Corporate Compliance

Miami billing company charged with Medicare fraud

Compliance Monitor, August 29, 2007

The owner of a Miami-based Medicare billing company has been charged with submitting $170 million in fraudulent bills to Medicare, according to the Florida Attorney General's Office. The two-count indictment alleges conspiracy to commit healthcare fraud and submitting false claims to the Medicare program.

From October 2002 to April 2006, R and I Medical Billing Inc. served as the medical biller for 75 Miami-based health clinics that purported to provide HIV infusion services to Medicare eligible beneficiaries. As part of the scheme, the clinic owners provided bills stating that HIV patients were receiving expensive HIV drugs in amounts that were medically impossible.

Of the $170 million in fraudulent bills submitted, approximately $105 million was paid to the clinics. The owner of the billing company received approximately 5% of all claims paid by Medicare.

The charge of conspiracy to commit healthcare fraud carries a maximum penalty of 10 years in jail, while the charge of submitting false claims to the Medicare program carries a maximum penalty of five years in jail.

To read more about the case, visit the Department of Justice Web site.

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