A new federal report points to South Florida as a hotspot of healthcare fraud. This report coincides with last week's jury verdict against the operators of a Miami mental health center. Both of these developments are examples of how prosecutors are increasingly focused on healthcare fraud cases in South Florida.
A wrongful termination lawsuit has led to accusations improper billing practices in a business comprised of nine doctors and six clinics. After firing an employee for "ongoing inappropriate and abusive conduct toward her supervisor and fellow employees" a Texas office may now face a Medicare fraud investigation if the fired employee's story is given credence by investigators.
The U.S. Government has decided to work in concert with state investigators and private insurance companies to target health care fraud. The partnership is intended to greatly increase the collaboration and overall effort to arrest and prosecute individuals and businesses suspected of Medicaid or Medicare fraud. The renewed efforts were no doubt inspired by the overhaul of the health care system by the Obama administration.
North Carolina is one of many jurisdictions testing new methods to avoid overpaying for Medicare and Medicaid expenses. IBM has developed software that uses predictive analytics to unearth potentially fraudulent Medicaid payments. The fraud detection software analyzes millions of claims for Medicaid eligible patients and looks for billing patterns that have been identified as potentially fraudulent. The goal of the systems is generally to avoid approving improper payments rather than waiting to pursue civil remedies from hospitals, doctors and other health care providers for Medicare or Medicaid fraud after the money has changed hands.
Seven defendants, mostly medical professionals, are standing trial for what federal prosecutors claim was a scheme to put patients in group therapy who could not benefit from the treatment in order to bill Medicare. The trial, which began on April 11, is another prong in the Justice Department's aggressive prosecution of employees of American Therapeutic Corp., a Miami-based chain of mental health clinics.
State officials released the results of the 2011 fiscal year recently. In total, the state is claiming it recovered $142 million in Medicaid fraud actions. That number comes from a report filed by the Florida Attorney General's Office and the Florida Agency for Health Care Administration. The time and resources used to investigate and prosecute Medicaid fraud cases has grown in recent years. The increased emphasis comes as the government looks to justify the increasing budget dedicated to Medicare and Medicaid.
The Department of Justice, the Federal Bureau of Investigation and the Department of Health and Human Services issued a joint statement yesterday. The groups charged a Houston area hospital administrator with seven counts in connection with fraudulent Medicare billing at his facility. The charges were again the result of the ongoing Medicare Fraud Strike Force investigations that have been conducted all over the country.
The fallout from the American Therapeutic Corp. case continued today as a Miami woman entered a guilty plea in federal court. The $200 million Medicare fraud case has led to 20 indictments of doctors, administrators, executives and others in South Florida. Ten criminal defendants have already entered guilty pleas or been found guilty at trial. The rest have been scheduled for trial in April.
The owner and operator of a halfway house in Fort Lauderdale is facing up to 10 years in prison and $250,000 in fines. He has pleaded guilty to conspiracy to commit health care fraud in Miami federal court. The man was accused of sending the residents of his halfway house to American Therapeutic Corp. and the American Sleep Institute for fake sleep treatments. He would receive a kickback for the patients he sent and those companies would bill Medicare for treatments that were unnecessary or were not even administered.
Florida is the lone testing ground in America for a new program for certain types of Medicare hospital payments. As a well known hot bed for Medicare fraud, Florida was chosen by government officials to determine if the new method could reduce the number of improper payments made under the system. The program targets heart operations and a few other specific medical procedures that are commonly used in health care fraud schemes. This particular program requires that all payments for these particular treatments be pre-approved by Medicare contractors.