Three People Charged For $109 Million Scheme to Defraud Medicare, HIPAA Violations
Wednesday, March 17, 2021
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law
In October 2020, Massachusetts federal prosecutors charged three people for their alleged roles in a multi-million dollar plot to defraud Medicare. Two individuals allegedly collected patient data and sold it to the purported mastermind, who used it to submit $109 million in false claims.
The two individuals who allegedly obtained the patient information were both located in Florida, wouldn't ya know. They were each charged with one count of receiving more than $1.6 million kickbacks in connection with a federal health care program. Prosecutors charged the third individual with criminal violations of the Health Insurance Portability and Accountability Act (HIPAA).
Fraudulently Collecting & Using Private Patient Information.According to court documents, both individuals in Florida owned marketing companies that enlisted foreign call centers to contact Medicare beneficiaries. Using a prepared script, they allegedly asked the patients they called if they would be interested in receiving durable medical equipment (DME) such as knee braces or compression sleeves "at little to no cost."
The call centers would then collect information, including the patient's name, address, insurance number, Medicare number, and doctor's name and address, prosecutors said. The information was then sold to the third individual, who filed fraudulent Medicare claims for DME that was never prescribed and not medically necessary.
According to court records, the alleged co-conspirators used the same patients' information repeatedly through a different shell company each time. More than 1,000 of the claims were made under the names of deceased beneficiaries. Click here to view the criminal information in this case.
Read the DOJ's press release on this case for additional information.
Also, you can read one of my prior blogs on a similar case in Florida.
Don’t Wait Until It’s Too Late; Consult with a Health Law Attorney Experienced in Medicare Issues Now.The attorneys of The Health Law Firm represent durable medical equipment (DME) suppliers and other health care providers in Medicare audits, ZPIC audits, MAC audits and RAC audits throughout Florida and across the U.S. They also health care providers in qui tam or False Claims Act (whistle blower) litigation and in other complex medical litigation. They also represent DME suppliers, physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions, and termination from the Medicare or Medicaid programs, They represent health care providers in formal and informal administrative hearings, federal or state.
For more information please visit our website at www.TheHealthLawFirm.com or call (407) 331-6620 or toll-free (888) 331-6620.
Sources:Sinay, Reenat. "Feds Charge 3 In Alleged $109M Medicare Fraud Scheme." Law360. (October 2, 2020). Web.
Szaniszlo, Marie. "Three charged in multi-million dollar fraud scheme." Sentinel Enterprise. (October 2, 2020). Web.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 Toll-Free: (888) 331-6620.
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