ibusinesslines.com November 20, 2018

6 medical professionals in Orlando included in health care fraud crackdown

01 July 2018, 09:28 | Melissa Porter

6 medical professionals in Orlando included in health care fraud crackdown

U.S. Attorney General Jeff Sessions arrives for a news conference to announce a nation-wide health care fraud and opioid enforcement action at the Justice Department in Washington

It's the largest health-care fraud takedown in U-S history.

The massive enforcement initiative - which spanned 58 federal districts - swept up 165 doctors, nurses and other licensed health professionals, including 76 doctors accused of prescribing and distributing opioids and other prescription painkillers.

Several doctors who live on Long Island have been charged with healthcare fraud as part of a national crackdown on allegedly improper billings for procedures that were either not medically necessary or not done at all.

According to the U.S. Centers for Disease Control and Prevention, 42,000 people in the U.S. died from opioid overdoses in 2016. "Some Houston-area medical professionals, including doctors, nurses and pharmacological representatives, have chosen to break the law and place their greed before those whom they are charged to heal".

In addition, HHS announced today that from July 2017 to the present, it has excluded 2,700 individuals from participation in Medicare, Medicaid, and all other Federal health care programs, which includes 587 providers excluded for conduct related to opioid diversion and abuse.

With the new cases being filed in "Spinal Cap", the fraudulent claims related to this scheme now span a 15-year period and total more than $950 million, prosecutors said.

Among dozens of new cases in South Florida, Greenberg zeroed in on Good Decisions Sober Living in West Palm Beach, whose operators recruited patients and paid kickbacks in order to bill $106 million for widespread fraudulent urine testing that was not medically necessary between 2011 and 2015, according to an indictment.

The case is considered the largest fraud in healthcare in US history. That's a loss of $337 million in false billings for services, including home health care and pharmacy fraud.

The indictment charges Irena Shut, 41, an attorney who lives in Hidden Hills, with paying kickbacks to two podiatrists to authorize prescriptions written on pre-printed prescription pads created to maximize insurance payments, regardless of the medical need for an expensive compounded formulary for each "patient".

Doctors, pharmacists, nurses and other medical officials are among the charged. "Health care fraud costs the country tens of billions of dollars a year, and the FBI seeks to identify and pursue investigations against the most egregious offenders involved in health care fraud through investigative partnerships with other federal agencies".

The informations charge each of the defendants with one count of conspiracy to commit wire fraud, mail fraud and health care fraud.

Erving Rodriguez: charged with one count of conspiracy to solicit and receive health care kickbacks.

In the Los Angeles-based Central District, most of the medical professionals were charged with schemes to defraud health insurance programs such as Medicare.

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