Medicaid fraud

Troubling allegations continue to emerge that the Naples-based Health Management Associates illegally pressured doctors and hospital staffs to admit and illegally bill Medicaid and Medicare, all in the name of making money.

The U.S. Department of Justice has signed on to eight false claims lawsuits against Health Management Associates, claiming the Naples-based hospital chain billed for unnecessary patient admissions and paid kickbacks to doctors who referred patients.

The government specifically alleges that former HMA executive Gary Newsome personally led the push to pressure emergency department physicians and hospital administrators to increase the number of inpatient admissions, “regardless of medical necessity,” the Department said in a statement.

Florida, one of the nation's hotspots for Medicare and Medicaid fraud, is at particular risk as budget changes in Washington combine to force the layoff this year of 400 employees of the Inspector General's office at the Department of Health and Human Services.

It has become a mere annoyance, a cost of doing business, for health-care companies to pay fines for health-care fraud. But the outcome of the Justice Department's prosecution of four former executives of WellCare Health Plans for their role in a Florida Medicaid ripoff may make others think twice, the Tampa Bay Times says.

Just when it seemed the trial against four former WellCare Health Plans executives might never end, the jury on Monday returned a verdict that found each of them guilty on at least some of the charges, the Tampa Bay Times reported. 

WMFE News

Attorney Gen. Pam Bondi’s office announced two Medicaid fraud arrests this week. The larger one involved an Orlando-area woman who billed taxpayers $3 million for mental-health case work that was never done. As WMFE News reports, Bondi said the woman spent the money living high on the hog, on cruises, fancy cars, and $175,000 worth of Louis Vuitton bags. 

A whistle-blower’s secretly recorded tapes were played for jurors Monday in the Medicaid fraud cases against former WellCare executives, the Tampa Bay Times reports.  Prosecutors said the tapes show that the company tried to hide profits.

Greg West, the number-cruncher at WellCare Health Plans in the bad old days, testified Thursday that he was ordered to falsify reports to the state so the Medicaid HMO could pad its profits, the Tampa Tribune reported.

The day that WellCare Health Plans dreaded for years arrived on Tuesday: The criminal trial of four company ex-executives began in earnest in Tampa's federal court, with lots of accusations about health fraud and conspiracy.

As the Tampa Tribune reported, interest in the case is so high that the courtroom was packed, with spillover space on another floor.

A press release on Thursday touted Florida's Medicaid fraud- and abuse-fighting efforts last year, saying 437 pill mills were squashed and state taxpayers recouped nearly $50 million.  What the release failed to mention was the significant decline in fraud cases and audit recoveries.

Gov. Rick Scott was never charged with wrongdoing in the fraud case against the company he ran in the 1990s; executives just weren't prosecuted then. But things have changed. In a few weeks, former WellCare CEO Todd Farha and four others will go on criminal trial in Tampa on charges of Medicaid fraud.

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