Tag Archives: medicare fraud

Three Sentenced in Miami For Medicare Fraud

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This week in Miami, three individuals related to a home therapy and care service were sentenced to prison, after having been convicted of conspiracy to commit health care fraud last year. The individuals, who operated Nany Home Health Inc were, according to court records, responsible for over fifty million in Medicare Fraud.

The defendants, Robert Gonzalez, Olga Gonzalez, and Fabian Gonzalez were sentenced to 120, 87, and 87 months in federal prison respectively, as well as 36 months of probation after their release. They were also fined forty million dollars, which is expected to be paid as a single fine for all co-defendants.

The owners of this home healthcare business plead guilty to a single count of conspiracy to commit healthcare fraud earlier and, as part of their plea agreement, admitted to attempting to defraud the US Federal Government. They admitted their role in utilizing patient recruiters, who were paid illegal kickbacks for providing Medicare patients to use their service. This included not just physical therapy, but also prescription drug fraud and unneeded medical services.

One interesting difference between this and some of the other common Medicare scams that involve recruiters is that, allegedly, the Gonzalez’s used staffing agencies located in Miami to help provide patients.

Prosecutors contend that many of the patients that received home healthcare services from the Gonzalez’s company were not qualified to receive these Medicare benefits, allegedly falsifying patient records to include symptoms that the Medicare recipient did not actually have.

The Medicare fraud is alleged to have taken place between 2006 and 2009, receiving almost forty million dollars from fraudulent claims they submitted to Medicare.

Nany Home Health is based in Florida and provided services to those on Medicare, including physical therapy and general home healthcare. According to public records, Nany Home Health Inc, which has a Miami address, has been in business for over 15 years, with tax records going back to 1995. Court records indicate that Roberto Gonzalez was the president, Olga Gonzalez was the vice-president, and Fabian Gonzalez was more closely tied to general operations.

Owner of Miami Clinic Gets 22 Years for Medicare Fraud

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As an update to yesterdays post, Michael De Jesus Huarte, who ran a clinic that committed Medicare Fraud in Miami, as well as several other southern states, including North Carolina, South Carolina, Louisiana, and Georgia, has been sentenced to 22 years in prison.

Huarte pleaded guilty to Medicare Fraud and Money Laundering, as well as several other charges last year, which stemmed from over $100 Million in fraudulent claims. Many of these claims were associated with HIV treatment. Huarte was sentenced yesterday, Wednesday January 27 2009, to 22 years in prison. In total, six people were indicted with Huarte, who were found to be complicit in Medicare Fraud. However, three of these defendants have been reported to have fled Miami or at least did not show up for their sentencing.

Medicare Fraud is very common and often involves filing false claims for durable medical equipment, although as is the case with Huarte, many also bill Medicare for procedures that are not preformed. Medicare, which is a state run insurance program mainly aimed at providing affordable health care to those over 65, has a long history of problems with fraudulent claims, so it is common for the courts to hand out very strict sentences in an effort to make an example of those who are caught.

Medicare Fraud Report

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Medicare, which is Federally Run Insurance/Heath Care System, is one of the most controversial departments of the US Government. It is often ripe with fraud and many in the Health Care Industry feel that Medicare and Medicaid do not pay enough to cover the costs of their service. However, many others, including many of those who are on Medicare, feel that it offers a quality of service that would be unaffordable for many seniors.

Medicare Fraud is actually one of the biggest downsides of Medicare and is something that is constantly occurring. For example, just in the last day, there are about 1000 newspapers articles in the Google News Database that are about Medicare Fraud. Of course, many of these are likely about similar cases, but it serves to illustrate how prevalent this problem is in Medicare.

Medicare Fraud Watch

In Miami, the owner of a Medicare Clinic is facing prison time and will be sentenced today, after submitting $100 million of fraudulent HIV claims and $30 Million in Fraudulent Medicare Claims. This occurred not only in Florida, but also North Carolina, Georgia, South Carolina, and Louisiana. Michel De Jesus Huarte, the owner of the clinic, faces up to 20 years in prison, while six others are also facing prison time.

In California, the owners of a Medical Center that found homeless people and preformed unneeded services on them has been ordered to pay $10 Million. The owners paid people who worked at homeless shelters to act as recruiters, finding homeless people that were on Medicare or Medicaid and paying using them, albeit as employees, in defrauding the government.

In Houston Texas, several individuals who own a durable medical equipment company were just sentenced to repay $36 Million in fines, after they used their position in the home medical equipment industry to bill Medicare for different types of durable medical equipment, like adjustable beds and mobility scooters, which was never actually given to the patient.

Common Types of Medicare Fraud

There are a lot of different types of Medicare Fraud, but more often than not, it is the suppliers of durable medical equipment who are found to be committing these crimes.

Medicare Part B Benefits include the coverage of durable medical equipment, which includes a wide variety of home medical equipment, such as wheelchairs, scooters, and adjustable beds. It also covers glasses, prostheses, and oxygen equipment. In most cases, providing the patient is covered by Medicare and has a prescription for the equipment, Medicare will cover 80% of the cost. There are exceptions to this rule though, such as Medicare Lift Chairs, which are not completely covered. However, for the most part, as long as there is a medical need for the item, Medicare will provide 80% reimbursement for it.

Unfortunately, the home medical equipment industry has always been ripe with fraud, not just with Medicare. This is in part because medical equipment suppliers are not necessarily run by health care professionals or doctors. Instead, they are usually business people who are out to make a profit, which of course leads to abuse. Also, it is much easier to fraudulently sell Medical Equipment than it is to bill for services that are not preformed, so Durable Medical Equipment fraud remains one of the most common types of Medicare Fraud.

Of course, as the examples above illustrate, there are many other types of Medicare Fraud and fraudulent billing is also very common.

The prevalence of this type of dishonest medical billing is one factor that many are using to argue against a state run health care program. However, to be fair, Insurance Fraud occurs all the time in all private insurance as well. However, since most private insurance companies are in the business of denying claims, rather than approving them, Medicare makes an easier target.