Catching Miami Vice: Fraud scheme recruiters, solicitors busted

Fraud schemes have kept law enforcement agents busy in Florida, where recent news focused on actions against recruiters and those who hired them to round up customers for health insurance scams.

Miami's Euridice Borroto, for example, pleaded guilty last week to one count of conspiracy to solicit and receive healthcare kickbacks and defraud the United States, the U.S. Department of Justice announced. As part of a $6.5 million Medicare fraud scheme, she collected bribes and kickbacks for recruiting patients on behalf of Nestor's Health Services Inc., according to the DOJ. The agency's owner paid Borroto to find patients for claimed home healthcare and therapy services that were medically unnecessary or not rendered.

Borroto has a checkered past with the program: She participated in similar fraud schemes at other agencies, the announcement noted.

In another scheme involving home healthcare, Miami's Lizette Garcia pleaded guilty in federal court to one count of payment of healthcare kickbacks linked to a $7 million dollar fraud, Local 10 reported. Garcia admitted paying kickbacks and bribes to recruiters in exchange for sending patients to Anna Nursing, a now-closed home healthcare company. As in the Borroto case, claimed care was medically unnecessary or not provided.

Miami is one of the fraud-prone cities where the Centers for Medicare & Medicaid Services extended its moratoria on new home healthcare provider applications, as FierceHealthPayer reported.

In other evidence of Miami's fraud vulnerability, a former patient recruiter for American Therapeutic Corporation (ATC) recently admitted his role in a $205 million-dollar scheme, according to the DOJ.

Michael Mendoza sent residents of assisted living facilities throughout southern Florida to ATC for bogus mental health services in exchange for money. Millions of dollars in illegal kickbacks traded hands for ineligible beneficiaries to attend treatment programs that weren't legitimate. That led to billings of $205 million for unnecessary services, along with $436,450 in false and fraudulent Medicare claims based on Mendoza's referrals, the DOJ noted.

For more:
- read the DOJ announcements on the Borroto and Mendoza pleas
- see the Local article (used with permission)