A Cell without a View


There are a variety of Medicare fraud and abuse laws on the books. If violated, penalties include nonpayment of claims, monetary penalties and exclusion from participation in the Medicare Program, as well as criminal or civil liability. One of these laws is called the Anti-Kickback Statute, which makes it a criminal offense to knowingly and willfully offer, pay, solicit or receive any payment or reward referrals of items or services paid by a federal health care program. As an article on WSVN.com reports, two Florida women are paying a pretty stiff penalty for their part in a Medicare kickback fraud scheme.

The story states that the defrauding duo was convicted of conspiracy and paying healthcare kickbacks from their home health agency, which provided skilled nursing and home health services to Medicare beneficiaries. The women paid approximately $141,000 in bribes and kickbacks to recruiters to obtain patients for their Miami-Dade-based business. Over approximately three years, Medicare paid the home healthcare business more than $4.1 million in claims for services that were medically unnecessary or not provided.

The 39-year-old and 42-year-old were each sentenced to 10 years in prison for their respective roles in the scam. They were also ordered to pay $733,000 in restitution. (Way to go judge. Sock it to ’em!)

These two fraudsters are trading in their jobs at the home health agency for a cell block without much of a view. (Or anything remotely scenic for that matter.) As this case proves, Medicare fraud, waste and abuse is taken very seriously, and the government punishes criminals with stiff penalties for a purpose – to prevent others from costing taxpayers billions of dollars and putting beneficiaries’ health at welfare at risk.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”2 Women Sentenced in $4M Medicare Fraud Scam,” published by WSVN.com on December 24, 2013.

MIAMI (AP) — Two South Florida women have been sentenced to 10 years each in prison for their roles in a $4.1 million Medicare fraud scheme.

The sentences were imposed Tuesday on 39-year-old Yiral Cardona and 42-year-old Susan Chi, both of Miami. They were convicted in October of conspiracy and illegally paying health care kickbacks from their Vista Home Health Services.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.