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.


$25 Million Miami Home Health Care Medicare Fraud Scheme Busted by Fraud Strike Force
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A combined effort of the Justice Department, the FBI, and the Department of Health and Human Services managed to bust three defendants who were running a $25 million scheme to defraud Medicare.

Lisandra Alonso, age 34, was the apparent mastermind of the plot to defraud Medicare. She served as the office manager for the fictional home health agency ABC Home Health Care, Inc. in Miami, Florida and was sentenced to over 6 years in prison and ordered to repay the federal government over $15 million in restitution. Her co-defendants were Jose Ros, age 72, who served as a patient recruiter for the fraud scheme and Farah Maria Perez, age 40, who was a registered nurse working for another fraudulent home health agency named Florida Home Health. Ros received a 1 year prison sentence and Perez was sentenced to 6 months of prison time. Both co-conspirators were also required to pay restitution.

The fraud apparently began in January 2006 and continued until it was shut down around March of 2009. Alonso and her co-conspirators identified patients who would allow ABC Home Health and Florida Home Health to fraudulently claim that they were entitled to and receiving home health physical therapy services. The co-defendants also assisted with the creation of false medical records and trained other employees to do the same. The scheme also involved an elaborate system of kickbacks that encompassed doctors, patients, and the owners of ABC Home Health Care and Florida Home Health, health care entities created solely to defraud the federal government.

The dissolution of this medicare fraud ring represents another successful prosecution of a case that was identified and investigated by the Medicare Fraud Strike Force, a group formed in March 2007 that operates in 9 locations across the U.S. to recover money fraudulently billed to the Medicare program.

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