In this story, two Miami men are sentenced to prison in a multi-million dollar false Medicare claims case. FROM THE SOUTH FLORIDA BUSINESS JOURNAL: Florida is considered the worst state for questionable Medicare billings by home health agencies – a problem so severe that regulators are considering a moratorium on new home health agencies in the state. Rogelio Rodriguez was sentenced to nine years while Raymond Aday was sentenced to four years and three months in prison. They were […]
Two health facility managers in Burlington, NC, plead guilty for fraudulently billing the state for services they never provided. FROM THE TIMES-NEWS: Fuller and McLean pleaded guilty to charges that they submitted or aided and abetted the submission of claims to the N.C. Medicaid program between June 2007 and Nov. 2008 for mental services that were never provided. The claims’ total came to about $400,000, the release said. McLean and Fuller “paid cash to some Medicaid recipients in order […]
The owner of a Harrisburg ambulance services company pleads guilty after facing indictments related to illegal billing. From The Patriot-News: …Sivchuk was indicted for allegedly billing Medicare illegally for non-emergency transports of Medicare clients to dialysis treatment centers. The claims were fraudulent, because the patients were ambulatory and the ambulance rides weren’t necessary, Smith said. He said investigators determined that Sivchuk sent doctored trip sheets with forged signatures to Medicare for reimbursement. The terms of Sivchuk’s plea agreement call […]
In this story, local agencies take action against growing Medicare fraud affecting families, children and the elderly in South Texas. FROM FOX RIO GRANDE VALLEY: According to the US Government, South Texas is the second most notorious area in the nation for medicare fraud. Today different agencies took action here in the valley. Since the day someone stole her credit card information. Dawn Grun says she knows she has to be very careful… Read the full story here.
Earlier this month, the departments of Justice and Health and Human services announced they recovered nearly $8 for every dollar invested in anti-fraud efforts in 2012. FROM HUFFINGTONPOST.COM: In particular, the hospital disclosed that it admitted patients for short stays – typically one or two days – that were not warranted by the patient’s medical condition, and thereby generated a larger reimbursement than was proper for each patient. Of the $4.9 million to be paid by St. Joseph’s, $4.6 […]
The Justice Department reports that a Towson, MD, hospital will pay $4.9M for false claims to Medicare, Medicaid and other federal healthcare programs. FROM THE U.S. DEPARTMENT OF JUSTICE: In particular, the hospital disclosed that it admitted patients for short stays – typically one or two days – that were not warranted by the patient’s medical condition, and thereby generated a larger reimbursement than was proper for each patient. Of the $4.9 million to be paid by St. Joseph’s, […]
In this story, Fox News discusses the rate of healthcare fraud and the impact on government retirement programs. FROM FOX BUSINESS NEWS: How big a retirement planning problem is Medicare fraud? In a May 2012 report, FBI Special Agent David Welker said, “The United States spends more than $2.5 trillion on health care annually, and rough estimates indicate that anywhere from 3% to 10% of all health care expenditures are attributed to fraud.” If you do Welker’s math, the […]
As part of ongoing coverage of healthcare fraud, CBS News delves into the case of The SCOOTER Store, a power wheelchair company that overbilled Medicare by $108 million. FROM CBS NEWS: The issue is that once a doctor has written a prescription, Medicare rarely verifies whether the chairs are actually necessary. The problem was crystallized when the Inspector General of the Department of Health and Human Services released this report, finding that industry-wide, 80 percent of Medicare payments for power […]
From the FBI website: Manhattan Doctor Pleads Guilty to $8.5 Million Medicare Fraud Scheme Preet Bharara, the United States Attorney for the Southern District of New York, announced that Dr. Roberto Aymat, a medical doctor, pled guilty today in Manhattan federal court to participating in a scheme to defraud Medicare out of approximately $8.5 million through the use of fraudulent HIV/AIDS clinics in New York. As part of the scheme, Aymat and others billed Medicare for medications that were […]
Recently, 60 Minutes investigated Health Management Associates, the fourth largest for-profit hospital chain in the country. An estimated $210 billion a year goes toward unnecessary tests and treatments, with a large chunk of those tests being billed to Medicare and Medicaid programs. Watch the story to learn more about widespread fraud in the system.