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.

Receive a financial reward for your information.

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


Detroit Medicare Fraud Earns Hefty Sentence
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Since March of 2007, 1,140 individuals have committed Medicare fraud by falsely billing the Medicare program for more than $2.9 billion; likewise, the Medicare Fraud Strike Force has worked diligently to charge these individuals. In the meantime, the Department of Health and Human Services’ Centers for Medicare and Medicaid Services is working to increase overall accountability among health care providers and patients. While the process remains an arduous one, progress is being made.
Nonetheless, Medicare fraud cases are rampant, and the Santiago Villa-Restrepo case is but one example. The Department of Health and Human Services, along with the FBI and the Department of Justice, were first on the scene to announce this type of fraudulent health care scheme in the Detroit area. Santiago Villa-Restrepo, a 34 year old man from Miami, pleaded guilty to Medicare fraud on November 29, 2011. The fraudulent $5.4 million health care scheme earned Villa-Restrepo a 30-month prison sentence, along with $2.9 million in restitution to be paid by him and his co-defendants.

According to plea documents, Villa-Restrepo cut a deal with Medicare patients to participate in completely unnecessary diagnostic testing in exchange for cash. Villa-Restrepo kept a careful paper trail of patient-signed documents indicating services both rendered to patients and billed to Medicare. These fraudulent activities took place in three separate health care facilities which were owned and operated by the co-defendants. This single health care fraud scheme cost Medicare over $5.4 million.

The FBI and Department of Health and Human Services handled all details of the fraud investigation. Assistant U.S. Attorney Philip A. Ross and Assistant Chief Benjamin D. Singer acted as prosecutors for the Santiago Villa-Restrepo Medicare fraud case. By January 26, 2012, Assistant Attorney General Lanny A. Breuer, U.S. Attorney Barbara L. McQuade, Special Agent in Charge Andrew G. Arena, and Special Agent in Charge Lamont Pugh III announced the sentencing.


Report Medicare fraud here.

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