As part of a nationwide federal law enforcement action to combat healthcare fraud, 52 defendants have been charged in the Southern District of Florida over the last six weeks. The federal charges filed in South Florida cover a wide range of healthcare fraud schemes.
It is alleged that $308 million in fraudulent claims was billed by the defendants charged in the Southern District of Florida during the six-week enforcement period. Over $106 million of that billed amount was paid. The healthcare fraud schemes include theft of COVID-19 personal protection equipment (PPE); fraud connected to substance abuse treatment facilities; healthcare fraud involving durable medical equipment suppliers, home health agencies, and pharmacies; payment of kickbacks; money laundering; and other schemes.
138 defendants, including 42 doctors, nurses, and other licensed medical professionals, in 31 federal districts across the United States, were charged during the enforcement period for their alleged participation in various healthcare fraud schemes that resulted in approximately $1.4 billion in alleged losses. The charges target approximately $1.1 billion in fraud committed using telemedicine (the use of telecommunications technology to provide healthcare services remotely), $29 million in COVID-19 healthcare fraud, $133 million connected to substance abuse treatment facilities or “sober homes,” and $160 million connected to other healthcare fraud and illegal opioid distribution schemes across the country.
Nationally, nine defendants are charged with engaging in various healthcare fraud schemes designed to exploit the COVID-19 pandemic.
In the Southern District of Florida, a defendant is charged with stealing PPE from a hospital and reselling it at inflated prices. In this case, a Miami resident is charged by indictment with conspiracy to steal medical products, theft of medical products, and transportation of stolen goods. Per the indictment, the Miami resident worked in the supplies department of Mount Sinai Hospital. From approximately April to November 2020, the Miami man stole N95 masks and other medical supplies from his workplace and sold them to various purchasers. Among other items, he sold $55,000 worth of stolen masks to a purchaser in California, according to the indictment. As a result of the thefts, during the height of the COVID-19 pandemic, Mount Sinai did not have the supplies needed for nurses, doctors, staff, and patients, and at one point was down to only a three-day supply of N95 masks.
In a different case, a Florida woman is charged by indictment with one count of falsely representing a social security number and one count of aggravated identity theft. According to the indictment, the Florida woman knowingly gave a false social security number to a Medicaid Managed Care Organization while applying for a job with the company, in order to hide her true identity.
In another case, a Florida man was charged with conspiracy to commit money laundering. According to available information, the Florida man conspired to launder $363,139 in healthcare fraud proceeds between July 2019 and October 2019, and these proceeds were related to a durable medical equipment company located in Miami that was committing healthcare fraud.
So far, during the 2020-2021 Fiscal Year (from October 1, 2020, through today), a total of 196 defendants have been charged in the Southern District of Florida with healthcare fraud-related offenses. It is alleged that approximately $2.2 billion was billed by these defendants and that approximately $488 million was paid.
Compliance Perspective
Issue
Fraud, waste, and abuse of federal and state funds is always illegal. It is imperative that all staff members, vendors, and any other individuals doing business with or for the company are trained and well versed in what constitutes fraud, waste, and abuse of federal and state funds. In addition, training should be provided on how to report any suspicions of fraud, waste, or abuse of government funds. Fraud, waste, and abuse can result in fines or civil penalties, which may include prison time.
Discussion Points
- Review all policies and procedures that pertain to prevention and detection of fraud, waste, and abuse of federal and state funds. Update policies and procedures as needed.
- Train all staff on what may be considered fraud, waste, and abuse of government funds and the steps they should take if they suspect it has occurred.
- Periodically audit staff understanding to ensure they are knowledgeable about what fraud, waste, and abuse of federal and state funds is, and how they can report suspicions that it has occurred.
