Earlier this summer, three Florida residents were charged in the largest health care fraud case by individuals in the nation’s history. News reports estimate that the amount of the fraud totaled one billion dollars. Those indicted allegedly gave patients services that were medically unnecessary and then billed those services to Medicare and Medicaid, the government programs that provide health insurance to people who are poor, disabled, or elderly. They are also accused of receiving kickbacks from other medical providers who they would refer for more unnecessary medical procedures. Philip Esformes, one of the alleged main perpetrators of the scam, has been in trouble with the United Stated government before for similar types of fraud. He is also accused of laundering money through fake charities and other fraudulent businesses.
The Department of Justice issued a report about the case. While this is the largest single health care fraud case ever brought against individuals, the Department of Justice credits data-driven law enforcement and other law enforcement partners for helping to take down the large scheme. About a month before these arrests, law enforcement officials arrested over 300 other people for Medicare and Medicaid fraud, with a hundred of these arrests taking place in South Florida, a special hotspot for Medicare and Medicaid Fraud. There are many different ways that people commit Medicare and Medicaid fraud in Florida and elsewhere.
Different Kinds of Medicaid and Medicare Fraud
Medicare and Medicaid fraud include many different kinds of specific behaviors, including:
False Billing – False billing means billing for medical tests or treatments that were never given or performed. This is one of the more common kinds of Medicaid and Medicare fraud. Bills will be submitted to the health insurance programs for medications, tests, home health aides, or any other medical cost without it actually being provided.
Providing Medically Unnecessary Services – Another way that people try to scam the Medicaid and Medicare system is by performing tests or treatments that are not medically necessary and then billing the programs for these services.
Kickbacks to Medical Professionals – Kickbacks involve a scheme wherein one medical professional refers someone to another medical professional; then, when the patient accepts the referral and goes to the second doctor, the second doctor sends money to the first doctor.
Kickbacks to Patients or Recruiters – This is similar to kickbacks between medical professionals, but arises when someone is paid for either signing up for Medicaid or Medicare or when someone is paid for getting other people to sign up for Medicare and Medicaid.
Unnecessary Medications – Sometimes in order to keep patients either unaware or unwilling of the fraud doctors and pharmacists will provide access to controlled substances or other medications that are not medically indicated.
Contact Our West Palm Beach White Collar Crimes Attorneys Today
If you are accused or charged with Medicaid or Medicare fraud, you should contact a knowledgeable white collar crimes attorney as soon as possible to defend you. Medicaid and Medicare fraud are serious crimes that are being increasingly investigated and prosecuted. Our experienced white collar crime attorneys at The Skier Law Firm, P.A., in West Palm Beach Florida can defend you against the charges.