Health care fraud cases are prosecuted by the Health Care Fraud Unit (HCF), a division from the Fraud section of the Criminal Division. The unit is made up of a team of fifty-five prosecutors who focus on cases that comprise a) significant financial losses from the public treasury b) harm to the patient. Furthermore, this unit boasts of proficiency and competence in prosecuting fraud cases related to the health care within the U.S. through its Strike Force. The Strike Force is designed to feature agents from the Centers for Medicare & Medicaid Services, local law enforcement forces, United States Attorney’s office, the FBI, DCIS, CPI, IRS, HHS-OIG, and the DEA.
In its drive to fight graft, the unit managed to charge defendants totaling 601 across different federal states. Among the defendants, were licensed medical professionals, nurses, and doctors who faced charges ranging from the prescription of dangerous narcotics such as opioids. Moreover, the thousands of individuals and providers were barred from involvement in Medicaid, health care programs sponsored by the Federal government, and Medicare ( The United States Department of Justice, 2019) . The defendants faced charges for their participation in fraudulent claims to TRICARE, Medicaid, Medicare, and private insurance firms for medical billings that were either never provided or unnecessary. Majority of the fraudulent schemes involved co-conspirators, patient recruiters and beneficiaries receiving cash handouts for providing information related to patients to the providers who billed Medicare. One of the patient recruiters was Sunshine Medical Care Group Inc.
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Miami’s Health Care Fraud Riddled Institution
Miami happens to be the location of the United States’ largest and first Strike Force in Medicare Fraud. The Strike Force is exemplary to other government law enforcement agencies in cities like Houston, Los Angeles, and Detroit. Furthermore, the Strike Force from Miami has recorded remarkable achievement in the prosecution of Medicare-related fraud comprising home health, community mental health, and HIV infusion. Prosecutors from the Miami strike force have spearheaded cases that have led to a number of the heftiest verdicts for crimes related to health care, comprising a fifty-year jail term in 2011 and a 25-year jail term in 2013. The culprits of the sentences were operators of amenities that maltreated patients with mental problems together with those experiencing degenerative disorders like dementia and Alzheimer.
Juliette Anais Tamayo who is Fifty-three-years old and the president of Sunshine Medical Care Group, Inc. was not left out of the HCF countrywide sweep. She was apprehended after being linked to a USD$ 3.7 million racket meant to defraud Medicare through submission of unnecessary or falsified bills. Moreover, Juliette did not submit the bills from her hospital only but also supplied three other homes with patient information with the intent to get a kickback ( The United States Department of Justice, 2019) . She took the plea of guilty for the crimes of wire scam and a plot to perform fraud in health care. Even though the Federal prosecutors claim that earlier on she had taken another plea of guilt for the charges of conspiring to receive and pay kickbacks.
Juliette’s guilty plea was made public by Brian A. Benczkowski, the Deputy Attorney General of the United States from the Criminal Division of the Justice Department, and Special Agent George L. Piro in Charge of the Federal Bureau of Investigations ( The United States Attorney’s Office, 2018) . The Strike Force was also made up of the United States Attorney Ariana Fajardo Orshan, Special Agent Brian Swain in Charge of Secret Service of the United States, and Special Agent Shimon R. Richmond in Charge of the United States Human and Health Services Office Department of Inspector General. Same as the majority of the professional practitioners, nurses, health service providers, and doctors who were arraigned in the different 58 federal courts, the president of Sunshine was alleged to have received monitorial handouts from providers ( Department of Justice, 2018) . She is also alleged to have conspired with other Miami-based home health bureaus in substitution for the provision of drug instructions for home-based services for health for patients in her clinic.
The prosecutors confirmed that the providers after receiving the fraudulent billings, in turn, used them to bill Medicare recipients. In her reply, Juliette said that she used the handouts from the service providers to pay doctors working in her institution, Sunshine to sweet talk them into writing falsified drug prescriptions ( The Department of Health and Human Services & The Department of Justice, 2006) . The service providers and a practicing medical doctor from Sunshine Medical Care Group Inc. both took the plea of guilty for charges of intending to compel health-related fraud case. The investigations were conducted by the Strike Force comprised of HHS-OIG, FBI, and the United States Secret Service. Likewise, the case is under the prosecution by Gary A. Winters from the Fraud Section of the Criminal Division, and trial attorney Adam G. Yoffie.
Since it was initiated way back in 2007, the strike force has successfully arraigned in court almost 4000 individuals who have in their unison fraudulently billed Medicare amounts to the tune of USD$ 14 billion. Furthermore, during the sweep that netted Juliette, the Strike Force charged approximately 124 culprits from Florida only with various counts comprising a staggering USD$ 337 million in unnecessary or falsified bills ( Department of Justice, 2018) . On her part, Sunshine’s president is waiting for her sentence scheduled on 30th April 2019.
References
The Department of Health and Human Services & The Department of Justice, (2006). Health Care Fraud and Abuse Control Program Health Annual Report For FY 2005 -OIG .HHS .gov
https://oig.hhs.gov/publications/docs/hcfac/hcfacreport2005.pdf
The United States Attorney’s Office, (June 28, 2018). National Health Care Fraud Takedown Results In Charges Against 601 Individuals Responsible For Over $2 Billion In Fraud Losses | USAO-MDGA | Department of Justice
https://www.justice.gov/usao-mdfl/pr/national-healthcare-fraud-takedown-results-charges-against-601-individuals-responsible
Department of Justice, (November 12 2018). Justice Department Awards $56 Million to Support Law Enforcement Health and Safety
https://www.justice.gov/opa/pr/justice-department-awards-56-million-support-law-enforcement-health-and-safety
Department of Justice, (December 21, 2018). Justice Department Recovers Over $2.8 Billion from False Claims Act Cases in Fiscal Year 2018
https://www.justice.gov/opa/pr/justice-department-recovers-over-28-billion-false-claims-act-cases-fiscal-year-2018
The United States Department of Justice, (February 20, 2019). Miami Medical Clinic Owner Pleads Guilty to Health Care Fraud Scheme. Justice News
https://www.justice.gov/opa/pr/miami-medical-clinic-owner-pleads-guilty-health-care-fraud-scheme
