Record-Breaking Recoveries Resulting From Joint HHS/DOJ Effort to Combat Health Care Fraud
Annual report shows that for every dollar spent on health care-related fraud and abuse investigations in the last three years, the government recovered $8.10.
Medicare Fraud strike force charges 89 individuals for approximately $223 million in false billing
Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announce a nationwide takedown by Medicare Fraud Strike Force operations in eight cities.
HHS would increase rewards for reporting fraud to nearly $10 million
Health and Human Services Secretary Kathleen Sebelius today announced a proposed rule that would increase rewards paid to Medicare beneficiaries and others whose tips about suspected fraud lead to the successful recovery of funds to as high as $9.9 million.
HHS Report to Congress on Progress of
Report to Congress Fraud Prevention System, First Implementation Year, September 2012.
- Read the Report (PDF – 3.7MB)
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April 14, 2014
California - S.F. Valley Woman Who Orchestrated Health Care Fraud Scheme that Submitted Nearly $25 Million in Bogus Bills Sentenced to over 7 Years
A North Hollywood woman who worked in the health care industry was sentenced this afternoon to 76 months in federal prison for orchestrating a scheme that submitted nearly $25 million in fraudulent bills to Medicare for services and supplies that were medically unnecessary and sometimes were never provided. Susanna Artsruni, 46, who formerly owned a durable medical equipment (DME) company and worked at a number of medical clinics in Los Angeles, was sentenced by United States District Judge Margaret M. Morrow.
March 18, 2014
Florida - Straw Owner of Clinic Sentenced in Medicare Fraud Scheme
A Florida man who had been the straw owner of a physical therapy rehabilitation facility has been sentenced to serve 30 months in prison for his role in a $28.3 million Medicare fraud scheme. Roberto Fernandez Gonzalez, 63, formerly of southwest Florida, was sentenced by U.S. District Judge Susan C. Bucklew in the Middle District of Florida and was ordered to forfeit $446,738 and pay the same amount in restitution. Fernandez pleaded guilty on June 24, 2013, to conspiracy to commit health care fraud.
March 14, 2014
Florida - Medical Clinic Owner Sentenced for Role in Multiple Health Care Fraud Schemes Totaling Over $20 Million
The owner and operator of a Miami medical clinic, Merfi Corp., was sentenced today to serve 108 months in prison for her participation in multiple health care fraud schemes. Isabel Medina, 49, of Miami, was sentenced by U.S. District Judge Ursula Ungaro of the Southern District of Florida. In addition to her prison term, Medina was also sentenced to serve three years of supervised release and was ordered to pay $8,437,393 in restitution.
March 12, 2014
Houston - Jury Convicts All Seven Defendants in $97 Million Medicare Fraud Scheme
A federal jury in Houston today convicted two owners of a former Houston mental health care company, Spectrum Care P.A. (Spectrum), several of its employees and the owners of certain Houston group care homes for their participation in a $97 million Medicare fraud scheme. Physicians Mansour Sanjar, 81, and Cyrus Sajadi, 66, the owners of Spectrum, were each convicted of conspiracy to commit health care fraud and conspiracy to pay kickbacks as well as related counts of health care fraud and paying illegal kickbacks. Adam Main, 33, a physician's assistant, was convicted of conspiracy to commit health care fraud and related counts of health care fraud. Shokoufeh Hakimi, 66, administrator of Spectrum, was convicted of conspiracy to commit health care fraud, conspiracy to pay kickbacks and a related count of paying an illegal kickback. Chandra Nunn, 35, a group home owner, was also convicted of conspiracy to commit health care fraud, conspiracy to pay and receive kickbacks and related counts of receiving illegal kickbacks. Sharonda Holmes, 40, a patient recruiter, was convicted of conspiracy to pay and receive kickbacks and a related count of receiving an illegal kickback. Shawn Manney, 51, a group home owner, was convicted of conspiracy to pay and receive illegal kickbacks.
February 18, 2014
Florida - Ernesto Hernandez was arrested at Miami after arriving on a flight from Cuba.
Investigators believe that Hernandez, through his company, submitted nearly $4 million in false claims to Medicare, billing for various health care benefits, items, and services that were not medically necessary, not prescribed by a doctor, and/or were never provided to beneficiaries. Hernandez received approximately $1.4 million in reimbursement from Medicare for these fraudulent claims.