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Federal Florida jury finds four guilty in Medicare fraud case

Jul 2, 2013 | Fraud

A Florida federal jury recently found four defendants accused of a lucrative Medicare fraud scheme guilty of various fraud crimes and related charges, including wire fraud, health care fraud, conspiracy to commit wire and health care fraud and conspiracy to pay bribes in connection with Medicare.

The scheme — which billed more than $70 million in fraudulent or false charges to Medicare between 2003 and 2012 — was discovered by the federal Medicare Fraud Strike Force. The interagency cooperative group tasked with the overwhelming job of putting an end to Medicare fraud has gathered evidence to charge 1500 defendants who collectively submitted more than $5 billion worth of fraudulent charges to Medicare.

The four involved in this case were all affiliated with a Florida, state-licensed psychiatric care facility named Hollywood Pavilion. Some of the defendants handled the drafting and processing of fraudulent claims to be submitted to Medicare for payment, including creating a false document trail to make false claims appear legitimate as well as to hide payment of bribes and kickbacks to others associated with the criminal enterprise. The scheme involved claims both for treatment not needed by individual patients as well as treatments never actually given to patients.

This case is unique from other Medicare fraud schemes in that it not only involves the submission of false or fraudulent claims, but also the payment of bribes and kickbacks to patient coordinators who recruited patients to the facility in spite of a lack of diagnostic criteria suggesting that the purportedly comprehensive inpatient or outpatient care programs offered by Hollywood Pavilion was necessary.

Source: Washington Times, “Medicare fraud trial ends with 4 convictions,” Jerry Seper, June 30, 2013


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