Medicare fraud
The healthcare reform law also provides for stricter penalties; for instance, requiring physicians to return any overpayments to CMS within 60 days time.
[citation needed] Defendants convicted of Medicare fraud face stiff penalties according to the Federal Sentencing Guidelines and disbarment from HHS programs.
Defendants can expect to face substantial prison time, deportation (if not a US citizen), fines, and restitution[citation needed] or have their sentence commuted.
From January 2009 to June 2012, the Justice Department used the False Claims Act to recover more than $7.7 billion in cases involving fraud against federal health care programs.
[22] According to US Department of Justice figures, whistleblower activities contributed to over $13 billion in total civil settlements in over 3,660 cases stemming from Medicare fraud in the 20-year period from 1987 to 2007.
[24] Recarey had "employed" Jeb Bush as a real estate consultant and paid him a US$75,000 fee for finding IMC a new location, although the move never took place.
Bush lobbied the Reagan administration successfully on behalf of Recarey and IMC to waive a rule of maximum 50% Medicare enrollee proportion.
These culminated in the company being raided by Federal agents searching for documents and eventually the ousting of the corporation's CEO, Rick Scott, by the board of directors.
In 2001, Hospital Corporation of America (HCA) reached a plea agreement with the U.S. government that avoided criminal charges against the company and included $95 million in fines.
[32] Starting in 2006, healthcare entrepreneur Adam B. Resnick sued Omnicare, under the False Claims Act, as well as the parties to the company's illegal kickback schemes.
[37] In addition to chemotherapy malpractice, the court found Fata guilty of mistreating patients with inappropriate octreotide, potent antiemetics, and parenteral vitamins.
After beginning a lifelong chemotherapy treatment prescribed by Fata, patient Monica Flagg broke her leg and was seen by another physician at his practice, Dr. Soe Maunglay.
Fatima Hassan, co-owned a company known as Jos Campau Physical Therapy with Javasundera, pleaded guilty on August 25, 2011, for her role in the Medicare fraud schemes and on May 17, 2012, was sentenced to 48 months in prison.
In May 2013, Federal officials charged 89 people including doctors, nurses, and other medical professionals in eight U.S. cities with Medicare fraud schemes that the government said totaled over $223 million in false billings.
[49] The bust took more than 400 law enforcement officers including FBI agents in Miami, Detroit, Los Angeles, New York and other cities to make the arrests.
The government said the fraudulent schemes netted approximately $712 million in false billings in what is the largest crackdown undertaken by the Medicare Fraud Strike Force.
[51] In April 2019, Federal officials charged Philip Esformes, 48 years old, of paying and receiving kickbacks and bribes in the then largest Medicare fraud case in U.S. history.
[52] Former Hospital Executive Odette Barcha, 50, was Esformes’ accomplice along with Arnaldo Carmouze, 57, a physical assistant in the Palmetto Bay, Florida area.
The assisted living and skilled nursing facilities would admit the patients and bill Medicare and Medicaid for unnecessary, fabricated and sometimes harmful procedures.
