Three Charged in $1 Billion Medicare Fraud Scheme in Miami

July 26, 2016

Three people have been convicted of alleged Medicare and Medicaid fraud in a $1 billion scheme in Miami.

“This is the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice,” said Leslie R. Caldwell, Assistant Attorney General the department’s criminal division, in a statement issued Friday.

A 47-year-old man allegedly led a scheme that referred Medicare and Medicaid beneficiaries who did not qualify to skilled nursing and assisted living facilities. The man owned 30 such facilities, giving him access to thousands of beneficiaries, according to reports.

Also charged in the scheme are a 49-year-old hospital administrator and a 56-year-old physician’s assistant.

The three also are accused of accepting kickbacks, disguised as charitable donations or paid in cash, for directing the beneficiaries to selected health care providers, including pharmacies, health care agencies and mental health centers, according to investigators.

Medicare or Medicaid fraud happens when a provider knowingly makes a false or misleading statement or representation for use in obtaining reimbursement from the medical assistance program. Medicare and Medicaid providers include doctors, dentists, hospitals, nursing homes, pharmacies, clinics, counselors, personal care/homemaker companies, and any other individual or company that is paid by the the programs.

Medicaid fraud includes, but is not limited to:

  • Billing for medical services that were never performed, known as phantom billing
  • Billing for a more expensive service than was actually performed, known as upcoding
  • Billing for multiple services that should be combined into one billing, known as unbundling
  • Billing several time for the same medical service
  • Dispensing generic drugs and billing for brand-name drugs
  • Giving or accepting something in return for medical services, which is known as a kickback
  • Providing unnecessary services
  • Filing false cost reports

If you are accused of Medicare or Medicaid fraud in Miami, you need to call a South Florida Medicare and Medicaid Fraud Defense Lawyer at Whittel & Melton at 561-367-8777. We can establish a powerful defense on your behalf to ensure your case has the best possible outcome.

Contact us online for a free consultation today!

Justia 10
Multi Million Dollar
Super Lawyers
American Association for Justice
Florida Legal Elite
Avvo Rating 10
Preeminent Badge 2018
Floride Justice Association
Best Lawyers 2015
Accredited Business
Best Lawyers
Namil Law
Motorcycle Injury Attorney
Top 100 2020

Client Reviews

This firm was extremely helpful and courteous to deal with. I did not expect to need their services, but was fortunate to find such a great firm. Thank you for your services.

E.S.

Great customer service. I was always kept updated on every new detail throughout my whole case. The staff made me feel very comfortable and confident in choosing their services. Highly recommend.

C.B.

I have been to this office three different times and have not one complaint ! Always prompt and on point. I wouldn't pick any other office!

R.S.

The staff was very attentive and answered all my questions regarding my criminal case. I was very pleased with the outcome and professionalism.

C.V.

Could never see myself using any other law firm. My case was a difficult one it was handled with perfection and extreme professionalism.

R.B.

Call Us Now: 866-608-5529

  1. 1 Free Consultation
  2. 2 Available 24/7
  3. 3 Experienced Representation
Fill out the contact form or call us at 866-608-5529 to schedule your free consultation.

Tell Us About Your Case

Visit Us

Main Office
11020 Northcliffe Blvd

Spring Hill, FL 34608

Phone: 352-666-2121 Fax: 352-556-4839 Toll Free: 1-866-608-5LAW