Medicaid Fraud Violations in Florida Lead to Prison Time

A Florida woman was recently accused of Medicaid fraud violations, that, upon investigation, led to more than four years in prison. The owner of a healthcare facility in Orlando was slammed with a 54 month sentence for Medicaid fraud violations due to allegations that she bilked the federal program for more than $200,000 in unlawful payments.

Medicaid Fraud Violations Used Homeless to Bill Government

According to the Medicaid fraud violations allegations, she exploited homeless people in an effort to bill Medicaid illegally. The state attorney general’s office managed the investigation into the fraud scheme. The owner of the facility previously pleaded guilty to first-degree felony charges of Medicaid fraud.

The circuit judge had originally established a sentence of 108 months for the defendant with the agreement that she turn herself in to receive reduced time. Several co-conspirators were also arrested with the owner in 2015 due to claims that they were recruiting homeless individuals in Orlando to pose as patients. Temporary housing and gas cards were used to recruit the homeless and to use the Medicaid IDs for the patients. Psychosocial rehabilitation services were then billed, even though the patients never received those services. When patients listed on the billing were interviewed, many admitted they had never even seen a doctor.

In addition to billing for services that were never provided, untrained staff members, including some who had a criminal past, were also involved in the Medicaid fraud violations. The owner of the facility was charged with two separate counts of Medicaid provider fraud and initially plead not guilty but later altered that plea. A maximum sentence of 30 years could have been given in the case.

Before the sentencing hearing, the owner of the facility forfeited over $170,000 to Florida for the restitution. The owner was also given a credit of 28 days served. The Medicaid Fraud Control Unit managed the investigation. Since 2011, that office has led investigations that garnered more than $750 million in judgments and settlements.

Investigations Into Medicaid Fraud

Medicaid fraud violations are investigated seriously by the state and federal government. Whether it’s a minor violation or a complex scheme, Medicaid fraud can involve civil as well as criminal penalties when identified.

Medicaid fraud schemes may include billing for services that were never performed, using staff members not approved to administer care to Medicaid recipients, or giving devices, treatments, and medications that are not needed to patients. All of these can lead to detrimental outcomes for the patient in addition to defrauding the government and the taxpayers.

If you know of Medicaid fraud violations in a facility in which you work, you may be able to serve as a whistleblower and to alert the government of these schemes. Talking to an attorney is strongly recommended to protect your rights- contact the experienced team at Bradley/Grombacher today to learn more about your next steps and how to protect your interests.

Note: Bradley/Grombacher is not representing the plaintiff in this lawsuit.