A federal district court judge sentenced the owner of a Lauderhill healthcare facility to 30 months in prison for his participation in a Medicare kickback scheme. Receiving payments in exchange for Medicare referrals is a form of healthcare fraud.
According to some estimates, fraudulent healthcare claims account for nearly 10 percent of Medicaid and Medicare spending every year. New provisions in the Affordable Care Act arm government investigators with smarter enforcement tools to help them combat Medicare fraud.
The owner of a medical equipment company based in Miami has been placed on the most wanted list of fugitives by the Department of Health and Human Services inspector general. The man is wanted in connection with a Medicare fraud scheme that may have racked up as much as $11 million in fraudulent bills to the government program. The man is currently in a Spanish detention facility facing drug charges. U.S. authorities are attempting to have him extradited in order to charge him for his Medicare related activities.
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.
A Florida-based insurer recently agreed to pay nearly $140 million to the federal government and to nine states to resolve claims that it overbilled Medicare and Medicaid.
The Justice Department and the Department of Health and Human Services concluded that the Good Samaritan Hospital used leading questions in determining that some patients were suffering from malnutrition. Federal investigators accused the hospital of committing Medicaid and Medicare fraud based on the enhanced reimbursement rate the hospital could claim for patients due to the malnutrition finding. The hospital agreed to pay nearly $800,000 in penalties to settle the matter while stating, "We have provided the highest level of quality care to our patients in accordance with all laws and regulations."
A doctor who was charged in connection with the Miami-Dade home health care agencies ABC Home Health Care and Florida Home Health Providers has been found not guilty. If convicted of Medicare fraud, the man could have been sentenced to 15 years in prison. More than 50 people have been convicted in connection with the home health care agencies, including patient recruiters, doctors, nurses and other medical field professionals, as well as the co-owners of the agencies, themselves.
Halfway houses, nursing homes and assisted living facilities often house large numbers of Medicare and Medicaid eligible people. The U.S. Department of Justice has targeted practices involving those facilities in their broad sweep of potential Medicare fraud perpetrators. Two companies, American Therapeutic Corp and American Sleep Institute recruited these facilities to send them patients, in some cases paying kickbacks to facility personnel or owners and in some cases paying residents directly. The owner of a Broward halfway house became the latest person to be sentenced in the federal court in Miami for his involvement with ATC and ASI.
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.