11 charged with recruiting foreigners in $25M enrollment scam

Authorities charged 11 south Florida residents with defrauding Medicare and Medicaid by enrolling ineligible people living in Nicaragua and the Dominican Republic, the FBI announced. As a result of false and fraudulent enrollment applications, the defendants reportedly cheated the programs out of $25,247,413.

Those indicted include a doctor and staff of Florida Healthcare Plus, a Coral Gables-based HMO raided by federal agents last week, according to NBC 6 South Florida. The HMO's operations were suspended by state regulators in September and authorities have since tried to liquidate the company in state administrative court, the South Florida Business Journal reported.

The defendants allegedly indicated on enrollment applications that those they recruited live in south Florida when they actually live abroad. Defendants persuaded ineligible people to enroll by telling them Medicare benefits are available in Nicaragua and the Dominican Republic, the announcement noted.

The defendants reportedly paid for people to travel from these countries so they could be seen by a U.S.-licensed physician. The defendants also caused doctors associated with Pharmovisa, Inc., Axis Le Professional Medical Group, Inc. and Rodney Montoya Corp.--each located in Miami--to be designated as primary care doctors for recruits living abroad, the announcement added.

As a result, Medicare and Medicaid made inappropriate monthly payments to FHCP and other Medicare plans, and Florida's Medicaid program paid Medicare premiums and deductibles for many people who don't live in the state, NBC noted.

"Providing Medicare services in foreign countries but billing as if they occurred in the United States is in-your-face fraud," Office of Inspector General Special Agent in Charge Derrick L. Jackson said in the announcement. "But our agents have a global reach, working with our law enforcement partners to track down and charge those responsible regardless of where they live in the world."   

Eight of the indicted individuals have been arrested; the other three remain at large.

Besides the indictment, the government is pursuing a civil action to freeze about $10 million in assets purchased with the proceeds of the alleged fraud.  

For more:
- here's the FBI announcement
- read the NBC6 South Florida article
- see the South Florida Business Journal article

Suggested Articles

The HHS OIG is asking for an additional $23.7 million to support fraud oversight that has benefited from an emphasis on data analytics.

A New York surgeon was sentenced to 13 years in prison for fraud and more physician practice news from around the web.

A federal judge has ruled that the U.S. government’s remaining fraud case against UnitedHealth can move forward.