Six Florida residents charged with Medicare fraud, two plead guilty

In Florida, known to some as the healthcare fraud capital of the country, six Miami residents have been charged with helping to scheme Medicare out of $13 million in fraudulent claims for HIV infusion therapies.

According to the indictment, T&R Rehabilitation clinic operators billed the Medicare program for HIV infusion therapy services that were medically unnecessary and were never provided, and allegedly paid Medicare beneficiaries to sign logs falsely stating they'd received the procedures.

As of Wednesday, four of the suspects had been arrested while two remained fugitives. On Thursday, two of the suspects plead guilty. During the plea hearing, Efren Mendez, vice president of the Research Center of Florida, admitted that the president of the clinic arranged to pay kickbacks to patients to come to the clinic, while Damian Beltran, a medical assistant, admitted to preparing false documentation. Each faces up to 10 years in prison, according to the South Florida Business Journal.

A Thomson Reuters report released last October said that in 2007, when the United States spent nearly $2.3 trillion on healthcare and both public and private insurers processed more than 4 billion health insurance claims, fraud was estimated to reach as much as 10 percent of annual healthcare spending. President Barack Obama has pledged a high-tech crackdown on healthcare fraud using sophisticated software programs to look for suspicious claim activity. He also will contract with private auditors who will receive a portion of recovered funds. 

For more information:
- read this Reuters article
- check out this DOJ press release
- read this South Florida Business Journal article

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.