Ripe for the Picking

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Florida is known for a lot of fun things including Disney World, the Space Coast, SeaWorld and Miami Beach. Unfortunately, South Florida is not only known for humidity and alligators, it’s also the nation’s capital of healthcare fraud. The incidence of healthcare fraud is so bad in that area that Miami has its own Medicare Strike Force office to handle what the Department of Justice considers to be 20 percent of all healthcare fraud takedowns in America. What a perfect segue into today’s Medicare fraud case which details a Miami, Florida woman’s role in stealing $4.66 million through several home health agencies.

It’s no wonder that today’s fraudster picked South Florida to carry out her scheme that lasted about four years. (Along with the citrus crop, the retiree haven is ripe for the picking.) According to our fraud article, she operated three home health agencies. She kept the clients flowing by paying kickbacks to patient recruiters in exchange for Medicare beneficiary referrals. (Many of them didn’t qualify or need home health services, but that didn’t stop her from submitting bogus claims to Medicare on their behalf.)

In addition to operating the three home health agencies, she became the owner of a nursing agency, which she placed in the name of a nominee owner. (Obviously, to disguise her illegal deeds.) Once again, she paid kickbacks to patient recruiters to supply her new company with clients. Because of her fraudulent claims across all agencies she operated, Medicare paid out $4.66 million.

The 29-year-old from Miami pleaded guilty to Medicare fraud. She received a sentence of 51 months behind bars for her role in the $4.66 million healthcare fraud scheme. In addition to paying restitution of $4,658,241, she must also forfeit $186,650.50. (Let’s not forget the 50 cents because every penny matters.)

Compared to her co-conspirator from Homestead, Florida who received a prison term of 78 months and the same restitution and forfeiture amounts for her part in the scheme, today’s fraudster should be grateful for a shorter prison term. (It looks like the Medicare Strike Force was able to make lemonade out of these two lemons who tried to put the squeeze on the government healthcare program.)

Today’s “Fraud of the Day” is based on a Department of Justice press release, Miami Woman Sentenced to Prison for Role in $4.66 Million Medicare Fraud Scheme,” released on January 28, 2019.  

A woman from Miami, Florida was sentenced to 51 months in prison on Jan. 17 for her role in a $4.66 million health care fraud scheme involving several Miami-area home health agencies, including Sunshine Home Health Services Inc., Empire Home Health Agency Inc., Mildred & Marce Home Health Care Services Inc., and Nursing Care PRN Inc., which purported to provide home health services to Medicare patients.   

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office made the announcement.

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.