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 Home Health Care Company Guilty in a $22 million home health Medicare fraud scheme
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According to a recent DOJ press release, Marietha Morales and Eduardo Saborit-Dominguez; the owner and employee of a Miami healthcare agency,  have pleaded guilty to charges involving a $22 million home health Medicare fraud scheme. 
The accused are scheduled to be sentenced in May 2012. This decision arrived after the owner; Marietha Morales who is 38 years of age, pleaded guilty to conspiring to commit health care fraud. She pleaded guilty before a U.S District Judge on January 24, 2012. His employee; Eduardo Saborit-Dominguez; who is 48 years of age, also pleaded guilty before judge Seitz on the 1st of March 2012. The accused pleaded guilty to one count of conspiracy to violate the Anti-Kickback statute. If the accused are found guilty, they stand to face a prison sentence of up to 10 years.

The two, Marietha Morales and Eduardo Saborit-Dominguez were the president and employee of Prime Home Health Services Inc. (a home health care agency based in Florida) respectively. The agency used to provide physical therapy services and home health care to its beneficiaries who were supposed to be eligible.

It is alleged that the president of the health care agency conspired with people who were not patients to act as patients so that they can bill them from Medicare. The citizens pretended to be patients and unnecessary therapy and health care services were done for them. The people who were recruited to be patients were in turn bribed and paid kickbacks in order to continue with the scheme. The distribution and coordination of the bribes to the recruited patients was done by the employee; Saborit-Dominguez while the source of the money was from Marietha Morales. The president; Marietha Morales would use the fake prescriptions and medical certifications that were offered to the recruited patients to illegally bill the Medicare program. All this they did knowing very well that it was illegal and a violation of the law.

The scam goes deeper to the extent that the staff in the hospital such as the nurses and other medical care personnel were used to make false patient files for Medicare beneficiaries although the patients never qualified for home health care from their agency.

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