Category Archives: Healthcare

NICB Launched Online COVID-19 Resource Center Due to Surge in Insurance Fraud Schemes

The National Insurance Crime Bureau (NICB) has created a new page on its website called the “NICB COVID-19 Resource Center.” The page provides the latest information on emerging fraud schemes due to an influx of insurance fraud cases tied to the COVID-19 outbreak.

The Coalition Against Insurance Fraud (CAIF) recently sent out a statement regarding a surge of fake coronavirus health coverage schemes. It warned that robocalls, text messages, and email phishing attacks could fake insurance deals to consumers, asking them to pay for health or travel insurance premiums without delivering coverage.

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Boca Raton Doctor Charged with Insurance Fraud

A Boca Raton osteopathic physician Dr. Max Citrin has been charged with insurance fraud for allegedly copying and pasting false symptoms for his patients. Citrin was charged with three felonies for submitting fraudulent claims to Blue Cross Blue Shield, Cigna and Humana, totaling nearly 1 million dollars.

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Tallahassee Doctor Accused of Billing Insurers for Phony Medical Procedures

Dr. Moses D. Degraft-Johnson of the Heart and Vascular Institute of Northern Florida in Tallahassee is accused of taking $26 million from health insurance agencies for phony medical procedures. According to federal prosecutors, Dr. Degraft-Johnson allegedly went to hospitals, scheduled patients for unnecessary visits, and billed for the services that never occurred. In some cases, the doctor was traveling when he claims to have done procedures in his office.

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Weston Doctor Sentenced for Conspiring to Illegally Distribute Oxycodone

Dr. Rodolfo Gonzalez Garcia was sentenced to eight years in prison for conspiring to dispense oxycodone, a charge to which he had previously pled guilty. Dr. Gonzalez Garcia and his co-defendants, including his wife Arlene Gonzalez, admitted to using a Hialeah medical office to provide prescriptions for the controlled substance, even though he did not conduct meaningful examinations to prescribe oxycodone appropriately. Dr. Gonzalez Garcia referred to himself as “El Chapo of Oxycodone.”

Co-defendants Arlene Gonzalez and Annie Suarez-Gonzalez pled guilty to conspiracy to pay and receive health care kickbacks. They were sentenced to 4 months in prison and one year of probation each. Co-defendant Fidel Marrero-Castellanos pled guilty to conspiracy to pay and receive health care kickbacks and conspiracy to distribute controlled substances. He was sentenced to 13 months in prison. The co-defendants were ordered to pay a total of $26,306 in restitution.

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Dozens Arrested in Medicare Fraud Crackdown in Miami

Miami police officers arrested at least 30 people on allegations of Medicare fraud. The scam involved people from four pharmacies who are facing three charges, including organized scheme to defraud. One of the pharmacies was paid over $5 million from federal funds for over 30,000 claims. Many of the claims were for medicines that were unnecessary and possibly never dispensed to patients. Included in the arrests were so-called “professional beneficiaries” — patients who allegedly allowed their Medicare benefits to be used for the scam in exchange for kickbacks.

 

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Man Arrested and Extradited to Florida for Posing as Doctor in Kissimmee

Ozioma Maduka was arrested and charged with allegedly diagnosing and treating patients as a health care professional with a license at Osceola Injury Center in Kissimmee. He is also accused of fraudulent billing for unlicensed medical treatments. Maduka’s medical license expired in 2017.

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Unlicensed Florida Doctor Arrested For Unlicensed Medical Treatments and Fraudulent Billing

Ozioma Maduka of Osceola Injury Center, LLC was arrested for allegedly practicing healthcare without an active, valid Florida medical doctor’s license as well as fraudulently billing unlicensed medical treatments. Maduka billed two insurance companies for more than $4,400 in claims for unlicensed treatment of auto accident victims.

Maduka could face up to 5 years in prison if convicted.

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Three South Floridians Arrested in Sober Home Health Care Fraud Scheme

Peter Port, 64, of Boca Raton; Brian Dublynn, 62, of Fort Lauderdale; and Jennifer Sanford, 57, Hollywood were arrested for allegedly billing health-insurance companies for services that were not performed or medically necessary. Port, Dublynn and Sanford made about $13 million in the scam through Safe Haven Recovery, a substance abuse treatment facility in Miami.

The trio was charged with conspiracy to commit health care fraud and wire fraud, health care fraud, conspiracy to commit money laundering and money laundering. They could face at least 20 years in prison if convicted.

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Former Medical Clinic Bookkeeper Charged with Insurance Fraud

Teresa Johnson of Lecanto has been charged with insurance fraud for allegedly defrauding Medicare and Medicaid while working as a bookkeeper for the now-closed Christ Medical Center. According to Johnson’s plea statement, she knowingly billed Medicaid and Medicare for services the now deceased clinic owner did not perform. She also ordered tests she knew were not medically necessary.

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Five People Charged in Mail-order Prescriptions Patient-Brokering Kickbacks

Five people have been charged with patient brokering, insurance fraud, money laundering, and racketeering in connection with a scam that raked in hundreds of thousands of dollars in kickbacks. Authorities allege that hundreds of prescriptions, many of them fraudulent, were sent to Express Care Pharmacy with prices ranging from $646 to $5,614. Many of the prescriptions were forged, unnecessary, or submitted without the patients or treating physician’s consent, according to the police report.

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Filed under Fraud, Healthcare