fraud

Insurance giant Humana Inc., which operates some of the nation's largest private Medicare health plans, knew for years of billing fraud at some South Florida clinics but did little to curb the practice even though it could harm patients, a doctor alleges in a newly unsealed whistleblower lawsuit.

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Malachi Love-Robinson had all the trappings of a medical practice — an office, a lab coat and stethoscope.

What he didn't have, authorities say, was a medical license — few 18 year olds do.

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Rose Radiology Centers Inc. has agreed to pay $8.71 million to resolve claims of false billing and kickbacks revealed in two whistleblower lawsuits, according to a news release from the U.S. Attorney's Office for the Middle District of Florida.

Lawmakers put the brakes on a Medicaid reimbursement plan this week after Attorney General Pam Bondi attended the bill’s first committee hearing to speak against it.

Federal prosecutors say the nation's largest nursing home rehabilitation therapy provider has agreed to pay $125 million to resolve a lawsuit that alleged it knowingly had nursing homes submit false Medicare claims.

Questionable salaries of several Broward Health cardiologists is a central complaint in a whistleblower lawsuit that led to a recent $69.5 million settlement, the South Florida Sun Sentinel reports. The federal government challenged the hours reported by “medical directors” at Broward Health, according to the Sun Sentinel.

The U.S. Chamber of Commerce says Florida’s lawsuit climate is among the worst in the nation—for businesses. The business lobby association is pushing state legislators to crack down on trial lawyers—including one big name in the industry.

Psssst — Need a phony ID? A fraudulent tax refund? Insurance money from a sham car crash? Florida may have just what you're looking for.

Since the first settlers hacked their way into the mangrove tangles and drained much of the swampland, sunny South Florida has been virtually synonymous with shady deals and scams.

Under a plea deal with the U.S. Department of Justice, a Miami pharmacist has pleaded guilty to one count of health care fraud for his role in submitting more than $1.8 million in false claims to Medicare, according to a news release from the DOJ. Evelio Fernandez Penaranda, the owner of  Naranja Pharmacy Inc., admitted to submitting claims for Medicare beneficiaries and doctors without their consent.

Eastlakeoncology.com

 A Florida oncologist was charged Thursday with giving cancer patients medications, including chemotherapy drugs, from other countries that were not approved by the federal Food and Drug Administration.

A Jacksonville dermatology clinic accused of billing Medicare for cosmetic procedures that were not medically necessary has reached a settlement with federal investigators, the Florida Times-Union reports. 

Federal authorities haven’t publicly accused taxpayer supported Broward Health of submitting bogus claims to Medicare and Medicaid, but the health system still has racked up a $10.2 million tab for legal advice, the Florida Bulldog reports.

U.S. Department of Justice

A doctor who ran clinics in Boynton Beach and Delray Beach has been indicted on eight counts of fraud, the Palm Beach Post reports. 

Dr. Isaac Kojo Anakwah Thompson defrauded Medicare when he submitted fraudulent diagnoses to the Humana HMO network for Medicare Advantage beneficiaries and received $2.1 million in excess fees as a result of the scheme, according to the Post.

An Orlando man is facing 37 charges for taking $1.8 million from investors. Gus Papathanasopoulos, Founder and CEO of Neofat Industries Inc., is in custody in a hospital bed because of an undisclosed health condition.

His company had a patented process to combine vegetable and coconut oils, billed as a health product. Papathanasopoulos sold $1.8 million worth of stock starting in 2002. State officials say Papathanasopoulos loaned himself $1.3 million from the company and then forgave the loans as CEO.

St. John's County

Former employees of a medical clinic accuse the St. Johns County Commissioner and his mother of improperly billing for nearly 40 Medicaid patients, illegally storing controlled substances and forging prescriptions, the Florida Times-Union reports. 

The veteran business executive hired by Florida Healthcare Plus is trying to repair the image of the firm after six former employees were indicted for their role in an international, $25 million Medicare and Medicaid scam, the Miami Herald reports.

In an interview, Susan Rawlings Molina says no one else at the company knew about the fraud, except for the ex-employees who are now facing charges. Only the former workers, not the company, are accused of wrongdoing.

A Tampa man has been sentenced to 11 years in prison for his part in a $28.3 Medicare fraud scheme, the Tampa Bay Business Journal reports.  In his guilty plea, Luis Duluc admitted to using physical therapy clinics and other businesses to submit false claims to Medicare. He was also ordered to pay $14.4 million in restitution, according to the Business Journal. 

A whistleblower’s lawsuit by an ex-Plaza Health Network executive alleges that false claims were submitted to Medicare and Medicaid to the tune of $130 million, the Broward Bulldog reports.

The director of a Miami home health care agency will serve 57 months in prison for his role in a $7 million Medicare fraud scheme, the Miami Herald reports.  A federal judge sentenced Armando Buchillon of Hialeah for fraudulently billing Medicare for procedures such as physical therapy that never were performed at his company, Anna Nursing Services Corp., the Herald reports.

A Pensacola-area veterinarian who was accused of writing prescriptions for thousands of methadone tablets for his ex-wife’s dog -- but was actually giving them to his daughter-in-law -- has been sentenced to 20 months in state prison, the Pensacola News Journal reports.

College students studying whistleblower law heard a first-hand account from the woman who accused Halifax Health of Medicare fraud, the Daytona Beach-News Journal reports. 

For the first time, Elin Baklid-Kunz spoke publicly to Stetson University students about the whistleblower lawsuit that was settled earlier this year for $86 million, and earned $20.8 million for Baklid-Kunz and her attorneys.

Gov. Rick Scott’s leadership of the Columbia/HCA hospital chain is well known, as is the company’s record $1.7 billion fine for filing false claims for Medicare and other federal health programs.

But as he faces re-election, stories about a simultaneous investigation in the 1990s are emerging involving Scott and attempts to buy the then-publicly owned Tampa General Hospital, The Tampa Tribune reports.

The co-owner of a Miami home health agency was sentenced to 70 months in prison for fraudulently providing therapy to Medicare recipients.

Between 2008 and 2014, Annarella Garcia’s Professional Medical Home Health received approximately $6.25 million in fraudulent Medicare claims, the U.S. Department of Justice announced Wednesday.

A federal report  found that 24 percent of people with questionable Medicare billing for HIV drugs live in Miami, according to the South Florida Business Journal. That’s remarkable, considering only 2 percent of the nation’s Medicare beneficiaries who get HIV drugs live in the area.

Health care workers across Florida have been arrested this week on charges they broke the law while on the job.

In Escambia County, two assisted living facility supervisors were jailed for refusing mental health workers access to residents, meaning the patients went without treatment for weeks, according to the Pensacola News Journal.

Medicare Scam Fugitive Now Most Wanted

Jul 8, 2014
HHS

 A Miami man has been added to federal health officials' list of most wanted fugitives.

Sandy De La Fe was indicted last year on charges of conspiracy to commit health care fraud and health care fraud. Investigators say De La Fe owned a Miami pharmacy and participated in a prescription drug fraud scheme that bilked Medicare out of millions of dollars.

Shands Health Care System will pay $3.25 million to settle part of a whistle-blower lawsuit claiming six Shands hospitals billed and received overpayments from the government’s Medicare, Medicaid and Tricare programs, the Orlando Sentinel reports.

Instead of helping to plan his elegant July wedding at the Biltmore Hotel in Coral Gables,  Eduardo Perez de Morales is being held in the Broward County jail on charges of Medicare fraud, the Miami Herald reports.

A physician who ran the American Cancer Treatment Centers in Rockledge and Titusville for almost 20 years failed to put up a defense in a whistleblower Medicare fraud case because he thought it was moot when his medical practice filed for bankruptcy.

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