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Medicare Fraud – The Biggest Scam of Them All

medicare_180x120-150x120For months, we’ve been writing about the different types of crime in Palm Beach County and South Florida. We saved the worst for last – Medicare fraud. There is no bigger crime in Palm Beach County and South Florida. According to 60 Minutes; “…Medicare fraud – estimated now to total about $60 billion a year – has become one of, if not the most profitable, crimes in America. And if you want to find Medicare fraud, the first place you should look is in South Florida…”

It is bigger than mortgage fraud, real estate fraud, cocaine, crack, marijuana grow houses, Internet scams, pill mills, and all the others put together. Why is Medicare fraud so out-of-control in South Florida? Is it because of all the senior citizens who live in South Florida?

This is what 60 Minutes says:

“Is the Medicare fraud business bigger than the drug business now?”

“I think it’s way bigger,” said Kirk Ogrosky, a top Justice Department prosecutor.

Asked what changed, Ogrosky said, “The criminals changed. They’ve figured out that rather than stealing $100,000 or $200,000, they can steal $100 million.”

“South Florida has a healthcare fraud industry where people do nothing but recruit patients, get patient lists, find doctors, look on the Internet, find different scams. There are entire groups and entire organizations of people that are dedicated to nothing but committing fraud, finding a better way to steal from Medicare,” FBI Special Agent Brian Waterman said.

Here is a recent arrest:

Two South Florida brothers were charged with submitting $14 million in bogus bills to Medicare for HIV medical services. Rolando and Jose Nogueira, who owned an HIV clinic that was supposed to treat Medicare patients with the AIDS virus, were charged along with four other people last week. They owned a phony clinic called T&R Rehab. Medicare reimbursed more than $4 million to the clinic. Hundreds of thousands of Medicare dollars were laundered through an investment firm and medical company owned by associates of the Nogueira brothers, the indictment said.

The charge is a result of major investigations by the Justice Department and U.S. Attorney’s Office involving “HIV infusion” scams. The Health and Human Services office reported that South Florida clinics submitted $2.2 billion in claims for HIV therapy in 2005 alone – 22 times the total HIV bills filed by the rest of the country combined.

Medicare Fraud Defense in Palm Beach County

The government doesn’t fool around with Medicare fraud anymore – especially since health care is such a politcal hot potato these days. Palm Beach County Medicare fraud charges are usually brought against doctors, clinics, pharmacies and medical supply companies. Medicare fraud includes billing for medicines not provided to patients, billing for services not performed, billing for unneeded medical devices and billing for medical devices that patients never receive. A conviction in Palm Beach County for Medicare fraud carries maximum prison time and fines.

The Medicare and Medicaid programs are very confusing and complex. It is easy to unintentionally violate current fraud laws. A simple clerical error can get picked up by an audit and lead to an investigation. A qualified attorney may be able to prove there was no intent to commit fraud. If you have been charged or if you are being investigated for Medicare fraud, it is critical to contact a Palm Beach attorney with medical fraud experience stat.

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