The Healthcare Entrepreneur Blog

$15 million Medicare fraud scheme paid kickbacks to fraudulent patients

by Tannus Quatre PT, MBA | August 26th, 2009 | No responses

Two Miami residents have plead guilty to submitting over $15 million in false and fraudulent claims to Medicare for heathcare services that were either not necessary or not provided from March 2006 through March 2007.  By itself this is a tragic tale, but the fact that the criminals paid cash and narcotic kickbacks to Medicare beneficiaries in return for their co-conspiracy in the fraud scheme is disgusting.

In his plea, Jose Rosario also admitted that Medicare beneficiaries were neither referred to Sacred Hope by their primary care physicians, nor for any other legitimate medical purpose, but rather were recruited to come to the clinic through the payment of kickbacks. In exchange for their kickbacks, the Medicare beneficiaries would visit the clinic and sign documents falsely indicating that they had received the services billed to Medicare. According to information contained in the plea documents, kickbacks came in the form of cash and prescriptions for narcotic drugs. Jose Rosario admitted he directed his nephew, co-defendant Arnaldo Rosario, to oversee and facilitate the payment of cash kickbacks to the Medicare beneficiaries. Jose Rosario admitted that he would routinely obtain cash that he would provide to Arnaldo Rosario for the purpose of paying the beneficiaries cash kickbacks.

And, this is just the tip of the iceberg.  The Miami case was brought forward by the Medicare Fraud Strike Force, who since their inception in March 2007, have obtained indictments of nearly 300 persons and organizations that have billed Medicare close to $700 million.

Click to read the full article from the USDOJ

Tannus Quatre PT, MBA
Tannus Quatre is a private practice consultant and principal with Vantage Clinical Solutions, Inc., a nationwide healthcare consulting and management firm located in Bend, OR and Denver, CO. Tannus specializes in the areas of healthcare marketing, strategy, and finance, and can be reached through the Vantage Clinical Solutions website.