South Florida is 'ground zero' for healthcare fraud

South Florida is a hot spot for schemes designed to defraud Medicare and Medicaid, according to an investigator for HHS' Office of the Inspector General. 

Omar Pérez Aybar, a special agent for HHS' Office of Inspector General in South Florida, told CNBC on March 9 that about 90 percent of durable medical equipment companies are fraudulent. 

"South Florida, without question, is the ground zero for healthcare fraud, but it's only one state. There are 49 others and territories where these types of schemes are occurring," Mr. Pérez Aybar told CNBC. 

Mr. Pérez Aybar described how fraudsters will establish durable medical equipment companies, which often sell no actual equipment. The company's owners will purchase patient information or pay kickbacks to participating physicians to submit claims to public payers. 

In Florida, there were 600 HHS investigations into fraud in 2022 and 43 criminal convictions in fraud cases, according to data from the Office of the Inspector General. 

Here are 13 notable fraud cases Becker's has reported in the region since March 2022, starting with the most recent: 

  • A Florida chiropractor and surgeon were convicted Jan. 30 of a $31 million scheme to defraud Medicare by billing for medically unnecessary medical equipment. 

  • A South Florida-based marketer pleaded guilty Jan. 27 to buying and selling more than 2.6 million Medicare beneficiary identification numbers and other personal identifying information.

  • A pair of Texas and Boca Raton, Fla., medical equipment company and pharmacy owners were indicted for allegedly for paying kickbacks to telemarketing firms in exchange for signed orders for unnecessary hip, knee and back braces, as part of a $14.5 million Medicare fraud scheme.

  • Nine Florida residents were arrested Dec. 6 for allegedly conspiring to bill $37 million in fraudulent claims to Blue Cross Blue Shield.

  • A Stuart, Fla.-based medical equipment company owner was sentenced in October to four and a half years in prison for a fraudulent Medicare billing scheme.

  • A Fort Lauderdale, Fla., lab owner agreed to pay more than $97 million in restitution and forfeit more than $31 million and a luxury boat after pleading guilty in September to charges in three federal billing fraud cases against him.

  • A mother and daughter who owned a pharmacy in Sunrise, Fla., were indicted in September on charges stemming from an alleged scheme to defraud Medicare out of more than $12 million.

  • A Miami durable medical equipment owner was sentenced in September to 87 months in prison for his role in using the company to commit Medicare and Medicaid fraud.

  • A Boca Raton, Fla., chiropractor was sentenced in September to four years in prison for a $20 million scheme that resulted in more than $10 million in payments from both Medicare and the Civilian Health and Medical Program of the Department of Veterans Affairs.

  • A Pompano Beach, Fla. specialty pharmacy agreed to pay $1.31 million in July to resolve allegations that it submitted false claims to Medicare for prescriptions for an expensive treatment used for opioid overdoses.

  • A Miami-based CEO running dozens of companies across two states was indicted in New Jersey in July after he allegedly trafficked billions of dollars worth of fake Cisco equipment and sold it to hospitals and other organizations.

  • A Delray Beach, Fla., telemedicine company owner was sentenced in June to 14 years in prison for healthcare and wire fraud that cost Medicare more than $20 million.

  • Three South Florida physical therapy clinic owners and a physician were sentenced in May for their roles in a $17 million medical billing fraud scheme. 

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