activity in the United States.
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.
In recent years, Florida has become the center of fraudulent activity according to many. South Florida, particularly Tampa and Miami, has seen a sharp increase in arrests and prosecutions for many types of fraud. Florida is now considered the hub of mortgage fraud, Medicare fraud and tax fraud among law enforcement officials. In response, state and federal agencies are devoting greater resources in a targeted attack on people suspected of fraud. The Fort Myers Fraud Conference last week covered many of the issues surrounding the proliferation of fraud and the means used to prevent it.
The former owner of a string of discount pharmacies was sentenced to 14 years in prison this week. The man pleaded guilty last December to charges of conspiracy to commit health care fraud and conspiracy to defraud the United States. According to the allegations against him, he defrauded the government of $23 million in fraudulent Medicare claims. In addition to the lengthy prison sentence, the man will likely be ordered to pay restitution. The issue of restitution will be decided in a hearing scheduled for late April.
A South Florida eye doctor is at the heart of a scandal that includes prostitution, political corruption and possible Medicare fraud. The doctor is facing numerous allegations and was the subject of a raid by the Federal Bureau of Investigation and the U.S. Department of Health and Human Services. He was already involved in an investigation regarding his dealings with New Jersey Senator Bob Menendez. The doctor is already the subject of an Internal Revenue Service lien of $11.1 million based on back taxes owed. Despite the two-day raid, some are still convinced that the controversy is politically based.