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Miami is center of Medicare fraud
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As part of the Obama administration’s focus on keeping healthcare costs down, more money and manpower will be allocated to teams from the Department of Justice and the Department of Health and Human Services in Miami, Houston, Detroit, Los Angeles and other strategic cities where officials say tens of billions of dollars are lost each year from Medicare fraud.
In Miami alone, long known as the center of US health care fraud committed by both providers and patients, the cost to the Medicare system has been more than $3 billion a year.
The new Health Care Fraud Prevention and Enforcement Action Team, has been dubbed the HEAT task force.
Some of the recent indictments and convictions involving Medicare in Miami-Dade in recent months include these cases:
-In January, the owners of two Miami Medicare clinics, along with their phlebotomist pleaded guilty to in a $5.3 million HIV and cancer infusion fraud scheme.
- In March, four Miami-area residents, including two physicians pleaded guilty in a $10 million fraud scheme involving HIV infusion clinics.
- In April, the, owner of Mitto Health Center, was sentenced to 46 months in prison for bilking Medicare of nearly $1.2 million for HIV infusion treatments.
- In May, the owner of a Hialeah pharmacy pleaded guilty to charges she submitted more than $5 million in fraudulent claims to Medicare for medical equipment, drugs and other healthcare items and services. She also admitted to laundering proceeds of her fraud scheme by writing thousands of dollars to carious entities.
- Also in May, a Miami physician was sentenced to eight years in prison and ordered to pay more than $9 million in restitution for his role in a multimillion-dollar Medicare fraud scheme involving HIV infusion services. The doctor was a co-owner of and clinician at Midway Medical Center, a Miami clinic that purported to specialize in the treatment of HIV patients. He admitted that, while at Midway, he and his co-conspirators billed Medicare for services that were medically unnecessary and in many instances never provided. He also admitted that he purchased only a small amount of the drugs that he claimed to administer to patients and that he falsified medical records. Several of his co-defendants have already been sentenced for their roles at Midway and related clinics.
-In June, eight residents of Miami were indicted on charges that they bilked Medicare out of nearly $100 million in a multi-state scam involving HIV infusion clinics, at least six of which operated with in Miami-Dade county. The clinics apparently submitted at least $50.2 million in false claims to Medicare for expensive medical treatments designed to treat patients suffering from cancer, HIV, AIDS, chronic pain, and varicose veins, according to the indictment. In a second alleged fraud that spanned five states, the defendants operated eight medical clinics and submitted at least $19.8 million in false claims, which paid the defendants approximately $4.6 million The defendants are also alleged to have used check-cashing stores to launder the proceeds.
“This case is remarkable, not only in terms of the amounts stolen from Medicare, but also in terms of its sophistication and geographic breadth,” Jeffrey H. Sloman, acting U.S. attorney told Florida Business News
-This month two Miami-Dade County men have been indicted in a $179 million Medicare fraud scheme involving durable medical equipment. Based on the fraudulent claims, the accused were paid about $56 million. In addition to health care fraud, they were charged with aggravated identity theft for using physicians’ Medicare identification numbers without the physicians’ authorization.
According to a comprehensive Miami Herald investigative report started last year, fraud is rampant in some neighborhoods where patients who barely speak English are recruited by brokers who offer hundreds of dollars for use of their Medicare numbers.
When the Justice Department started a strike force in Miami in 2007, there were just a handful of prosecutors. Federal and local officials often argued over whether to prosecute patients, along with the providers, who were participating in elaborate fraud schemes. Also by the time law enforcement was alerted to a suspicious company, the business might have already shut down, setting up somewhere else under a different name.
The new partnership and comprehensive national approach should promote better sharing of real-time intelligence data on health care fraud patterns. Agents will be able to monitor claims payment data, spot suspicious billing patterns immediately and conduct surveillance on targeted providers.
In addition to identifying Medicare fraud, the HEAT task force will work with state Medicaid officials to audit providers and more closely monitor their activities. The Justice Department is also working to establish more enforcement teams to prosecute fraud in the Medicare Part D program and the Medicaid/Children’s Health Insurance programs.
For more information: How to report Medicare fraud
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