Florida Residents Charged in $2 Million Medicare Fraud Scheme

Seven Floridians, including four doctors, are among 35 people arrested Friday by the FBI for alleged involvement in a $2.1 billion fraud that charged Medicare for false cancer genomic tests (CGx tests).

According to the U.S. Department of Justice (DOJ), the alleged fraud was perpetrated by defendants in Florida, Georgia, Louisiana and Texas and exploited seniors’ curiosity about genetic medicine by enticing them to get unneeded DNA tests.

Dubbed “Operation Double Helix,” the crackdown targeted telemedicine companies, nine doctors and numerous labs following a joint investigation by the DOJ, the FBI, the U.S. Health & Human Services (HHS) Inspector’s General Office and U.S. attorneys’ offices.

The DOJ said the alleged scheme involved a telemarketer or in-person “recruiter” who would persuade a Medicare enrollee to take a genetic test, assuring them the program would pay full cost.

A doctor “in league with the fraudsters” would then approve the test and collect a kickback from the “recruiter,” the indictment reads.

A lab would run the test, bill Medicare, and share payments with the “recruiter,” according to the DOJ.

Reports indicate that the genetic testing bills submitted to Medicaid ranged from $7,000 to $12,000, with some as high as $33,000. In many cases, he said, the patient never got a report back, or the results provided were incomprehensible.

U.S. attorney’s offices in the Southern and Middle districts of Florida filed charges against defendants while four Florida doctors were indicted by U.S. attorneys in New Jersey. 

The federal government and the state of Florida are serious about finding and punishing those who are involved in health care fraud. Law enforcement uses any means to uncover fraud like task forces and undercover operations. Anyone can be the target of an investigation from an individual doctor to a billing company to an entire hospital system.

Our Florida Medicare Fraud Defense Attorneys at Whittel & Melton have extensive experience defending clients against accusations of fraud and related state and federal crimes. We can help with the defense of anyone in the healthcare industry, including:

• Doctors, nurses and pharmacists
• Hospitals, hospital systems and clinics
• Home health care companies
• Medical billing and coding companies

Medicare and Medicaid fraud investigations in Florida are often the result of inaccurate claims. These claims may include excessive charges, charges that weren’t authorized, and false charges.The federal government will label these claims as fraudulent billing or reimbursement requests. The most common causes of a Medicare or Medicaid fraud investigation are:

• Phantom billing – billing for services that were never performed
• Submitting a claim for unnecessary medical services or medical equipment
• Submitting a claim for medical supplies, equipment, or services that were never ordered
• Submitting a claim of certification for medically unnecessary supplies 
• Submitting a claim of certification for medically unnecessary services, like hospice or home health care
• Double billing
• Upcoding
• Inflating charges
• Overusing medical equipment or services
• Providing or accepting kickbacks

Doctors, nurses, health care services, physician-owned entities, nursing homes, registered care providers and facilities, hospitals, clinics, pharmacies, laboratories, DME providers, DNA centers, and cancer centers are the most common targets of a health care fraud investigation. As we have stated before, this list is certainly not all-inclusive and any individual, business, facility, or entity in the healthcare industry can be the subject of health care fraud criminal charges. If a person submits a false claim to a federal health care program, even if they do not realize that the claim will be classified as false, they may end up as the subject of a Medicare or Medicaid fraud investigation.

Criminal penalties for Medicare or Medicaid fraud may include one or more of the following:

• Hundreds of thousands of dollars in fines
• Up to 10 years in prison for each count of Medicare or Medicaid fraud
• Up to 20 years in prison for each count of Medicare or Medicaid fraud that resulted in serious bodily harm
• Life sentence behind bars if the Medicare or Medicaid fraud results in the death of the patient 

Medicare or Medicaid fraud prosecutions are highly specific and lead by the U.S. Attorney’s Health Care Fraud Division. Your defense requires investigating a large amount of health data and the specific understanding of billing practices, compliance issues, and medical necessity. Our Florida Medicare and Medicaid Fraud Defense Attorneys at Whittel & Melton have the knowledge and experience necessary to establish a strong defense against charges of health care fraud. We strongly urge you to act fast if you have been arrested, charged or are aware of an investigation against you.