South Florida

South Florida still No. 1 for healthcare fraud, following massive takedown across nation

Federal agents with Health and Human Services, the FBI and IRS carried out a nationwide takedown of healthcare fraud offenders in June.
Federal agents with Health and Human Services, the FBI and IRS carried out a nationwide takedown of healthcare fraud offenders in June. U.S. Department of Health and Human Services-Office of Inspector General

No surprise: South Florida is still the nation's capital of healthcare fraud.

On Thursday, the Department of Justice unveiled an array of new healthcare fraud cases accusing about 600 defendants nationwide of submitting $2 billion in false bills to the Medicare program for the elderly, the TRICARE system for military members and private insurance companies.

Of that staggering total, about 125 defendants were charged in South Florida with filing nearly $340 million in fraudulent claims for opioid addiction treatment, home healthcare and prescription drugs covered by taxpayer-funded programs and other insurance plans.

"The sustained losses are astronomical," U.S. Attorney Benjamin Greenberg said during a news conference in Miami, pointing out that South Florida was responsible for 20 percent of the defendants charged in the healthcare fraud takedowns across the country. "It really shows the problem is quite severe down here."

Greenberg focused on the theme of fighting scofflaw drug treatment centers and sober homes for opioid addicts during his presentation, which echoed a news conference led by U.S. Attorney General Jeff Sessions in Washington, D.C. Sessions has made fighting the nation's opioid crisis, fueled by an average of 115 overdose deaths every day, a top priority of the Trump administration.

Over the past decade, both the Justice Department and U.S. Attorney's Office have coordinated yearly efforts to spotlight the latest crackdown on healthcare fraud offenders from Miami to West Palm Beach by agents with the FBI, Health and Human Services and Internal Revenue Service.

Among dozens of new cases in South Florida, Greenberg zeroed in on Good Decisions Sober Living in West Palm Beach, whose operators recruited patients and paid kickbacks in order to bill $106 million for widespread fraudulent urine testing that was not medically necessary between 2011 and 2015, according to an indictment. The so-called sober home, which houses patients with addiction problems, was paid more than $31 million by private insurers.

The indictment, prosecuted by Justice Department attorney James Hayes, accused owner Kenneth Bailynson, 45, medical director Mark Agresti, 55, and employees Stephanie Curran, 35, and Matthew Noel, 32, with conspiracy to commit healthcare and wire fraud

Authorities also highlighted a major healthcare fraud case against a Delray Beach sober home, Halfway There Florida, and a substance abuse treatment facility, Real Life Recovery Delray. The treatment facility's CEO, Paul R. Materia, 43, and patient brokers Joseph Lubowitz, 29, and Christopher Fuller, 33, were charged with illegally recruiting patients, paying kickbacks and defrauding healthcare programs by billing for urine testing and substance abuse treatment that were medically unnecessary.

Both the sober home and treatment center billed more than $58 million to insurance plans and were paid $20 million, according to an indictment.

"We are seeing a disturbing reality — doctors, medical directors, clinicians, treatment center owners and employees are actually fueling the opioid crisis rather than doing something to reduce it," Greenberg said.