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.


Patient Recruiters for Home Health Care Agency Guilty of $14 Million Medicare Scheme
Print E-mail

Four people who took part in a scheme to defraud the Medicare program of $14 million entered guilty pleas in federal court. Curtis Mallory and Theodore Haile worked as patient recruiters for Patient Choice Home Care Inc. and All American Home Care Inc., two home health agencies located in Oakland County, Michigan. The two admitted they paid kickbacks to beneficiaries who provided their Medicare information and signed therapy documents. The owners and operators used the information and documents to bill Medicare for physical therapy services the agencies never provided. Haile and Mallory received a payment for each beneficiary they recruited.

Patient Choice and All American paid John Thomas, a physical therapist, to document physical therapy visits that never took place or were provided to Medicare beneficiaries who did not need them. Maira Suleman worked as an office manager for Patient Choice. She admitted to designing systems used to fraudulently bill Medicare for physical therapy visits. She also worked with the recruiters and physical therapists to collect and maintain the data needed to create false visit documents for physical therapy sessions. 

In another case, the owner of a psychotherapy clinic in Detroit, Gerald R. Funderberg, pleaded guilty to billing Medicare $3 million for services that were never provided or were not needed. Funderberg did not obtain the consent of nearly 476 beneficiaries, or the social workers who allegedly conducted the sessions, when he used their information to fraudulently bill Medicare. Between November 2006 and April 2011, he admitted to causing 4,658 claims to be submitted to Medicare. 

The maximum penalty for each defendant is 10 years in prison and a fine of $250,000. Haile, Mallory, Thomas and Suleman will be sentenced April 19, 2012. The sentencing of Gerald Funderberg is set for June 8, 2012. 

The Department of Justice, FBI and Department of Health and Human Services announced the guilty pleas in late January. Both cases resulted from investigations conducted by the Medicare Fraud Strike Force, a joint effort of the FBI and Health and Human Services - Office of the Inspector General. Formed in March 2007, strike force investigations around the country have resulted in charges against over 1,160 people. These schemes fraudulently billed the Medicare program over $2.9 billion.

Report Medicare fraud here.

Help stop government waste and abuse, and get rewarded for your efforts. Our attorneys have significant experience representing healthcare industry whisteblowers. Complete the secure form on this page or call 1-800-581-1790 for a free no obligation consultation with a lawyer.