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Miami Hospital Executive, Nine Others Charged in $1.4 Billion Rural Hospital Billing Scheme in Florida

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adhy-savala-zbpgmGe27p8-unsplash-300x18810 people from Florida and elsewhere are accused of submitting $1.4 billion in fraudulent bills to insurance providers through rural hospitals, federal prosecutors announced Monday.

The indictment charges Jorge A. Perez, 60, of Miami-Dade, FL, and nine other defendants with health care fraud for allegedly exploiting federal regulations that allow some rural hospitals to charge significantly steeper rates for laboratory testing. The nine others named in the indictment are:

  • Seth Guterman, 54, of Chicago, IL
  • Ricardo Perez, 57, of Miami-Dade County, Fl
  • Aaron Durall, 48, of Broward County, FL
  • Neisha Zaffuto, 44, of Broward County, FL
  • Christian Fletcher, 34, of Atlanta, GA
  • James Porter Jr., 49, of Marion County, FL
  • Sean Porter, 52, of Citrus County, FL
  • Aaron Alonzo, 44, of Miami-Dade County, FL
  • Nestor Rojas, 45, of Miami-Dade County, FL

According to the indictment filed in the U.S. District Court in Jacksonville, the defendants allegedly bilked Florida Blue and other private insurance companies out of $1.4 billion to process urine and blood tests for patients who never set foot in their hospitals. Through the alleged fraud scheme, the defendants were purportedly able to obtain $400 million in reimbursements because the hospitals they used qualified for higher insurance payments.

“This was allegedly a massive, multi-state scheme to use small, rural hospitals as a hub for millions of dollars in fraudulent billings of private insurers,” said Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division. “The charges announced today make clear that the department is committed to dismantling fraud schemes that target our health care system, however complex or elaborate.”

The indictment claims Perez and some of the other defendants took over multiple struggling rural hospitals that had contractually negotiated higher reimbursement rates with private insurers for tests that were billed through outside labs. The rural hospitals involved in the alleged scheme are:

  • Cambellton-Graceville Hospital in Graceville, FL
  • Regional General Hospital in Williston, FL
  • Chestatee Regional Hospital in Dahlonega, GA
  • Putnam County Memorial Hospital in Unionville, MI

Perez and his co-conspirators reportedly used the hospitals as a shell to fraudulently bill insurers for tests that were often not medically necessary. They obtained the samples for testing by paying kickbacks to recruiters from substance abuse treatment centers and sober homes.

Many of the hospitals they managed have since shut down as they ran out of money when insurance providers refused to pay for the fraudulent billing. Half of the rural hospital bankruptcies filed in the U.S. in 2019 were affiliated with Perez’s enterprise, sources indicate.

“Trust and integrity undergird the confidence and reliability in our healthcare system,” said U.S. Attorney Maria Chapa Lopez for the Middle District of Florida. “Fraudulent and deceptive business practices undermine those values and erode the public’s trust in the system. We will continue to pursue those who set these tenets aside and compromise the care and safety of our citizens for profit.”

Billing fraud is the most common form of health care fraud. Anyone charged with this offense should immediately consult an experienced fraud defense attorney who can review the case and tailor a winning defense strategy.

South Florida Fraud Defense Attorney

Are you accused of committing health care fraud in South Florida? Contact Brian Silber, P.A. for a free initial consultation with one of South Florida’s most experienced fraud defense attorneys.

Source: 6.29.20 10 defendants charged in $1.4 billion rural hospital pass-through billing scheme.pdf

Florida Man Who Operates Durable Medical Equipment Company Charged in Health Care Fraud Scheme

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pexels-photo-48604-300x191Authorities in Georgia have announced charges against a Florida man who operated a durable medical equipment company in the state for his alleged involvement in a Medicare kickback and telemedicine fraud scheme.

According to court documents, Patrick Wolfe, 48, of Belleair Beach, FL, was the owner of Wilmington Island Medical Inc., which does business as WI Medical Inc. in Georgia. He is accused of conspiring to pay kickbacks for “leads,” which were in actuality signed orders from doctors and nurses, and then billing those orders to Medicare Part B and Medicare Part C through his medical equipment company.

The amount of money Wolfe amassed through the alleged scheme is believed to be in the millions. He is the 25th defendant investigated as part of “Operation Double Helix” and “Operation Brace Yourself,” which are nationwide operations by the Department of Justice that have thus far included allegations involving billions of dollars in fraudulent claims for pain creams, genetic testing, orthotic braces, and other items.

Previous charges in this string of cases include eight physicians, two nurse practitioners, three operators of different telemedicine companies, two patient data brokers, and several owners of durable medical equipment companies. The Medicare and Medicaid beneficiaries whose identities were used as part of the fraud schemes are from all over the U.S., including the Southern District of Georgia.

“White collar crime—and particularly health care fraud—continues to be a priority for this office and we are proud to work with our dedicated law enforcement partners to aggressively pursue those who illegally exploit government safety-net programs for personal gain,” said U.S. Attorney Bobby L. Christine for the Southern District of Georgia.

These cases amount to the largest fraud operation prosecuted in the history of the Southern District of Georgia, with a combined total of more than $475 million charged so far, according to Christine.

“This is another in a long line of charges in a continuous investigation into fraud that hurts every taxpayer and steals money earmarked for those who need it to meet their healthcare issues,” said Chris Hacker, Special Agent in Charge of FBI Atlanta. “The FBI and our fellow federal partners will not rest until everyone involved in wrongdoing is brought to justice.”

Telemedicine refers to all the ways a patient and a doctor can use technology to communicate without being in the same room. It includes emails, phone calls, video calls, and text messages. As telemedicine becomes a more common practice in our healthcare system, particularly during the coronavirus pandemic, accusations of fraud and kickbacks are also on the rise.

Any physician, nurse practitioner, or medicine equipment manufacturer suspected of fraud or accepting illegal kickbacks relating to telemedicine, including fraud related to COVID-19, should immediately consult an experienced healthcare fraud attorney who can review the case and determine the best course of action.

South Florida Health Care Fraud Attorney

Accused of committing healthcare fraud? Contact Brian Silber, P.A. for a free initial consultation with one of Miami’s most experienced healthcare fraud defense attorneys.

Source: 5.13.20 Durable medical equipment company owner charged in kickback scheme.pdf

John Holland Accused of Paying Bribes and Defrauding Medicaid of Millions in Miami, Florida

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John_Holland-199x300John Holland, a former Tenet Healthcare Corp (THC) senior vice president, has been charged in Miami, Florida for allegedly paying millions in kickbacks to a clinic in exchange for patient referrals in a scheme to defraud Medicaid of millions of dollars.

Holland, 59, also purportedly misled federal authorities about THC’s amends for illegal billing practices over the past decade. He was indicted last week on mail, kickback and healthcare fraud charges and pleaded not guilty to all the charges on Wednesday.

According to indictment, Holland reportedly paid Clinica de la Mama $12 million in kickbacks and in exchange, the clinic referred pregnant women to THC’s hospitals for neonatal services that were charged to Medicaid.

Clinica de la Mama predominantly provided care to undocumented immigrants before referring them to the THC’s hospitals in South Carolina and Georgia. While the undocumented women were not eligible for Medicaid benefits, they still qualified for services like emergency delivery at the expense of American taxpayers.

Holland allegedly paid the kickbacks by falsifying THC’s records and circumventing the corporation’s internal accounting controls. THC is the country’s second-largest hospital chain with a dozen hospitals in Florida alone. The corporation has previously paid a $513 million settlement to resolve civil claims with the Justice Department.

Holland is being charged in Miami because the hospital chain reportedly bilked at least $400 million from Medicaid through a billing center in Boca Raton that he controlled.

Source: 2.1.17 Holland Medicare Fraud.pdf | Image Source: Businesswire.com