Consumer Fraud

Feds Bust $8.6 Million Home Health Care Fraud Operation in Miami

Pills Stethascope on Money 435x289 Feds Bust $8.6 Million Home Health Care Fraud Operation in MiamiTwo Florida residents face time in federal prison for operating a home health care fraud scheme that cheated Medicare out of $8.6 million.

The U.S. Department of Justice said that a federal judge in Miami sentenced Alexander Ros Lazo, 54, the owner of T.L.C. Health Services of Miami to 87 months in prison. According to the government’s complaint, Mr. Ros Lazo and his employee, Misleidy Ibarra, 46, conspired with others in building their Medicare patient base and in billing the government for illegitimate physical therapy services.

Federal prosecutors said that Ms. Ibarra performed home health therapy services without a license and that T.L.C. Health Services billed Medicare for those services. She was sentenced to serve two years in federal prison.

As part of his guilty plea, Mr. Ros Lazo admitted that he paid kickbacks and bribes to his co-conspirators in exchange for home health services prescriptions and the referral of Medicare beneficiaries to T.L.C. Health Services.

He also admitted that he and Ms. Ibarra arranged with their co-conspirators to commit health care fraud by billing Medicare for physical therapy services that Ms. Ibarra performed on behalf of licensed therapists, despite knowing she was unqualified to provide those serves and ineligible for Medicare reimbursement.

As a result of this health care fraud scheme, Medicare paid $8.6 million in benefits that it otherwise would not have paid, the U.S Department of Justice said.

In addition to their prison sentences, both defendants will have to pay restitution to the U.S. The judge ordered Mr. Ros Lazo to pay the U.S. $8,603,859 in restitution and forfeit the same amount. The amount of restitution Ms. Ibarra will have to pay will be decided in a later hearing.

The U.S. launched the Medicare Fraud Strike Force in 2007 to combat the rising tide of health care fraud in the U.S., most of which impacts Medicare, Medicaid and other taxpayer-funded health care programs. The Strike Force maintains 14 operations in 23 U.S. districts where health care fraud is especially prevalent. Since its inception, the Medicare Fraud Strike Force has charged nearly 4,000 defendants for fraudulent Medicare billings totaling more than $14 billion.