Healthcare Fraud Investigations Are on the Rise

There has been a recent increase in arrests and prosecutions for health care fraud in Florida as a result of increased law enforcement efforts in investigating these crimes. Healthcare fraud largely involves medical providers committing fraudulent billing practices to increase their profits, including submitting charges for reimbursement to insurance companies, Medicare, and Medicaid for services that weren’t provided. Additional investigations include accepting illegal kickbacks for patient referrals and billing insurance companies under incorrect billing codes to increase the payments received.

On July 31, 2017, seventy-seven people were arrested in Florida for their involvement in various health care fraud schemes that totaled over $141 million dollars in fraudulent billing. These arrests were part of a larger investigation by the Medicare Fraud Strike Taskforce that resulted in 412 individuals facing charges for over $1.3 billion in false billings. These investigations involved a multi-agency effort, involving local law enforcement, the FBI, the Department of Health and Human Services, the Medicaid Fraud Control Unit, and the Florida Attorney General’s Office.

In one white-collar crime case that resulted from this investigation, Eric Snyder, owner of Halfway There Florida, LLC, and Real Life Recovery Delray, LLC, and patient broker Christopher Fuller, both of Palm Beach County, Florida, were charged with conspiracy to commit health care fraud. The two were alleged to be involved in a scheme to illegally recruit patients, pay illegal kickbacks, and commit health insurance fraud. The scheme involved providing kickbacks or bribes to get individuals to reside in their residential facility if the patients also agreed to participate in therapy sessions and frequent drug screenings they could later bill for. Fraudulent billings were alleged to have been submitted for services never provided, including services provided to residents who were no longer participating in the program and therapy sessions that were never attended. Services were alleged to have been provided by non-licensed and unqualified employees with licensed professionals then signing off as if they had performed the services themselves. Drug screens were also alleged to have been tampered with to send the samples to more than one lab, or bill for one drug screen multiple times to generate a larger profit.

On February 13, 2018, Mahmoud Rahim, M.D., of West Bloomfield, Michigan was convicted of conspiracy to commit health care fraud and wire fraud, committing wire fraud, and conspiracy to and receiving health care kickbacks for his role in a $10.4 million conspiracy to defraud Medicare. He was sentenced to 72 months in prison, required to forfeit over $1.6 million, and will be required to pay restitution. The office manager, Janet Nahkle, was also convicted of conspiracy to receive health care kickbacks and sentenced to 18 months in prison.

Not only can a provider charged with health care fraud face incarceration and heavy fines, but it can also cost them their professional license and livelihood. Anyone under investigation or charged with health care fraud should contact an experienced attorney as soon as possible.