10 Miami Businessmen Charged in $1.4 Billion Healthcare Scheme in Florida | Whittel & Melton

June 30, 2020

One of Florida’s largest health insurance fraud cases resulted in the arrest of 10 Miami businessmen Monday.

According to federal prosecutors, the men were charged with submitting $1.4 billion in fraudulent claims for urinalysis and blood tests at several rural hospitals in Florida, Georgia, and Missouri.

An indictment for the men shows that they are accused of submitting claims to Florida Blue and other private insurance companies for $400 million worth of tests that were executed at private labs and not the rural hospitals. The U.S. Attorney’s Office in Jacksonville says that the men were able to increase their reimbursements by doing this as the rural hospitals received higher insurance payments from 2015 to 2018.

The men charged reside in Miami-Dade County, Broward County, Marion County, Citrus County, Chicago, and Atlanta.

According to the indictment, some of the defendants allegedly used the financial reins of rural hospitals that were facing troubles and then billed private insurers, like Florida Blue, for pricey blood tests and urinalysis that were conducted at other private labs.

Prosecutors claim that the men used these rural hospitals facing financial hardships as a shell to fraudulently bill for these tests to get a higher reimbursement.

The indictment goes on to say that these tests were also not medically necessary. The men are also accused of paying kickbacks to patients with alleged drug problems as well as other healthcare providers.

The rural hospitals include:

Campbellton Graceville Hospital

5429 College Dr, Graceville, FL 32440

Regional General Hospital

125 SW 7th St, Williston, FL 32696

Chestatee Regional Hospital

227 Mountain Dr Dahlonega, GA 30533

Putnam County Memorial Hospital

1926 Oak St, Unionville, MO 63565

When someone is accused of healthcare fraud, the prosecution must prove that they participated in a scheme to bilk money out of a healthcare program, which in this case is allegedly Florida Blue. Healthcare fraud cases are extremely complex and usually evolve after years of investigations. These cases and their charges cover a broad span of conduct. Most insurance fraud cases involve “tricks” or bribery to steal money and the government takes these allegations quite seriously. These cases can be quite in-depth and involve deliberate dishonesty, which is why the government targets any suspicious activity to catch those believed to be playing a role in these crimes.

Many insurance fraud cases involve billing for unnecessary services or for services that were never actually provided. Upcoding, double billing, kickbacks, and other infractions go hand in hand with these charges. Our South Florida Healthcare Fraud Attorneys at Whittel & Melton help clients accused of fraud charges at the state and federal level. We will go to work right away for you and help you establish a compelling defense for your charges. After reviewing the facts of your case, we may be able to show that the claims submitted were legitimate or that you were unaware the insurance claim was not correct and you did not submit it intentionally. Every case is different and requires a unique defense strategy. As former prosecutors, we can put our experience to work for you and make sure you have a powerful defense. We will fight aggressively to obtain an outcome that you can live with.

If you have been accused of false billing, falsifying documents, upcoding, billing for unnecessary tests or services, double billing, kickbacks or referrals, billing for unnecessary medical equipment, or any other fraudulent allegations, we are here to help you. Again, in these cases, the prosecution must prove intent in these cases. In many of these cases, billing mistakes are not intentional. At Whittel & Melton, we will fight to protect your reputation, rights, and freedom. We urge you to get in touch with us today to discuss your case and get started developing a strong defense strategy. We are available 24/7 to help you – we can meet in person, over the phone, through video conference, etc.