When the owner of a Miami home healthcare agency was arrested this week in connection with an $8 million Medicare fraud scheme, attention was refocused on how home healthcare services have proven to be a fertile field for fraudulent schemes. And San Francisco qui tam lawsuit lawyer Gregory J. Brod would also point out that the news serves as a reminder that South Florida is a major hotbed for healthcare fraud.
According to the FBI Miami Division, an indictment that was returned on September 25 and unsealed on Tuesday charged Orelvis Olivera of Miami with conspiracy to commit healthcare and wire fraud, conspiracy to pay and receive kickbacks and paying and receiving kickbacks in connection with a federal healthcare benefit program.
The indictment accuses Olivera’s Acclaim Home Health, a Miami-based home healthcare agency, of purportedly providing home healthcare and physical therapy services to Medicare enrollees. Olivera allegedly paid kickbacks to patient recruiters in return for the recruiters’ referral of Medicare beneficiaries to his home healthcare agency. Olivera also allegedly solicited and received kickbacks in return for referring Medicare beneficiaries to other Miami-area home healthcare agencies.
As a result of the aforementioned alleged actions, from May 2008 to June 2014, Acclaim Home Health billed Medicare approximately $8 million for bogus claims and, in turn, Medicare paid Acclaim Home Health approximately $7.3 million for those claims.
As a measure of how serious a problem Medicare fraud is in the United States, the Medicare Fraud Strike Force, which was established in March 2007, has charged nearly 2,000 defendants who have collectively billed Medicare for more than $6 billion, but no one is certain how much fraud goes undetected. Conservative estimates have placed the hit to the taxpayers at $100 billion per year while more generous estimates peg the loss at closer to $300 billion every year.
Whatever the total amount of losses due to fraud really is, there is no doubt that South Florida could be dubbed “fraud central” in the United States without any exaggeration. Indeed, according to the Miami New Times, FSF prosecutors charged 1,480 defendants with $4.8 billion in fraud from 2007 through the spring of 2013 and more than half of those indictments originated from the unit in Miami. The depth and creativity of the schemes is so impressive that Special Agent in Charge Christopher Dennis calls Miami “the crown jewel of Medicare fraud,” and that “a lot of the schemes are typically started here (Miami) – and farmed out to other parts of the country.”
Home healthcare fraud schemes have been a particular problem in the Miami area, so much so that the state of Florida now requires health workers who conduct home visits to call in from the patient’s telephone during every appointment, thus allowing voice recognition technology to match the healthcare worker’s voice pattern against the one stored electronically, a procedure that has made a dent on billing for schemes in which no visit actually takes place.
But for every improvement in monitoring procedures, fraudsters invariably come up with new schemes to remain steps ahead of the authorities. That is why the role of a whistleblower with information about fraud is so important to the quest of going after fraudsters who might not otherwise be prosecuted. Whistleblowers enjoy protections under the federal False Claims Act, and their sharing of key information with an experienced attorney can be the basis for a qui tam lawsuit on behalf of the government. Should funds be recovered from the schemers, the government will award the whistleblower a share of the proceeds. If you have such vital information on fraud committed against Medicare or any other government program, please contact the legal team at the Brod Law Firm for a free consultation.
-James Ambroff-Tahan contributed to this article.
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Medicare Fraud and the Home Health Care Industry