Taking a Gamble


To participate in Medicare fraud is to take a huge gamble. The odds of winning are not great as a former owner and manager of three Florida home health agencies can testify. The Medicare Strike Force successfully prosecuted him for his role in a $57 million fraud scheme.

For approximately seven years, the owner of the home health care companies and his co-conspirators supposedly provided home health care services to Medicare beneficiaries in the Miami area. (As you might guess, these services were not medically necessary and were generally not provided.)

The owner and his co-conspirators conducted the scheme by paying kickbacks to physicians, patient recruiters and staffing groups who all referred Medicare beneficiaries to the three health care companies. (That’s a big no-no.) Court documents show that the three agencies submitted approximately $57 million in bogus claims and received about $40 million in compensation from Medicare.

At the end of a two-week trial, the owner was convicted of one count of conspiracy to commit health care fraud and wire fraud and one count of conspiracy to defraud the U.S. and pay health care kickbacks. The 40-year-old was sentenced to 20 years in prison. One co-conspirator was sentenced to 10 years and another is scheduled to be sentenced.

This fraudster took a big risk by participating in Medicare fraud. (Let this serve as an example to those who are considering stealing government benefits they don’t deserve.) He not only gambled away his future, but also the benefits of those he was supposed to care for. Congratulations to the Medicare Strike force for adding these criminals to the growing list of nearly 2,300 defendants and stopping them in their tracks.

Source: Today’s ”Fraud of the Day” is based on a Department of Justice press release entitled, ”Former Owner and Manager of Miami-Area Home Health Agencies Sentenced to 20 Years in Prison for Role in $57 Million Medicare Fraud Scheme,” released on August 30, 2016.

The owner and manager of three now-defunct Miami-area home health agencies was sentenced today to 240 months in prison for his role in a $57 million Medicare fraud scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer 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
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.