South Florida | Medicare fraud

Medicare fraud crackdown nets 33 arrests in South Florida

 

Federal authorities charged more than 30 South Florida suspects with Medicare fraud, including some associated with a Hollywood psychiatric hospital.

 

A Federal Agent enters the offices of Professional Home Care Solutions Home Health Agency located on SW 47th street and 71st avenue in Miami, suspected of Medicare Fraud on October 3, 2012
A Federal Agent enters the offices of Professional Home Care Solutions Home Health Agency located on SW 47th street and 71st avenue in Miami, suspected of Medicare Fraud on October 3, 2012
C.M. GUERRERO / EL NUEVO HERALD
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Hollywood Pavilion’s Web page boasts that the family-owned psychiatric hospital’s primary goal is to “return a healthier, motivated individual to family and to community.”

In reality, authorities say, the Broward facility’s operators appear to have been guided by a far more sinister objective: ripping off Medicare.

At the crack of dawn Thursday, federal agents arrested Hollywood Pavilion’s chief executive officer, Karen Kallen-Zury, on charges of paying kickbacks to recruiters and patients so that the hospital could bilk Medicare of more than $50 million.

Kallen-Zury, 59, of Lighthouse Point, was among 33 South Florida defendants charged with a variety of Medicare fraud offenses as part of a national takedown announced by the Justice Department Thursday. Collectively, all of the local defendants were accused of submitting about $205 million in phony claims to the taxpayer-funded Medicare program.

“We’re going to fight this indictment,” said Kallen-Zury’s defense attorney, Michael Pasano. “It’s built on the testimony of liars, addicts and people who have cooperation deals with the government.”

Nationwide, an additional 58 suspects were charged in six other cities from New York to Los Angeles. Those defendants filed fraudulent claims totaling $225 million, authorities said.

Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius held a joint news conference to spotlight the Justice Department’s “strike force” arrests by 500 agents with the FBI, HHS and U.S. Postal Inspection Service.

“Today’s enforcement actions reveal an alarming and unacceptable trend of individuals attempting to exploit federal healthcare programs to steal billions in taxpayer dollars for personal gain,” Holder said.

The Obama administration has carried out a series of crackdowns in an effort to stem the estimated theft of tens of billions of dollars a year in Medicare funds earmarked for the elderly and disabled.

Meanwhile, Medicare, with a notorious history of lax oversight, has developed more sophisticated technology to flag suspicious billing patterns.

Medicare’s anti-fraud czar, Peter Budetti, said the agency’s goal is to move beyond its “pay-and-chase model” of targeting fraud offenders after they have already received millions in taxpayer dollars and blown the money. He said Medicare’s objective is to “stop fraudsters before they can successfully bill Medicare.”

The Miami area, where schemes involving home care, mental health and physical therapy fraud have flourished for years, has stood out as the nation’s epicenter of Medicare corruption. And the latest arrests, accounting for one-third of the total nationwide, reinforce that reputation.

Miami U.S. Attorney Wifredo Ferrer called the feds’ fight against Medicare fraud “one of my top priorities,” stressing that offenders not only steal from the government but also the “most vulnerable among us.”

In the Hollywood Pavilion case, Kallen-Zury and two other executives, Daisy Miller and Michele Petrie, all residents of Broward, conspired to pay thousands in bribes to recruiters and patients who did not need the facility’s inpatient or outpatient mental health services, authorities said.

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