Department of Justice charges 16 in multi-million dollar Medicare fraud schemes
In the span of less than a week, the U.S. Department of Justice secured indictments on 16 Miami-Dade County, Fla., individuals linked to Medicare fraud schemes totaling more than $120 million.
Eight Miami, Fla., residents were indicted June 18 in what officials said was a five-state, $100 million Medicare and Medicare Advantage Fraud Scheme, according to the U.S. Attorney’s Office in the Southern District of Florida. Authorities say the schemes involved two separate conspiracies.
In one alleged fraud scheme, six purported medical clinics in Miami-Dade County, Fla., submitted at least $50.2 million in false claims to Medicare for infusion therapy, injection therapy and other expensive medical treatments designed to treat patients suffering from illnesses including HIV, AIDS, and cancer.
As a result of the fraudulent claims, Medicare paid out $19.2 million, the Department of Justice said.
In the second Medicare fraud conspiracy, officials said, two individuals set up false medical clinics in Florida, Georgia, Louisiana, North Carolina and South Carolina, collectively submitting at least $19.8 million in false claims to various private insurance companies that offered coverage to Medicare beneficiaries through Medicare Advantage programs. Based on the false claims, the companies paid out $4.6 million, mostly for expensive cancer and HIV infusion medications.
Eight days after those indictments, the Southern District of Florida office announced another eight Miami-area residents were being charged in an alleged $22 million Medicare fraud scheme involving home health care agencies.
That indictment charges another eight individuals linked to a pair of agencies purported to be home health companies catering to Medicare beneficiaries. The indictment alleges that at both agencies, beneficiaries were recruited and received kickbacks and bribes to arrange for their Medicare beneficiary numbers to be used by their co-conspirators to file claims with Medicare for services that were never provided and not medically necessary, according to the Department of Justice.
The two agencies submitted more than $22 million to Medicare for services and were paid more than $15 million for the alleged fraudulent claims, officials said.
In conjunction with the criminal case, the U.S. Attorney’s Office also obtained a temporary restraining order to freeze the assets of the two home health care agencies.
“Health care fraud schemes in South Florida range from simple billing schemes and fly-by-night durable medical equipment providers, to more sophisticated frauds, including infusion fraud, fraud on the Medicare Advantage Program, and now fraud in the delivery of home health services,” said acting U.S. Attorney Jeffrey H. Sloman in a statement. “Today’s coordinated criminal and civil action delivers an effective one-two punch to health care fraudsters: they were not only caught and criminally charged, but they are also being stripped of their illegal proceeds.”


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