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.
A report released by the Department of Health and Human Services and the Office of the Inspector General (OIG) outlines the difficulties that many businesses have in conforming to Medicare billing requirements. Roughly one quarter of durable medical equipment suppliers are accused of Medicare fraud in the first year they supply products covered by Medicare. The accusations typically concern fraudulent billing, meaning billing for services not provided or for services that are not properly covered by Medicare.
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.
There are roughly 6.6 million Medicare beneficiaries in Florida. The federal government is now looking to enlist the assistance of that group in uncovering Medicare fraud. The Florida Senior Medicare Patrol was given $400,000 for 2012 by the federal government as part of an anti-fraud campaign. The goal of the campaign is to enlist the assistance of seniors in identifying and avoiding Medicare fraud.
A recruiter has pleaded guilty for her role in an operation that resulted in more than $25 million in improper Medicare claims. Federal investigators arrested more than a dozen people in connection with the Medicare fraud scheme. The Department of Health and Human Services, along with the Department of Justice and the Federal Bureau of Investigation announced the plea this week as part of their nationwide efforts to target health care providers for improper billing.
Federal investigators might have a new target for Medicare fraud cases: hospice care providers. That industry has created headlines recently as high profile executives have been charged with fraudulent Medicare billing and with using taxpayer money for personal expenses. The entire hospice industry is facing fire for lax standards and insufficient controls on who gets billed and for what. With a large elder population, Florida is likely to be at the forefront of criminal investigations involving Medicare fraud and hospice care.
A Houston anesthesiologist was sentenced in federal court last week in connection with the use of her Medicare provider number. The woman's provider number was used to bill more than $29 million in fraudulent Medicare claims. The woman worked for City Nursing Services for a two year period where it was her role to decide which Medicare patients required physical therapy services. The owner of clinic used her provider number during her employment and continued to use it after she left. Last week, he was found guilty of Medicare fraud and received a sentence of 27 years in prison.
The owners and operators of a Lakeland, Florida, physical therapy business have been sentenced in federal court. The pair pleaded guilty to a charge of conspiracy to commit health care fraud for their roles in submitting more than $750,000 in fraudulent Medicare claims. The men were sentenced to 42 months and 46 months in prison. They were also ordered to pay restitution and will be subject to supervised release for up to three years after serving their sentences.
The September 18 blog detailed the case against a Miami executive who was accused of making $205 million in false Medicare claims as co-owner of American Therapeutic Corp. He was convicted and sentenced to 50 years in federal prison for Medicare fraud. Prosecutors are drawing attention to a new wrinkle that drew their attention in the case against the man and his company. He is said to have undertaken significant lobbying efforts in Washington to make it easier to obtain money through fraud.
The co-owner of American Therapeutic Corp., a 40 year old Miami woman, has been sentenced to 35 years in prison and ordered her and her associates to pay back $87 million in restitution. This Medicare fraud sentence comes close on the heels of the 50 year sentence received by fellow owner Lawrence Duran last week. The woman pleaded guilty to 21 felony counts for her role in operating the mental health company.