Miami is an epicenter of fraud related to government-run healthcare programs such as Medicare and Medicaid. Each year, we see medical facility and pharmacy owners, doctors, and even hospital systems wrapped up in fraudulent billing or referral practices. Just this summer, there have been two major fraud-related crackdowns that have affected a wide network of assisted-living facilities here in Miami. These stories show the intricacies and details of how serious this issue is here in South Florida.
Florida Pharmacy and Assisted-Living Facility Owner Kickbacks
This summer, 10 assisted-living facility (ALF) owners were arrested in connection with a kickback scheme that defrauded Medicare and Medicaid out of over a million dollars. The owner of Florida Pharmacy in Hialeah admitted to paying kickbacks to the ALF owners for sending Medicare and Medicaid patients receiving prescriptions and durable medical equipment to her pharmacy. The ALF owners would then return any unused medications to the pharmacy for resale, which would create a situation where the government programs would be fraudulently billed twice by the pharmacy for the drugs or equipment. In all, $1,446,551 in fraudulent funds was pushed through the pharmacy owner's account, where she wrote checks for herself, and eventually handed out kickbacks to the ALF owners for their part in the scheme.
Most of the parties involved with this crime received a sentence of a year and a day in federal prison, along with three years of supervised release.
State Worker Accused of Accepting Bribes from ALF Owner
In another case, a state healthcare worker is arrested on charges that she helped a local ALF owner by warning him of deficiencies in his businesses, as well as informing him when to expect "surprise" visits from state inspectors in exchange for cash bribes. In turn, the owner could prepare his facilities in advance of inspections and avoid revocation of his license in order to continue to bill Medicare for fraudulent medical services. The ALF owner is accused of exploiting his network of 20 Miami-Dade County ALFs to file false claims for services that were not necessary or not even provided. He is also accused of working with doctors and hospital workers for a referral circuit that would send patients to his facility and back to the hospital again. Through his network of co-conspirators, over $1 billion was billed for medical services between 2009 and last year, with Medicare paying out $500 million of that. The network of conspirators of these claims took home about half of that money.
Medicare and Medicaid fraud is a serious crime. If you have been accused of fraudulent billing or activities, it's important that you contact an experienced defense attorney. Your attorney will help you understand the charges brought against you, and may be able to lessen your charges or punishment.
Florida healthcare official charged in $1B Medicare/Medicaid fraud case. (n.d.). Retrieved August 02, 2017, from http://www.modernhealthcare.com/article/20170731/NEWS/170739997
[email protected], D. J. (n.d.). These 10 people assisted in a million-dollar Medicare fraud. Now they're paying for it. Retrieved August 02, 2017, from http://www.miamiherald.com/news/local/community/miami-dade/hialeah/article163906828.html