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National Insurance Crime Bureau

National Health Care Fraud Enforcement Action Results in Charges of Over $308 Million in Intended Loss Against 52 Defendants in the Southern District of Florida

Miami, Florida – Over 50 defendants were charged in the Southern District of Florida in the last six weeks, as part of a nationwide federal law enforcement action to combat health care fraud.

The federal charges filed in South Florida cover a wide range of schemes, from novel crimes like theft of Covid-19 personal protection equipment and fraud connected to substance abuse treatment facilities (sober homes), to more familiar violations like health care fraud involving durable medical equipment suppliers, home health, pharmacies, payment of kickbacks, money laundering, and more.  It is alleged that $308 million in fraudulent claims was billed by the defendants charged in the Southern District of Florida during the six-week enforcement period.  Over $106 million of that billed amount was paid.   

Nationwide, 138 defendants, including 42 doctors, nurses, and other licensed medical professionals, in 31 federal districts across the United States, were charged during the enforcement period for their alleged participation in various healthcare fraud schemes that resulted in approximately $1.4 billion in alleged losses. Nationally, the charges target approximately $1.1 billion in fraud committed using telemedicine (the use of telecommunications technology to provide health care services remotely), $29 million in COVID-19 health care fraud, $133 million connected to substance abuse treatment facilities, or “sober homes,” and $160 million connected to other health care fraud and illegal opioid distribution schemes across the country.

“The results of the coordinated law enforcement effort that we announce today exemplify my Office and its law enforcement partners’ enduring commitment to combatting all forms of health care fraud-related schemes.” said Juan Antonio Gonzalez, Acting U.S. Attorney for the Southern District of Florida. “We will not relent in holding accountable those in South Florida who exploit health care programs and patient trust for personal gain, particularly during the COVID-19 global pandemic.”

“This nationwide enforcement action demonstrates that the Criminal Division is at the forefront of the fight against health care fraud and opioid abuse by prosecuting those who have exploited health care benefit programs and their patients for personal gain,” said Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division. “The charges announced today send a clear deterrent message and should leave no doubt about the department’s ongoing commitment to ensuring the safety of patients and the integrity of health care benefit programs, even amid a continued pandemic.”

Today’s enforcement actions were led and coordinated by the Health Care Fraud Unit of the Criminal Division’s Fraud Section, in conjunction with its Health Care Fraud and Appalachian Regional Prescription Opioid (ARPO) Strike Force program, and its core partners, the U.S. Attorneys’ Offices, the Department of Health and Human Services Office of Inspector General (HHS-OIG), FBI, and the Drug Enforcement Administration (DEA), as part of the department’s ongoing efforts to combat the devastating effects of health care fraud and the opioid epidemic.

The Southern District of Florida, in particular, worked with the Department’s Criminal Division and the following law enforcement organizations to investigate and prosecute the cases filed during the enforcement period: FBI Miami; U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG), Miami Region; Social Security Administration, Office of Inspector General (SSA-OIG), Atlanta Field Division; Homeland Security Investigations (HSI), Miami; United States Postal Inspection Service (USPIS), Miami Region; Florida’s Office of the Attorney General, Medicaid Fraud Control Unit (MFCU); Florida State Attorney’s Office; City of Miami Beach Police Department; Palm Beach County Sober Homes Task Force; Amtrack Office of the Inspector General; and the Department of Insurance Fraud.

“South Florida is ground zero for health care fraud.  As such, the FBI and its partners devote vast resources to investigate, catch and prosecute those committing this fraud,” said George L. Piro, Special Agent in Charge, FBI Miami.  The victims are U.S. taxpayers, you and me.  Our message to those who commit health care fraud and steal from U.S. taxpayers is clear: you will be caught, and you will be punished.”

“Healthcare fraud is hardly a victimless crime. The well-being and trust of patients and taxpayers are at risk when corrupt providers engage in schemes that drain taxpayer-funded health care programs and undermine impartial medical judgement,” said Special Agent in Charge Omar Pérez Aybar of HHS-OIG Miami. “These cases demonstrate our resolve to investigate bad actors and protect the patients served by vital federal health and human services programs.”

“Those who misuse the Social Security numbers of other individuals for personal gain are warned -- we will hold you accountable.” said Rodregas W. Owens, Special Agent-in-Charge, SSA-OIG, Atlanta Field Division. “We will continue to work aggressively to identify such fraud in an effort to protect taxpayers against fraud, waste, and abuse.”

“We as a law enforcement community will not allow individuals to defraud government health-care programs for their own personal gain,” said Anthony Salisbury, Special Agent in Charge, HSI Miami. “HSI and its partners will continue to pursue individuals and companies who are taking advantage of innocent patients seeking medical care.”

“My Medicaid Fraud Control Unit works tirelessly to stop the exploitation of the taxpayer-funded Medicaid program and protect the vulnerable Floridians who rely on its services. I’m proud of our partnership with federal authorities to hold these criminals abusing the system accountable,” said Florida Attorney General Ashley Moody.

News Article: https://www.justice.gov/usao-sdfl/pr/national-health-care-fraud-enforcement-action-results-charges-over-308-million-intended