National Medicare Fraud Roundup Includes 73 South Floridians

The owner of a Miami mental health facility allegedly cheated the Medicare program out of $64 million by billing for treatments that were nothing more than moving patients from place to place, U.S. Attorney General Loretta Lynch said Thursday.

“Several of these patients suffered from illnesses like Alzheimer’s and dementia and were unable even to communicate with their supposed caregivers,” Lynch said.

Greater Miami Behavioral Healthcare owner Dean Butler and associates Nery Cowan and Irina Mora were indicted last week on charges including health care fraud, money laundering, conspiracy to defraud the United States, and paying and receiving health care kickbacks.

The charges are part of the largest criminal health care fraud takedown in the history of the Justice Department, Lynch said. Federal prosecutors charged or unveiled charges against 243 people over the past three days, including 73 in South Florida.

The South Florida schemes amounted to $262 million in false Medicare and Medicaid billings, U.S. Attorney Wifredo A. Ferrer said. Defendants include doctors, nurses, pharmacists and clinic owners.

“They have cast aside their professional oaths … for their own personal gain,” Ferrer said.

The effort by Medicare Fraud Strike Force was a collaboration of the U.S. Departments of Justice and Health and Human Services, seven U.S. attorney’s offices, and state and local law enforcement agencies.

South Florida saw a wave of health care fraud involving durable medical equipment that was never provided, Ferrer said. Nowadays, fraudulent billing tends to involve services such as home health care or community mental health.

The two biggest trends in the fraud roundup was alleged fraud and kickbacks connected to Medicare Part D, he said.

Fraudsters are increasingly taking advantage of Medicare’s prescription drug program through private insurance companies, Ferrer said. Small pharmacies are popping up around South Florida, billing for drugs that are not medically necessary or even provided to patients.

“A lot of these mom-and-pop pharmacies are billing more to Medicare Part D than the local Walgreens,” Ferrer said. “That doesn’t make sense.”

Miami resident Jorge Collazo, an owner of Sonic Pharmacy, was charged with health care fraud and wire fraud as part of the crackdown. He allegedly submitted fraudulent prescription drug claims and received more than $1.3 million in overpayments from Medicare drug plan sponsors in just three months.

Ferrer said those flash-in-the-pan schemes are common.

“Once Medicare finds them, they close down the shop and they open up another one,” he said.

Kickback schemes in South Florida are also becoming more common. Patients are paid to pretend to need medical services, hand over their drug cards or otherwise funnel money to patient recruiters.

“If anybody offers you money to go see a doctor, that’s fraud,” Ferrer said.


Recovering Funds

Ferrer said it is usually difficult for his office to recoup money in health care fraud schemes.

“The monies received from Medicare, they’re spent almost immediately,” he said.

In fiscal year 2014, Ferrer’s office recovered $125 million in health care fraud cases. Assistant U.S. attorneys helped obtain two major civil settlements in fraud cases this week, he said.

In Miami-Dade County, skilled nursing facility Hebrew Health Homes Network and former president William Zubkoff agreed Tuesday to pay $17 million to settle allegations that he improperly paid doctors for referrals of Medicare patients.

A Vero Beach doctor settled his case for $4 million Wednesday. The government alleged Donald Proctor’s Grove Place Surgery Center billed Medicare for Mohs skin cancer surgeries that were medically unnecessary or never occurred. The center will be excluded from federally funded medical programs for five years, Ferrer said.

Florida Attorney General Pam Bondi said the government crackdown serves as a warning to anyone who thinks of falsely billing Medicare.

“When you charge for a medical procedure you never performed, for something a patient never needed or asked for, and steal millions from our taxpayers, we are coming after you,” she said.


Source:  DBR

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