Medicare fraud

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 U.S. Department of Justice claims a company with a Florida connection paid spinal surgeons kickback fees for using its devices, the Miami Herald reports (paywall alert).

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.

The last of about 40 defendants linked to a sprawling Medicare scam have been convicted in federal court, the Miami Herald reports.

A jury took just a few hours to find Roger Bergman, 65, and Rodolfo Santaya, 55, guilty for their involvement in the American Therapeutic Corp. scam that was first discovered in 2010, according to the Herald.

The owner of a Miami home health care company pleaded guilty for her connection to a $74 million Medicare fraud scheme.

The U.S. Department of Justice said Elsa Ruiz, owner of Professional Home Care Solutions Inc. and administrator of Miami’s LTC Professional Consultants Inc., admitted in federal court on Wednesday to one count of conspiracy to commit health care fraud.

The board overseeing Halifax Health on Friday will consider settling a whistle-blower lawsuit that already has cost the publicly owned hospital $109 million, the Daytona Beach News-Journal reports.

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.

A South Florida man has pleaded guilty to recruiting patients in exchange for illegal kickbacks as part a $205 million Medicare fraud scheme.

Former Network Resource Consultant Inc. chief Michael Mendoza pleaded guilty to health fraud conspiracy Thursday in Miami federal court. Mendoza faces a maximum of 10 years in prison at sentencing in August.

WUSF 89.7 News

While Gov. Rick Scott’s re-election campaign and the GOP are focusing on his role in creating jobs, the first Democratic TV ad of the 2014 governor’s race is set to bring up an old weakness: Columbia/HCA’s Medicare fraud.

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.

WellCare Health Plans

Todd Farha, former CEO of WellCare Health Plans, drew a three-year sentence for Medicaid fraud Monday, far below the sentencing guidelines. The judge said Farha has already suffered the loss of his reputation and career and that he is unlikely to repeat his "mistake."

Other former WellCare executives also drew sentences lighter than the guidelines:   former CFO Paul Behrens, two years; William Kale, who led the subsidiary where the fraud took place, one year and one day; and Peter Clay, a former vice president, who received probation.

HHS.gov

Fifty-seven people in Tampa and Miami were arrested Tuesday in a nationwide crackdown on Medicare fraud.

The U.S. Department of Health and Human Services (HHS) announced that the Medicare Fraud Strike Force made 90 arrests that included 27 doctors and other health care professionals. The schemes involved about $260 million in false billings, the agency said in a news release.

The Florida Department of Children and Families is asking a judge to approve the release of details on 177 children under agency care who have died since November.  The request follows criticism of the agency for withholding information on child deaths, the Miami Herald reports.

U.S. Coast Guard via Miami Herald

The search for an overdue boater wanted for Medicare fraud has been called off and officials suspect he has fled the country, the Miami Herald reports. Robert A. Garcia-Esquerro’s wife reported him missing May 4 to the U.S. Coast Guard, a day after he left the Key West Marina for a fishing trip.

A bruising $85 million whistle-blower settlement for Halifax Health won’t change its mission to remain a public hospital, its board chairman says.

While only a small fraction of doctors receive more than $3 million a year from Medicare, Florida accounts for way more than its share -- one in four. And guess which state is home to the doctor who made nearly $21 million?

Those are among the findings of an Associated Press analysis of physician data released Wednesday by the Obama administration, part of a move to open the books on health care financing.

 A crackdown on Medicare fraud in South Florida is pushing illegal prescription drug trafficking north, federal investigators told a U.S. Senate Committee.

The Senate Committee on Aging learned that groups are moving north of Miami, the epicenter of prescription drug trafficking, and into the Treasure Coast and Central Florida, the South Florida Sun Sentinel reports..

Halifax Health could be on the hook for $116 million to resolve part of a whistleblower lawsuit, the Daytona Beach News Journal reports.

Halifax Hospital agreed Monday to settle a whistle-blower case by paying an amount so large it breaks previous records for hospital systems accused of Medicare fraud.

(Update late Monday) Jurors prepared to be questioned in a Medicare fraud whistle-blower case Monday learned that Halifax Health has reached a partial settlement with the U.S. Department of Justice, the Daytona Beach News-Journal reports (paywall alert).

The Federal Bureau of Investigation

The FBI has arrested a Cuban immigrant who acted as a shell owner in a massive South Florida Medicare fraud ring, according to the Miami Herald.

Several doctors convicted in a $40-million pill mill case saw their sentences reduced substantially this week in exchange for testifying against two alleged co-conspirators: Drs. Cynthia Cadet and Joseph Castronuovo, the Palm Beach Post reports.  The oxycodone network is blamed for the deaths of 50 patients.

Federal officials are lengthening a temporary moratorium on new home health care agencies in Miami-Dade and Monroe counties, and have also included Broward County in the ban. As the Miami Herald reports, the six-month ban that starts today is an attempt to deter Medicare and Medicaid fraud. Federal health officials say Miami-Dade has the highest ratio of home health agencies to Medicare beneficiaries and has the biggest payments.

Public trading of shares for the Naples-based Health Management Associates chain ended Monday, as its multibillion-dollar sale neared completion. HMA’s 23 hospitals will now be added to the Community Health Systems’ chain.

The New York Stock Exchange suspended trading of the HMA stock, which has been converted into shares for its new parent company, Community Health Systems, according to corporate disclosure statements.

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.

The owner of a South Florida clinic has pleaded guilty to defrauding Medicare to the tune of almost $20 million, the Associated Press reports. Isabel Medina could face 10 years in prison for her role in several health schemes.

 

MIAMI - A South Florida woman has pleaded guilty to involvement in several health care fraud schemes that cost the Medicare program an estimated $20 million.

Former Merfi Corp. clinic owner Isabel Medina pleaded guilty Tuesday in Miami federal court to health care fraud conspiracy, which carries a maximum 10-year prison sentence. The 49-year-old Medina will be sentenced in March.

Adventist Health System/Sunbelt Inc., the parent company of Orlando-based Florida Hospital, has settled a whistleblower suit that alleged seven of its hospitals systematically overbilled federal programs Medicare, Medicaid and Tricare for more than a decade, the

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