by – Sheri de Grom
Compiling satisfactory evidence for prosecution of individual(s) committing health care fraud requires thousands of man hours and sheer determination that this time, this one isn’t going to get away. Often it takes years of full-time investigation on one case.
I thought you might be interested in how serious health care fraud must be before it will be considered for prosecution. The following actions occurred in June, 2014 and they represent a small fraction of current cases being worked.
The owners of Elizabethtown Hematology, PLC of Louisville, KY agreed to pay $3,739 to settle false billing to Medicare, Medicaid, Tricare and the Federal Employes Health Benefit Program.
Leonard Kibert, MD and four others of Houston, TX were charged in a 47-count indictment alleging a conspiracy to defraud Medicare of $2.9 million. A trial date is pending.
A Los Angeles physician was indicted for a $33 million scheme to defraud Medicare and one count of conspiracy to commit health care fraud. A trial date is pending.
Husband and wife owners of Ohio Ambulance Company were sentenced to prison and ordered to repay $800,000 to Medicaid for transportation services they didn’t actually provide.
Indictment of two Florida scientists for obtaining government research contracting by fraud. Additional charges included wire fraud, identity theft and falsification of records in a federal investigation. If convicted on all counts, each faces a maximum penalty of twenty years in federal prison. The United States is also seeking a money judgment in the amount of $10,000,000 which reflects the proceeds of the charged criminal conduct.
A Miami Beach osteopathic physician was sentenced to 70 months in prison followed by 3 years of supervised release as a result of a Medicare fraud scheme. In addition, the judge entered a $1.6 million forfeiture money judgment against the physician and ordered the forfeiture of his Miami Beach residence and a 2002 Mercedes Benz. The doctor is also to pay restitution to the Centers for Medicare and Medicaid Services.
The U.S. Department of Justice has ordered Omnicare, Inc., the nation’s largest nursing home pharmacy company to pay $124 million to settle allegations involving false billing to federal health care programs. Omnicare, Inc., has agreed to pay $124 million for allegedly offering improper financial incentives to skilled nursing facilities in return for their continued selection of Omnicare to supply drugs to elderly Medicare and Medicaid beneficiaries.
I could list page after page of medical fraud abuse convictions and indictments for June 2014. However, the purpose of this blog is to give you an idea of the size and frequency of fraudulent claims against Medicare and other health care insurance plans before prosecution will be considered.
I’ve seen thousands of cases wherein individual(s) are committing health care fraud on a daily basis, yet the dollars aren’t deemed high enough to qualify assigning a team of agents to investigate the activities in order to press federal charges.
Due diligence is required of every citizen to insure their insurance company is not being gouged by a medical provider and they are using your name in the process. Insurance fraud is the fastest growing criminal activity of white collar crime in the United States.