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Medicare Fraud Takes Down Major Florida HMO

Florida state regulators recently took over Florida Healthcare Plus after the insurer found itself in the middle of an FBI Medicare fraud investigation. Florida Healthcare Plus was a $130 million-per-year company with over 200 employees. It had almost 10,000 Medicare beneficiaries as members. While the company itself was not charged with fraud, 11 individuals were charged by the FBI in an elaborate Medicare scheme. The scheme allegedly resulted in $25.2 million in Medicare and Medicaid benefits being funneled to retired U.S. expatriates living in Central America. The wrongdoing was discovered by internal and external audits, after business executives noticed suspiciously large payments being submitted to a couple of healthcare providers.

The 11 individuals, half of whom were former Florida Healthcare Plus employees, allegedly submitted false and fraudulent Medicare and Medicaid enrollment applications. The applications falsely claimed the beneficiaries lived in Florida, when in fact they lived in Nicaragua and the Dominican Republic. The defendants are also alleged to have had licensed physicians on the take, to ensure the overseas beneficiaries were seen by U.S.-licensed doctors. They were charged in federal court with conspiracy to commit healthcare fraud and wire fraud; substantive counts of health care fraud; conspiracy to defraud the United States, and to make false statements related to healthcare matters; and substantive counts of making false statements related to health care matters. Not only were the individuals indicted, but in a parallel civil action, $10 million in fraudulently obtained assets were frozen.

Furthermore, Florida Healthcare Plus was fined $113,200 by the Centers for Medicare and Medicaid (CMS) for inappropriately denying or delaying care to legitimate Florida beneficiaries. CMS sanctioned Florida Healthcare Plus in September, prohibiting the insurer from enrolling new members.

Because of the wrongdoing of six former employees, including the CEO and marketing directors, the entire company and its employees suffered. The company’s offices were raided and its assets seized. Now, the company has been taken over by the state, which in turn will liquidate it. Furthermore, any members of the company’s Medicare or Medicaid plans now have until February 28, 2015, to enroll in new plans with other companies.

Medicare and Medicaid Fraud is an extremely complex crime, with far-reaching implications. Even before the individual defendants were indicted by the U.S. Attorney’s Office, the mere accusations of impropriety, the office raids, and the complete inability to meet capitalization requirements effectively tanked Florida Healthcare Plus. Executives and others within a company facing fraud accusations, who may or may not have been involved in the fraud, are at serious risk of being implicated or having capital frozen, even if they report the wrongdoing in a timely fashion. This is why it is so important to have an attorney experienced in dealing with federal and Florida health care fraud laws.

Let Me Defend You Today

If your employer is a company in the health care field, and you learn that the company is under investigation, it is critical that you secure the services of an experienced criminal attorney to guide you through the process. Please contact Attorney Tony Moss at the Tony Moss Firm, L.L.C. to discuss any defense matters. He has locations in Miami and Fort Lauderdale, and is prepared to put his skill and expertise to work for you.

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