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Medicare Fraud Allegations Result in Numerous Arrests in Miami-Dade County

A recent Miami-Dade Medicare fraud bust focused on the roll that patients can play in fraudulent schemes to collect funds from the federal government. According to a report by the Miami Herald, 50 suspects were arrested over the course of two days, with allegations of theft attempts totaling $66 million. The article explains that 37 of those arrested were allegedly working as “patient recruiters” or brokers.

The alleged Medicare scam is reportedly carried out in the following manner:

  • Health agencies, including home health care companies, pharmacies and mental health programs contract brokers to find patients for their services.
  • Brokers recruit patients with Medicare benefits to utilize the agency’s services, regardless of need.
  • The patients are paid for allowing the agencies to bill Medicare for services rendered, most of which are unnecessary or false.
  • The brokers are paid by the service agency for providing patients.

United States Attorney Wifredo Ferrer was quoted in the article. He said that these types of “kickbacks” fuel the rampant levels of Medicare fraud, explaining that patient recruiting is competitive and brokers are increasingly demanding higher prices for the patients they provide. Though this particular bust was part of a nationwide crackdown, South Florida was the location with the majority of arrests. Altogether, 90 physicians, clinics, patient recruiters and patients were arrested on various fraud charges. The Medicare claims in question reportedly total more than $260 million.

The arrests included several prominent members of the Miami-Dade medical community, including a psychiatrist and the operator of a mental health facility. Medicare fraud is usually tried as a federal crime. Along with the possibility of lengthy jail sentences and extensive fines, these suspects must also face public scrutiny and a severe blow to their professional reputations.

Defenses to Medicare Fraud

There are numerous possible defenses to Medicare Fraud. Intent is a major element of fraud. The prosecution must prove that you intended to provide false information and receive some gain as a result. If your attorney can create reasonable doubt about your intent to defraud Medicare, you may be acquitted of the charges. Your attorney can also put forward a successful defense by proving that the claim in question is accurate. Evidence may be provided to show that the service did actually occur for the duration of the billed amount. Proof of accuracy negates the existence of any fraud.

Lastly, mistake is a viable defense to Medicare fraud. The privilege of billing Medicare for services comes with significant responsibility. Errors by a subordinate employee can potentially result in fraud charges for those in supervisory positions. Multiple billing for the same service and over billing are common mistakes on the part of a medical professional. From a patient perspective, confusion about services rendered is often the cause of Medicare fraud charges. Misunderstandings about the exact services can lead patients to make false verifications. An experienced attorney can take these mistakes and create a defense to Medicare fraud allegations.

If you or a loved one is facing Medicare fraud charges, Miami Attorneys Mycki Ratzan and Jude Faccidomo can provide you with an aggressive and comprehensive defense. Contact Ratzan & Faccidomo, LLC today at 305-600-3519 for a confidential and free consultation.

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