Federal agents have dismantled a Miami-based ring they said schemed to defraud Medicare of $100 million by filing false claims for obsolete HIV therapy across five states — although two of the suspects who posed as clinic owners have fled to Cuba.
The eight-person organization, which was paid $30 million by the federal health insurance program, exported a fraudulent local business enterprise to Georgia, Louisiana, North Carolina and South Carolina by using empty storefronts and post office boxes, agents said.
The alleged conspiracy, outlined in a 20-count indictment unsealed Tuesday, exploited not only Medicare but also private insurers that administered the government entitlement program under the Medicare Advantage plan.
"These defendants have taken healthcare fraud to a new level," said Acting U.S. Attorney Jeffrey Sloman. "The breadth and scope of the scheme is different than what we've ever seen before."
Since 2005, the U.S. attorney's office in Miami has charged about 800 suspects for filing a total of $2 billion in phony claims – accounting for one-third of all Medicare fraud cases brought nationwide.
Of those defendants, about 60 are fugitives who have fled to Cuba, Latin America and Europe.
The latest indictment comes as the Obama administration pushes to fight billions of dollars in Medicare fraud as part of health care reform that aims to include coverage for more than 40 million uninsured Americans.
The initiative established a joint task force between the Department of Justice and Department of Health and Human Services, and expanded federal strike forces in Miami, Los Angeles, Houston and Detroit.
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