What is Medicare Fraud?

Medicare fraud occurs when a hospital, nursing home, doctor's office, hospice care facility, ambulance service, pharmacy, rehabilitation center, or any other type of healthcare provider overbills Medicare.


Who can report Medicare fraud?

Medicare fraud whistleblowers are almost always healthcare professionals. They are commonly employed as hospital administrators, nurses, hospice or nursing home workers, ambulance drivers, pharmacists, or as any other type of healthcare professionals.

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Healthcare professionals may be entitled to a significant financial reward for becoming Medicare whistleblowers. Learn about receiving a financial reward for your information here.


Miami man sentenced to prison in "patient recruiter" Medicare fraud scheme
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On June 7, 2011, the US Department of Justice (DOJ) issued a press release indicating that a Miami man was sentenced to 77 months in prison for his participation in a $9 million Medicare fraud scheme in Detroit, Michigan.
The man, Reynel Betancourt, 51, had pleaded guilty on March 29, 2011 to two conspiracy charges: one count of conspiracy to commit health care fraud and another of money laundering conspiracy.

The presiding judge, US District Judge Cecilia M. Altonaga of the Southern District of Florida, also piled on additional punishment: three years of supervised release upon finishing his prison term and payment of $6 million in restitution, along with his co-defendants.

Betancourt originally faced an indictment in the Eastern District of Michigan. However, after his arrest in Miami, he agreed to have his case tried in the Southern District of Florida for his plea and sentencing.

According to plea documents, beginning in March, 2006, he entered into a business arrangement with Dearborn Medical Rehabilitation Center (DMRC) owner to recruit patients for the facility. The center purported to provide infusion and injection therapy services for Medicare patients.

Betancourt said he paid patients to sign documents claiming they had received special medications and injection therapy services which they never received.

DMRC then billed Medicare for more than $9 million in treatments, which were neither medically necessary nor provided. To cover up his involvement, Betancourt admitted he laundered the Medicare fraud proceeds through two fake companies he created solely for that purpose.

The case’s success can be attributed to the joint work of the FBI and the Health and Human Services-Office of Inspector General, as part of the Medicare Fraud Strike Force.

The Force has had great success since its 2007 inception: in nine locations, the operations have charged more than 1,000 defendants who fraudulently billed Medicare for more than $2.3 billion.

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