In our first blog of 2018, we reported that the Department of Justice had recovered a whopping $2.4 billion from health care fraud schemes in 2017. Perhaps unfazed by the large number of individuals who are serving prison sentences because of their roles in defrauding health insurance programs like Medicare and Medicaid, fraudsters seem to be looking to break the record this year.

2018 is on pace to have a record year in health care fraud charges.

As reported by Thomas Beaton on HealthPayerIntelligence.com just yesterday, “law enforcement agencies have charged providers and organizations in health insurance fraud schemes more than $310 million in the opening weeks of 2018.” If we were to take that number as January’s total and calculate the pace at which these fraudulent actions are ringing up illegal dough, 2018 would see a mark north of $3.7 billion recovered.

We’re not exactly sure if the destined-to-be increased recovery amount is a good thing for law enforcement agencies and federal health care administrators or a bad thing for the state of health care fraud in this country. Perhaps, it is a little of both. As Beaton points out, prosecution involving health care fraud perpetrators was very aggressive last year and looks to continue to be throughout this year.

Texas city mayor accused in kickback scheme.

“Enforcement agencies have recently charged alleged criminal entities with millions in kickback schemes, medically unnecessary prescribing activities, and unnecessary medical billing practices,” reports Beaton. Among them is the mayor of Rio Bravo, Texas – a city of less than 5,000 people on the Rio Grande, 14 miles south of Laredo. Along with three other individuals, 82 year-old Francisco Peña was charged with obstruction of justice and money laundering.

Peña is accused of participating in a kickback scheme involving members of the Merida Health Care Group that included offering bribes to Medicare directors in exchange for certifying patients for home health services. To increase their Medicare revenues, the group fraudulently kept multiple patients on hospice services. As well, Peña is accused of providing a false statement to FBI investigators, claiming he didn’t know about the kickback scheme.

Not surprisingly, the residents of Rio Bravo are now looking to have the Webb County Attorney remove Peña from office. As reported by KGNS.tv, former mayors of the city are in on the action, campaigning for a replacement who can be trusted to not take advantage of their tax dollars.

Detroit office manager guilty of scheme involving unnecessary prescriptions.

In Detroit, Michigan, 35 year-old Yasser Mozeb has pleaded guilty to his involvement in a scheme that defrauded Medicare of $131 million. The guilty plea includes one count of conspiracy to commit health care fraud and one count of conspiracy to defraud the United States by paying and receiving kickbacks.

“Mozeb admitted that he conspired with the owner of Tri-County Network, Mashiyat Rashid, to pay illegal kickbacks to Medicare beneficiaries and co-conspirator patient recruiters to obtain patients for Tri-County,” reports Beaton, “He also admitted that he worked with Rashid to give individuals living with substance addiction additional prescriptions for oxycodone, hydrocodone and opana.”

At Allegiant Experts, we take health care fraud very seriously. If you’re an attorney, please don’t hesitate to contact us to learn more about how our clinical expertise can assist you in your health care fraud case. Call us at 407-217-5831 or email us at info@allegiantexperts.com.