Three Medicare fraud schemes in recent weeks have targeted a total $139.4 million, which led the Department of Justice to seek multiple convictions and a combined 33 years in prison sentences.
Each of the alleged schemes involved the use of provider kickbacks, a popular activity in healthcare, to entice healthcare professionals to inappropriately redirect clients and beneficiaries to specific healthcare businesses.
Law enforcement officials began their crackdown on Medicare fraud earlier in the year with a mix of provider convictions and settlements involving roughly $3 million dollars.
Combating healthcare fraud continues to be a top priority for law enforcement officials because of the dangers it presents to vulnerable beneficiaries in the Medicare program, as well as the potential to recover billions in Medicare spending.
A Detroit provider was sentenced to six years in prison for $10.4 kickback scheme. The case apparently involved kickbacks for unnecessary electromyogram (EMG) tests and physical therapy tests.
He was convicted of one count of conspiracy to commit healthcare fraud, one count of wire fraud, two counts of receiving healthcare kickbacks, and had to personally forfeit $1.69 million.
A 70-year-old Boca Raton man was sentenced to five years in prison for $63 million in home health care fraud. Him and eleven other co-conspirators apparently submitted false and fraudulent claims to Medicare through kickbacks that were medically unnecessary, were not eligible for Medicare reimbursement, or were never provided by his clinic.
The man was found guilty of hiding the payments by using his clinic to provide a salary through the kickbacks, and was paid a flat rate based on the number of individuals he referred. The man also admitted patients for partial hospitalization program (PHP) services even though he knew the patients didn’t qualify for PHP service.
He was convicted of one charge of conspiracy to defraud the United States and to receive healthcare kickbacks. He personally had to forfeit $9.9 million and a personal money judgement over $400,000.
The case was investigated by the FBI, HHS, and OIG with supervision from the Medicare Fraud Strike Force and the US Attorney’s Office for the Southern District of Florida.
A 52-year-old Miami owner of multiple home health agencies was sentenced to 20 years in prison for $66 million in Medicare fraud that used his network of 20 home health agencies to host an elaborate kickback scheme.
The man and other co-conspirators were found guilty of recruiting individuals to represent his home health agencies in order to hide the man’s identity as they paid illegal bribes and kickbacks to patient recruiters to refer patients to these agencies.
The man also admitted that he submitted false and fraudulent home healthcare claims for Medicare beneficiaries that did not qualify for many services.
He had to forfeit $66.4 million in restitution and is convicted of one count of conspiracy to commit healthcare fraud and wire fraud.
The case was investigated by the FBI and was brought forward by the Medicare Fraud Strike Force and the US Attorney’s Office for the Southern District of Florida.
The Federal Anti-Kickback Statute makes it a felony to knowingly and willfully offer, pay, solicit, or receive remuneration, directly or indirectly, in order to induce business that is reimbursable under any federal health care program, such as Medicare or Medicaid. If accused of this crime, you could be facing both criminal and civil penalties.
Are you under investigation for Medicare fraud? You are not alone. About 1,400 individuals are indicted in federal court for health care fraud every year and more than 2,500 individuals are currently being investigated for Medicare fraud.