- The FBI estimates every year tens of billions of dollars is lost due to healthcare fraud. While the financial impact is great, the personal impact is just as costly. Individuals can have their medical information compromised, be misdiagnosed, and experience unnecessary medical procedures.
- Companies/Cities are now spending more on healthcare for their employees than materials to produce their products. This must stop! A major cause of this problem is “FRAUD”.
- Self-insured or Self-funded organizations are at greater risk due to the fact that they usually do not have the required expertise or systems in order to identify potential fraud, waste or abuse.
THE CAUSE (2017 Statics)
- More than 400 defendants in 41 federal districts were charged for their alleged participation in schemes involving more than $1.3 billion in false billings to vital health care programs. Of those subjects charged, 115 are medical professionals—particularly doctors and nurses.
- Miami-Dade County had per capita standardized Medicare costs of $14,470 in 2014—a figure 36% higher than costs statewide and 61% higher than national per capita costs, according to the CMS. At least part of that high cost may be because of fraud, said Steve Ullmann, chairman of the Department of Health Sector Management and Policy at the University of Miami School of Business Administration.
Three 2017 Florida Healthcare Fraud Examples (there are hundreds)
- Florida’s recent hospital settlements include Adventist Health System in Alamonte Springs, which paid out $118.7 million, and Halifax Health in Daytona Beach, which paid $85 million.
Both were accused of illegally compensating physicians. Halifax denied wrongdoing. Adventist said it regretted its lapses in oversight and made changes, but the settlement included no admission of liability.
- $1 billion alleged Medicare fraud, money laundering scheme leads to Florida Arrests.
Three Florida residents have been charged in the “largest single criminal health-care fraud case ever brought against individuals” by the U.S. Justice Department — an alleged Medicare fraud and money laundering scheme that netted participants a whopping $1 billion since 2009.
The owner of more than 30 Miami-area skilled nursing and assisted living facilities, as well as a hospital administrator and a physician’s assistant were charged in an indictment with conspiracy, money laundering, and health-care fraud, the U.S. Attorney’s office in Miami said.
- Twenty Individuals Arrested in $200 Million Healthcare Fraud Case in South Florida
Twenty individuals, including three doctors, were charged today in the Southern District of Florida for various health care fraud, kickback and money laundering charges related to their alleged participation in a fraud scheme involving approximately $200 million in Medicare billing for purported mental health services, announced the Departments of Justice and Health and Human Services (HHS).
The 38-count indictment unsealed today in U.S. District Court in the Southern District of Florida alleges that the defendants worked with and for American Therapeutic Corporation (ATC) and Medlink Professional Management Group Inc. According to court documents, the defendants participated in a scheme to defraud Medicare by submitting false claims for mental health services administered at ATC facilities that were medically unnecessary or not provided at all. The indictment alleges that various defendants paid kickbacks to patient brokers and owners and operators of halfway houses and assisted living facilities (ALFs), in exchange for delivering patients to ATC facilities. Various defendants are charged with participating in an extensive and complicated money laundering scheme related to the cash for kickback payments
Comprehensive Compliance Concepts offers solutions that identify fraud, prevent a reoccurrence, and recover errant payments. We are compensated on a percentage of recovered monies, not on an hourly or project basis. For every dollar we recover the client will see a 5 to 1 return.
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