According to the United States Department of Justice, our Federal government continues to battle Medicare fraud to the tune of tens of billions of dollars each year, edging close to $100 billion.[1] As a result, in 2007, a multi-agency team created a Medicare Fraud Strike Force in order to stop criminals from bilking our taxpayers.

South Florida is a well-known hotbed for Medicare corruption, especially when it comes to mental health providers.[2] Although there is corruption around the country, it is noted that Florida submits over six hundred times as many mental health Medicare claims as Michigan does (which is also a problem zone for Medicare scams).[3]

One of the most far-fetched examples was when the Inspector General for the Department of Health and Human Services found a Broward County mental health facility billing Medicare for a patient that resided in Hawaii![4] They took creative billing to a new level.

However, the most egregious crimes cost taxpayers billions of dollars in false Medicare claims.[5] In the Southern District of Florida alone, one hundred defendants were charged with schemes totaling over $200 million in fraudulent billings, some of which were for mental health services.

Former US Attorney Wilfredo Ferrer describes the Medicare corruption problem as being like a “game of whack-a-mole.”[6] With all the government subsidizes for elderly health care, corruption is rampant. The elderly are often packed into poorly run assisted living facilities and forced into mental-health programs, so that the agencies don’t lose their funding.[7]

Another scam involved assisting patients who were looking to live in the United States by any means possible. Falsifying their immigration forms by citing mental illness, they could avoid taking the citizenship test.[8]

Philip Esformes and his cohorts scammed Medicare and Medicade to the tune of one billion dollars in South Florida in 2016.[9] They were reported to have run many patients through their facilities despite the fact that the people never needed treatment, including mental health services.

Also in 2016, Miami psychiatrist Dr. Fernando Mendez-Villamil pled guilty to defrauding various government institutions. U.S. District Judge Federico Moreno sentenced him to twelve years and seven months in prison and ordered that he repay the $50.6 million he stole from four different government agencies through his multiple elaborate schemes. Dr. Mendez-Villamil’s crimes included flooding the streets of Miami with anti-psychotics, then billing Social Security for disability benefits for his so-called “patients’” medications.[10]

This particular psychiatrist had a long history of outrageous criminal fraud. He first attracted attention from Iowa Senator Charles Grassley, who reported to officials that Mendez-Villamil had purportedly written 96,685 prescriptions within two years.[11]

Recently, two employees of the American Therapeutic Corporation, a Miami psychiatric care facility, were denied an appeal for their part in defrauding Medicare of $200 million in false claims. Rodolfo Santaya, one of their patient recruiters, would troll low-income areas for elderly candidates and bring them in, receiving a kickback for each new patient. Many had no medical need, so Santaya told them to lie about their symptoms in order to qualify.[12]

Unfortunately, our government and private health insurance forks over billions of dollars a year to psychiatrists and psychologists in an attempt to treat mental illness, only to be defrauded by the so-called professionals who have claimed a monopoly over the field of mental health.[13] It’s vital that we continue to bring these criminals to justice.

 

 

[1]http://www.miamiherald.com/news/health-care/article91393077.html

[2]http://www.palmbeachpost.com/news/crime–law/south-florida-medicare-cheats-switch-strategies-elude-feds/4rZqgTPh8deZ5cuT0H6GRI/

[3]http://www.palmbeachpost.com/news/crime–law/south-florida-medicare-cheats-switch-strategies-elude-feds/4rZqgTPh8deZ5cuT0H6GRI/

[4]http://miami.cbslocal.com/2012/08/30/report-no-area-of-u-s-cheats-medicare-more-than-s-fla/

[5]http://www.psychiatrictimes.com/cultural-psychiatry/fraud-waste-and-excess-profits

[6]http://www.palmbeachpost.com/news/crime–law/south-florida-medicare-cheats-switch-strategies-elude-feds/4rZqgTPh8deZ5cuT0H6GRI/

[7]http://miami.cbslocal.com/2012/08/30/report-no-area-of-u-s-cheats-medicare-more-than-s-fla/

[8]https://federalcrimesblog.com/tag/health-care-fraud-prevention-enforcement-action-team/

[9]http://www.cnbc.com/2016/07/22/1-billion-alleged-medicare-fraud-money-laundering-scheme-leads-to-florida-arrests.html

[10]http://www.miamiherald.com/news/health-care/article91393077.html

[11]http://www.miamiherald.com/news/health-care/article53792465.html

[12]https://www.healthcarelaw-blog.com/2017/04/convictions-will-stand-mental-health-employees-200-million-medicare-fraud-case.html

[13]http://www.cchr.org/cchr-reports/massive-fraud/introduction.html