An Inside Job

New Medicare Card ++First one rejected for Copyright Trademark issues. Please let me know what I need to remove or alter. Is it the DHHS LOGO? Card design curve? Part of number shown? You accept Social Security cards with the same logo. This was accepted in 2018. iStock # 653549364. Just let me know how to get the new card accepted… thanks!++++

The most common perpetrator of a healthcare fraud scheme is someone within the healthcare profession. This is the case in today’s fraud story, which explains how a man who owned a medical equipment company targeted and defrauded Medicare beneficiaries. 

Colombian national Juan Buitrago pleaded guilty in a federal court in Boston to one count of healthcare fraud and one count of payment of kickbacks. Buitrago submitted more than $109 million in false claims to Medicare for durable medical equipment (DME) including arm, back, knee and shoulder braces.(Buitrago should brace for the fact he may be facing prison time.)

While residing in Lighthouse Beach, Fla., Perez instructed his employees to establish shell companies in more than a dozen states so they could submit fraudulent Medicare claims. The shell companies were registered as DME providers using fictitious names and listing Buitrago’s mother, wife, and yacht captain as corporate directors. (I think the captain would agree that it doesn’t look like smooth sailing ahead for Buitrago.)

Buitrago fraudulently purchased the data of Medicare patients from both domestic and foreign call centers. The call centers would offer ankle, arm, back, knee, and shoulder braces to elderly beneficiaries for “little to no cost”.  (He preyed on the fact that elderly folks want something to alleviate the discomfort they experience on a daily basis.) The claims for the DME were also submitted without obtaining a prescriber’s order as they were not medically necessary. 

No equipment was provided to patients for more than $7.5 million of the fraudulent claims. When DME was provided to patients, Buitrago billed insurance providers more than a dozen times the average price. Buitrago also submitted claims for the same beneficiary multiple times as well as claims for beneficiaries who were deceased. (As if this isn’t something an insurance company would eventually discover.)

More than $109 fraudulent claims were submitted to Medicare over the course of this scheme resulting in Buitrago collecting more than $12 million in reimbursements. Four of Buitrago’s associates have also pleaded guilty for their roles in this fraudulent billing scheme. (Everyone who helped take advantage of the “little old lady next door” is now facing prison time.)

Florida residents Nathan LaParl and Talia Alexandre pleaded guilty to receiving kickbacks in connection with a federal healthcare program. Stefani Hirsch of Los Angeles, Calif., and LaParl both agreed to plead guilty to violating the HIPAA statute. Colorado resident Jessica Jones and Florida resident Elizabeth Putulin have both agreed to plead guilty to conspiracy to commit health care fraud.

Buitrago faces up to a decade in prison, three years of supervised release, and a fine of $250,000 for each charge of healthcare fraud and payment of kickbacks in connection with a federal healthcare program. He will be sentenced in March 2021.

To report suspected Medicare fraud, call the Office of Inspector General’s national fraud hotline at 1-800-MEDICARE or fill out their online form.

Today’s Fraud of the Day comes from a Department of Justice press release, “Colombian National Pleads Guilty to $109 Million Medicare Fraud Scheme,” dated October 29, 2020.

BOSTON – A Colombian national residing in Lighthouse Beach, Fla., pleaded guilty today in federal court in Boston in connection with submitting more than $109 million in false and fraudulent claims for durable medical equipment (DME) such as arm, back, knee and shoulder braces.

Juan Camilo Perez Buitrago, 31, pleaded guilty to one count of health care fraud and one count of payment of kickbacks in connection with a federal health care program. U.S. Senior District Court Judge George A. O’Toole Jr. scheduled sentencing for March 4, 2021.

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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.