Three Individuals Charged in $1 Billion Health Care Fraud Scheme.

Date posted: August 1, 2016

The Department of Justice (DOJ) recently announced that it brought criminal charges against three individuals for their participation in a $1 billion scheme involving several Miami-based health care providers.  The DOJ indicted the owner of numerous skilled nursing and assisted living facilities, a hospital administrator, and a physician’s assistant for defrauding Medicare and obstructing justice.  The charges and allegations surround the largest criminal health care fraud case brought upon individuals in Medicare Fraud Strike Force history.

Key allegations included the following:

  • The defendants wrongfully admitted and provided medically unnecessary services to unqualified beneficiaries;
  • The defendants directed the ineligible beneficiaries to other providers, including community mental health centers and home health care providers, in exchange for illegal kickbacks;
  • The providers offering kickbacks to the defendants also fraudulently billed Medicare and Medicaid for medically unnecessary services;
  • The defendants paid kickbacks in cash and categorized kickbacks as charitable donations, service payments, and lease payments to conceal them from law enforcement; and
  • Certain defendants attempted to flee the United States to avoid trial.

The DOJ advised that the charges are simply accusations, and the defendants are innocent until proven guilty in a court of law.

The DOJ Justice News article is available at:

United States Department of Justice.  “Three Individuals Charged in $1 Billion Medicare Fraud and Money Laundering Scheme.”  Justice News.  22 Jul. 2016.

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