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Florida Medicare Fraud Goes Beyond Borders

Another tactic used by suspected Medicare fraudsters has piqued the attention of state and federal authorities looking to crack down on Medicare fraud.

This strategy, known as the foreign-enrollment loophole, occurs when Medicare is paid to individuals living abroad. In general, Medicare is not available outside the U.S., except for certain emergency situations. Thus, fraudsters who live abroad use friends’ addresses, mail forwarding services, and U.S. post office boxes to give the appearance of a U.S. address in order to cash in on Medicare payments. The government claims to have authorized $25 million in payments to residents abroad in a three-year period. Because the government has already labeled Medicare as a high-risk program due to its size and complexity, it is no wonder the Centers for Medicare and Medicaid Services (CMS) is now trying to crack down on this new form of health care fraud.

One foreign-enrollment case that has received intense government scrutiny ties Florida to Nicaragua. Ten people were allegedly involved in a scheme that included two executives at Florida Healthcare Plus. While Florida Healthcare Plus – one of the companies billing Medicare for patients receiving treatment abroad – was not accused of wrongdoing, the 10 individuals pled guilty. The defendants were arrested last October. While one remains at large, eight of them cooperated with the Department of Justice investigation. Six of them have received prison sentences ranging from fifteen months to four years. The government, however, has only recouped $1million of the $25 million lost to the scheme.

Their scheme was fairly straightforward. The defendants convinced U.S. residents living abroad in Nicaragua to enroll into Florida Healthcare Plus’ Medicare Advantage Plan. The fraudsters placed ads in buses and other clinics in Nicaragua claiming premium U.S. healthcare with no copay. Because Florida Healthcare Plus only operated in specific Florida counties, the individual patients were told they needed to maintain addresses in those counties so that their doctors’ visits would be billed to Medicare.

As CMS and other federal agencies begin to scrutinize Medicare providers even more closely, these providers need to handle their patient recruiting, billing, and patient practices accordingly. For example, the Government Accountability Office found that 24,000 patients had suspicious addresses. It is safe to assume CMS, DOJ, and the other agencies involved in fraud investigations will be looking into all of those addresses. However, it is unclear what addresses those agencies will target for heightened scrutiny, as even the presence of a foreign address does not necessarily mean fraud is taking place. Again, it is a reminder that all providers must take extra care in ensuring their patients, recruiters, and billing professionals are legitimate.

If you think you need a lawyer, YOU DO. Call Now!

Are you looking for a skilled attorney who can help defend you against healthcare fraud charges? Please contact Attorney Tony Moss at the Tony Moss Firm, L.L.C. to discuss these, or any other defense matters. He has locations in Miami and Fort Lauderdale, and is prepared to put his 27 years of experience to work for you.

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