Protecting the integrity of Medicaid by prosecuting fraud
When criminals defraud Floridas Medicaid program, they are essentially stealing money from taxpayers.
November 21, 2013 at 07:00 PM
3 minute read
One of my office's primary responsibilities is to investigate and prosecute cases of Medicaid fraud. When criminals defraud Florida's Medicaid program, they are essentially stealing money from taxpayers. As Florida's attorney general, I am dedicated to working with various partners to identify and stop Medicaid fraud.
My Medicaid Fraud Control Unit (MFCU) has eight offices throughout Florida. Florida's Medicaid program is a more than $22.9 billion state and federal partnership that serves more than 3 million Floridians. As such, we work closely with the Agency for Health Care Administration (AHCA). AHCA carefully scrutinizes claims it receives and refers any possible fraudulent claims to MFCU. We also receive tips about Medicaid fraud directly from other sources, including citizens and other state agencies.
Typical schemes involve doctors, dentists, clinics and other healthcare providers billing for services never performed, overbilling for services provided, or billing for tests, services and products that are medically unnecessary. The MFCU also houses a Patient Abuse, Neglect and Exploitation Unit that investigates cases where elderly, ill and disabled residents are abused in nursing homes, facilities for the mentally and physically disabled and assisted care living facilities.
We also have a Complex Civil Enforcement Bureau that investigates and prosecutes qui tam cases brought by whistleblowers and by the State of Florida under the Florida False Claims Act. The Complex Civil Enforcement Bureau actively participates in multistate qui tam actions. Since I took office, our qui tam settlement figures total more than $300 million.
One unique aspect of the Florida MFCU is that we were the first state to receive a waiver from the federal government to perform data mining. This program allows us to analyze Medicaid claims data routinely and proactively in order to detect fraud. With this waiver, we mine data on the billing practices of Medicaid providers, such as hospitals, doctors, and pharmacies, and can identify trends that suggest fraud.
To protect the integrity of the Medicaid program, we continually work with local, state and federal partners. In one of our most egregious cases, my office worked with the Metropolitan Bureau of Investigation, Homeland Security Investigations, and the Florida Department of Law Enforcement to arrest a woman for committing more than $3 million in Medicaid fraud, racketeering and identify theft. The Orlando woman billed the Medicaid program for more than $3 million for services that were never provided, and she used the Medicaid funds to purchase luxury vehicles, trips and jewelry. Expenses using these ill-gotten funds include: Cadillac Escalades, a Ducati Superbike, a seven-person Carnival cruise, a trip to Cozumel, Mexico, and more than $175,000 of Luis Vuitton products. By working together with our partners, we were able to seize the defendant's illegal assets.
My office will continue to pursue cases of Medicaid fraud and seek monetary recoveries to make the Medicaid program whole and to hold individuals responsible for committing this fraud.
This content has been archived. It is available through our partners, LexisNexis® and Bloomberg Law.
To view this content, please continue to their sites.
Not a Lexis Subscriber?
Subscribe Now
Not a Bloomberg Law Subscriber?
Subscribe Now
NOT FOR REPRINT
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
You Might Like
View AllCrypto Industry Eyes Legislation to Clarify Regulatory Framework
SEC Official Hints at More Restraint With Industry Bars, Less With Wells Meetings
4 minute readTrump Fires EEOC Commissioners, Kneecapping Democrat-Controlled Civil Rights Agency
Trending Stories
- 1Understanding the HEMS Standard in Trusts
- 2Mergers Are About People, Not Paperwork: Here’s Why
- 3Wachtell Partner Leaves to Chair Latham's Liability Management Practice
- 4Morris Nichols Partners to Be Involved With PLI Program
- 5How I Made Practice Group Chair: 'Cultivating a Culture of Mutual Trust Is Essential,' Says Gina Piazza of Tarter Krinsky & Drogin
Who Got The Work
J. Brugh Lower of Gibbons has entered an appearance for industrial equipment supplier Devco Corporation in a pending trademark infringement lawsuit. The suit, accusing the defendant of selling knock-off Graco products, was filed Dec. 18 in New Jersey District Court by Rivkin Radler on behalf of Graco Inc. and Graco Minnesota. The case, assigned to U.S. District Judge Zahid N. Quraishi, is 3:24-cv-11294, Graco Inc. et al v. Devco Corporation.
Who Got The Work
Rebecca Maller-Stein and Kent A. Yalowitz of Arnold & Porter Kaye Scholer have entered their appearances for Hanaco Venture Capital and its executives, Lior Prosor and David Frankel, in a pending securities lawsuit. The action, filed on Dec. 24 in New York Southern District Court by Zell, Aron & Co. on behalf of Goldeneye Advisors, accuses the defendants of negligently and fraudulently managing the plaintiff's $1 million investment. The case, assigned to U.S. District Judge Vernon S. Broderick, is 1:24-cv-09918, Goldeneye Advisors, LLC v. Hanaco Venture Capital, Ltd. et al.
Who Got The Work
Attorneys from A&O Shearman has stepped in as defense counsel for Toronto-Dominion Bank and other defendants in a pending securities class action. The suit, filed Dec. 11 in New York Southern District Court by Bleichmar Fonti & Auld, accuses the defendants of concealing the bank's 'pervasive' deficiencies in regards to its compliance with the Bank Secrecy Act and the quality of its anti-money laundering controls. The case, assigned to U.S. District Judge Arun Subramanian, is 1:24-cv-09445, Gonzalez v. The Toronto-Dominion Bank et al.
Who Got The Work
Crown Castle International, a Pennsylvania company providing shared communications infrastructure, has turned to Luke D. Wolf of Gordon Rees Scully Mansukhani to fend off a pending breach-of-contract lawsuit. The court action, filed Nov. 25 in Michigan Eastern District Court by Hooper Hathaway PC on behalf of The Town Residences LLC, accuses Crown Castle of failing to transfer approximately $30,000 in utility payments from T-Mobile in breach of a roof-top lease and assignment agreement. The case, assigned to U.S. District Judge Susan K. Declercq, is 2:24-cv-13131, The Town Residences LLC v. T-Mobile US, Inc. et al.
Who Got The Work
Wilfred P. Coronato and Daniel M. Schwartz of McCarter & English have stepped in as defense counsel to Electrolux Home Products Inc. in a pending product liability lawsuit. The court action, filed Nov. 26 in New York Eastern District Court by Poulos Lopiccolo PC and Nagel Rice LLP on behalf of David Stern, alleges that the defendant's refrigerators’ drawers and shelving repeatedly break and fall apart within months after purchase. The case, assigned to U.S. District Judge Joan M. Azrack, is 2:24-cv-08204, Stern v. Electrolux Home Products, Inc.
Featured Firms
Law Offices of Gary Martin Hays & Associates, P.C.
(470) 294-1674
Law Offices of Mark E. Salomone
(857) 444-6468
Smith & Hassler
(713) 739-1250