Federal agents raided Florida Healthcare Plus in Cora Gables Wednesday for allegedly running a more than $25 million Medicare, Medicaid, and wire fraud scheme.
Authorities said eleven people were involved in the schemed to defraud the government. According to the federal indictment, Florida Healthcare Plus (FHCP) was authorized by Medicare and Medicaid to offer plans to the beneficiaries, which was then allegedly taken advantage of by the defendants.
The indictment said the group recruited people living in the Dominican Republic and Nicaragua to fraudulently sign up for Medicare and Medicaid by saying they lived in Florida. Medicare and Medicaid then made monthly payments to FHCP and other Medicare plans based on the fraudulent residents’ submitted to them.
In addition, the Florida Medicaid program paid Medicare premiums and deductibles for many beneficiaries who didn’t live in Florida, the federal indictment alleged. Federal officials also said doctors were designated as a primary care physician who saw the people and then provided diagnoses which were used by the defendants to calculate how much to charge Medicare.
Federal officials said Pedro Hernandez, 51, of Miramar was the chief operating officer at FHCP until May 8, 2013, during the time of the alleged fraud.
“Health care fraud is a devastating crime that threatens the strength and integrity of our health care system,” said U.S. Attorney Ferrer. “We are dedicated to protecting Medicare from fraud and abuse to ensure that beneficiaries of federal health care programs receive appropriate medical care. The charges announced today demonstrate that law enforcement in Miami will continue to fight the battle against health care fraud locally and across our borders.”
For legitimate patients, the news was "upsetting."
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"Strenuous you know," said Dinorah Rangel. "It's upsetting because after all, we are retired and we should not be dealing with this."
The defendants are charged with conspiracy to commit health care fraud and wire fraud, substantive counts of health care fraud, conspiracy to defraud the United States and make false statements related to health care matters and substantive counts of making false statements related to health care matters.
