Articles Posted in Medicare Fraud

BY JOSEPH MARKS 12/20/2011

Medicare officials should better evaluate whether a new system designed to spot fraudulent claims and roll back the program’s roughly $50 billion in annual improper payments is living up to its potential, a bipartisan group of senators said Tuesday.

The Centers for Medicare and Medicaid Service responded that it had been measuring results from the $100 million system since soon after its July launch and would update Congress on the results soon.

Diakon agrees to pay federal government $10.5 million

Diakon Hospice Saint John, which operates hospice care at facilities in Hazleton, Allentown, and Wyomissing, has agreed to resolve its liability for violations of the False Claims Act by paying the United States $10.56 million.

The announcement was made today by the United States Attorney’s Office for the Middle District of Pennsylvania and the U.S. Department of Health and Human Services‘ Office of the Inspector General.

Operators of South Florida assisted-living facilities and halfway houses charged in one of the nation’s biggest Medicare fraud cases are rushing to plead guilty rather than face risky trials and long prison sentences.

Six defendants are now looking at shorter federal sentences because of their plea agreements.

And a seventh defendant, Joseph B. Williams, 41, who ran an assisted-living facility in Pompano Beach, plans to plead guilty next week to defrauding the taxpayer-funded Medicare program, court records show.

BATON ROUGE, La. — Four Louisiana physicians wrote hundreds of bogus prescriptions that powered multimillion-dollar health-care frauds in the Baton Rouge area, according to evidence amassed by the nearly two-year-old local Medicare Fraud Strike Force.

Yet all four physicians remain licensed to practice medicine, including two who pleaded guilty and a third convicted at a jury trial in August. The fourth doctor, who had previous probations of his license, is fighting the charges in his indictment.

In a similar case that dates from before creation of the Strike Force, the Advocate reports ( ) a Louisiana physician in 2009 retained his medical license even though he was convicted of health care fraud.

The article below illustrates why having excellent legal defense for Medicare and Healthcare Fraud is so important. If you have been accused of Medicare, Medicaid, or Healthcare Fraud, contact Robert Malove for a free consultation.


From the Miami Herald, Nov 13, 2011

Photobucket MIAMI, FLORIDA (AUGUST 22, 2011) – Elizabet Lombera, 39, of Miami Lakes became the tenth person arrested in a large-scale scheme to defraud the Medicare system of more than $27 million.
Lombera controlled five durable medical equipment companies in Miami, but to conceal her involvement, she and fellow conspirators put nominee presidents in place. The companies: Mercy Medical Supply, Inc., JHH Group, Inc., La Numero 1 Farmacia Discount Corp., Yani’s Pharmacy, Inc., and El Perimetro Farmacia Discount Corp, submitted fraudulent for more than $27 million and received $12,438,952 as reimbursement. Allegations levied against Lombera state she used the proceeds for personal gain, which included taking a trip to Japan.

Photobucket LOUISVILLE, KENTUCKY (AUGUST 15, 2011) – Although their durable medical equipment company was based in Florida, Yunior Lopez, 34, of Miami, Florida and Arturo Esquivel, 39, of Hialeah, Florida, had a 13-count indictment leveled against them regarding their false billings to Medicare on behalf of Kentucky patients.

The defendants allegedly used two Kentucky doctors’ names when submitting the false claims to Medicare for products never provided to the patients. Investigators found the defendants’ two businesses, Universal of Work Services and Steel Quality Medical had none of the supplies they were claiming to have provided to patients.

If convicted, the defendants face a maximum sentence of 35 years imprisonment. Arraignment for both defendants is scheduled for August 23, 2011 before the U.S. Magistrate Judge in Louisville, Kentucky.

Photobucket MIAMI, FLORIDA (AUGUST 10, 2011) – A Miami nurse, Armando Santos, 46, received 10 years imprisonment from his role in a scheme that saw $11 million in fraudulent claims made to Medicare.
Between 2007 and 2009, as an employee of Ideal Home Health company, Santos billed Medicare for services given to Medicare beneficiaries that were either not medically necessary or that were never given, including giving insulin injections to two patients that did not need insulin. Santos worked with the owners of the home health company, Elizabeth Acosta Sanz and Luis Alejandro Sanz in perpetrating the fraud. Of the $11 million in bogus claims filed, $7 million was received.