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.


Four Plead Guilty to Medicare Fraud Scheme
Print E-mail

In a $14 million Medicare fraud scheme, four people plead guilty to charges against them. The Department of Justice, the Department of Health and Human Services and the FBI announced the guilty pleas. Curtis Mallory, a 38-year-old patient recruiter, Theodore Haile, a 33-year-old patient recruiter, Maira Suleman, a 31-year-old office manager at Patient Choice and John Thomas, a 33-year-old physical therapist for All American and Patient Choice were charged.
Thomas admitted that he received payments for fabricating therapy documents for people who did not need and who did not receive services. The agencies billed Medicare for these non-existent services. 

Suleman, the data entry person at Patient Choice, managed data entered into the database. She designed systems to make it easy to enter fraudulent billing data into databases that are used to bill Medicare. She stated she also worked with physical therapists and recruiters to get pre-signed forms that therapists use to make up therapy visits. 

Mallory and Haile admitted to receiving payments — kickbacks — from the owners of All American and Patient Choice for every person they recruited. They then billed Medicare for unnecessary physical therapy services. Those services were never provided to those patients. 

In a separate case, authorities accused Gerald R. Funderburg, Jr., of using the Medicare information of 476 beneficiaries to bill Medicare for psychotherapy services. Funderburg used patient information without permission from the patients. The services were allegedly never provided, and if services were provided, they were not medically necessary. Funderburg admitted, according to court documents, that he used social workers’ information to claim the workers provided psychotherapy sessions. The social workers did not know Funderburg was using their names. 

Funderburg allegedly submitted 4,658 claims which totaled $3.3 million for fraudulent services. 

The strike force operations, created in March 2007, charged over 1,100 people who billed Medicare under false pretenses. HHS’s Centers for Medicare and Medicaid Services is now working with HHS-OIG to implement programs that increase accountability. 

Each defendant faces a $250,000 fine and up to 10 years in prison. Sentencing for Suleman, Thomas, Haile and Mallory is scheduled April 19, 2012. Funderburg’s sentencing is scheduled for June 8, 2012.

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.