Payer Roundup—Florida home health company owner sentenced in $8.6M fraud scheme

File folders labeled "insurance," "fraud," "claims," and "under investigation"
The owner of a Florida home health company was sentenced to prison for his role in an $8.6 million Medicare fraud scheme, plus more insurance news. (Getty Images/Olivier Le Moal)

Florida home health company owner sentenced to prison in $8.6M fraud scheme

The owner of a Florida home health company was sentenced to serve 87 months in prison for his role in an $8.6 million Medicare fraud scheme.

Alexander Ros Lazo, 54, owner of T.L.C. Health Services of Miami, admitted to paying kickbacks and bribes to co-conspirators in exchange for Medicare patient referrals for home care. Ros Lazo was also ordered to repay the $8.6 million in restitution, according to the Department of Justice.

A co-conspirator was also sentenced alongside Ros Lazo. Misleady Ibarra, 46, performed home health services unlicensed and will serve 24 months in prison.

Free Daily Newsletter

Like this story? Subscribe to FierceHealthcare!

The healthcare sector remains in flux as policy, regulation, technology and trends shape the market. FierceHealthcare subscribers rely on our suite of newsletters as their must-read source for the latest news, analysis and data impacting their world. Sign up today to get healthcare news and updates delivered to your inbox and read on the go.

Ibarra will also pay restitution; the amount has yet to be determined, DOJ said. (Announcement)

Dems restart talk of stabilizing ACA exchanges

Bipartisan plans to fix the ACA exchanges fizzled, but moderate Democrats in Congress have restarted those conversations.

The House’s New Democrat Coalition, which includes about 100 centrist members, wants to “immediately” begin a bipartisan path to reducing premiums and reversing “sabotage” by the Trump administration.

The group wants to create a national reinsurance program, boost premium assistance for enrollees and re-instate cost-sharing reduction payments, which the White House ended in 2017.

“It is a personal issue to every [American],” Rep. Ami Bera, D-Calif., one of the coalition’s members, said. (The Hill)

Fidelity reaches 1M members in its health savings accounts

More than 1 million people have a health savings account through Fidelity, the company announced.

Fidelity’s HSAs hold about $4.1 billion in assets, it said. Most members, however, aren’t using their contributions to invest for future potential services—about 91% hold them in cash.

Fidelity added 232 new employers to its HSA business in 2018, emphasizing the concern employers and employees both have about healthcare costs, the company said.

“There is no disguising the sense of urgency we hear from employers and individuals who say that rising healthcare costs are among their biggest financial concerns,” Begonya Klumb, head of HSA at Fidelity Health Care Group, said. (Announcement)

Suggested Articles

Humana filed suit Friday against more than a dozen generic drugmakers alleging the companies engaged in price fixing.

Medicare Advantage open enrollment kicked off last week, and insurers are taking new approaches to marketing a slate of supplemental benefit options. 

Centene announced another five states have approved its pending $17B merger with WellCare, bringing total number of approvals to 24.