Latest news with #healthcareFraud
CBS News
7 hours ago
- Business
- CBS News
11 charged in major Medicare fraud bust, including Brooklyn business owner
Federal prosecutors in Brooklyn have now charged 11 people in one of the largest Medicare fraud busts in history, including the owner of a local business. CBS News New York first reported on the man and a slew of connected Medicare fraud complaints last year. Brooklyn business collects taxpayer dollars through alleged Medicare fraud In February 2024, CBS News New York investigative reporter Tim McNicholas went looking for the owner of G&I Ortho Supply in Gravesend. Dozens of Better Business Bureau complaints revealed G&I was collecting taxpayer dollars for catheters under the names of Medicare members who never requested them. The search led McNicholas to Staten Island, where one man said he'd recently sold the company to another man who was allegedly using a fake Texas ID. However, prosecutors said the name the buyer used was real: Kevin Valdhans. A second man — Jonathan Vaz, of Fort Lauderdale — said Valdhans also bought his company, but didn't remove him from their billing system after the sale. Vaz said at the time, he saw that Valdhans had billed about $7 million worth of catheters in just one week. Suspects received $41 million from Medicare, investigators say A federal indictment unsealed Thursday says Valdhans was part of a criminal organization based in Eastern Europe that bought more than 30 legitimate companies, then used them for Medicare fraud. Prosecutors say the group's leader was based in "Russia and elsewhere." Eight of the people charged are Estonian citizens, one is a United States citizen, and Valdhans is from the Czech Republic. The indictment accuses the group of "stealing the identities and personal identifying information of more than 1 million Americans." Investigators say the group submitted $10 billion worth of bogus Medicare claims and actually received $41 million from Medicare, plus $900 million from Medicare Supplemental Insurers. Prosecutors say the operation lasted until September. Similar fraud complaints at Queens-based business A Queens business has also been connected to Medicare fraud complaints, but that medical supply shop is not mentioned in the indictment. Some of the claims connected to that business were submitted as recently as this month. As far as we know, there is no direct connection between that business and the Russia-based organization, but it is a similar pattern in the sense that a man said he recently sold the Queens business and then started learning of fraud complaints.
Health Line
9 hours ago
- Health
- Health Line
How to Identify and Report Medicare Fraud
Medicare fraud is when a person knowingly submits false information or misuses the Medicare system to achieve personal financial gain or to receive benefits for which they are ineligible. Medicare has numerous official channels for reporting suspected fraud. While estimates vary, the Senior Medicare Patrol reports that Medicare losses due to fraud could be as high as $60 billion annually. What's clear is that Medicare fraud and abuse are pervasive, put significant stress on the system, and have the ability to affect the care that older adults receive. Medicare fraud can be perpetrated by various people and organizations, including healthcare providers, such as doctors, clinics, or hospitals, as well as criminal groups and individuals. In this article, we'll discuss what Medicare fraud is, how to identify it, and where to report it. Common types of Medicare fraud Medicare fraud can take many forms and can affect both beneficiaries and providers. Common types of Medicare fraud include: Medical identity theft: This can take many forms. It could involve using another person's Medicare number to obtain healthcare services or benefits or using a physician's identifier to fill prescriptions. Billing for unnecessary services: Under Medicare regulations, many procedures only receive coverage if they're considered medically necessary. If a provider intentionally bills for unnecessary procedures, it is a form of fraud. Kickbacks: Kickbacks are when a provider receives some form of compensation in exchange for referrals or utilization of services. An example would be a doctor who receives personal payment from a lab facility for referring patients. Billing for services never rendered: This is when a provider bills Medicare for services or procedures it never actually administered. It may involve falsifying documentation to create the appearance of authenticity. Upcoding and unbundling of services: Upcoding involves billing for services at a higher complexity than those actually rendered. Unbundling involves submitting bills in a staggered fashion to maximize payment when Medicare requires that those bills be submitted together to reduce costs. Vigilance is important in matters related to Medicare and billing. Understanding what to look for can help you identify fraud in practice. As a consumer and Medicare beneficiary, be sure to regularly check your Medicare claims and keep an eye out for irregularities. Look for: unfamiliar charges on your Medicare summary notice line items for services you didn't receive bills from unfamiliar providers If you have regular contact with a healthcare professional, facility, or other provider, you may notice trends that could signal potential fraud. These include: unusual billing patterns geographic anomalies suspicious documentation patient complaints How to report Medicare fraud If you suspect fraud may be occurring with a given provider, it's important to notify the Centers for Medicare & Medicaid Services (CMS). Reporting suspected fraud, waste, or abuse in Medicare programs is key to protecting both the integrity of the Medicare system and the individuals it serves. You can do this in various ways: Contact Medicare by phone at 800-MEDICARE (800-633-4227). Submit a complaint online with the Office of Inspector General of the Department of Health and Human Services (HSS-OIG). Contact the HSS-OIG by phone at 800-HHS-TIPS (800-447-8477). Individuals with a private Medicare plan, such as a Medicare Advantage (Part C) or Part D plan, can also reach out to the Investigations Medicare Drug Integrity Contractor (I-MEDIC) with fraud complaints. You can reach I-MEDIC by phone at 877-772-3379. Before filing a complaint, it's important to collect all relevant documentation to back up your claim. This includes: your Medicare number the subject of your complaint, including information that can identify them the service in question and the date of receipt the cost of the service Summary Fraud and abuse cost Medicare billions of dollars each year. Reporting Medicare fraud is important for protecting individuals and maintaining the integrity of the Medicare system. Always guard your Medicare card, number, and other personal medical information. Additionally, review your Medicare summary notices routinely for irregularities that suggest inappropriate billing. If you think you were billed incorrectly, consider contacting Medicare for clarification. While errors happen, and not all errors are due to fraud, it's best to be safe and report your concerns. The information on this website may assist you in making personal decisions about insurance, but it is not intended to provide advice regarding the purchase or use of any insurance or insurance products. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction. Healthline Media does not recommend or endorse any third parties that may transact the business of insurance.
Washington Post
a day ago
- Business
- Washington Post
11 Eastern Europeans charged in $10.6 billion Medicare fraud scheme
Federal prosecutors on Thursday unveiled charges against 11 Eastern Europeans they accused of running a sophisticated, $10.6 billion Medicare fraud scheme in what appears to be one of the largest such busts in government history. According to an indictment unsealed in federal court in New York, the group based in Russia and elsewhere submitted billions of dollars in false health-care claims using personal information stolen from more than 1 million Americans in all 50 states. Prosecutors say the organization bought more than 30 previously legitimate U.S. companies and turned them from legitimate businesses into consistent vehicles for fraud.
CTV News
18-06-2025
- CTV News
Czech police nab fake dentist with dozens of patients
Prague, Czech Republic -- A fake dentist and two assistants who treated dozens of patients after learning the trade on the internet have been charged in the Czech Republic, police said Wednesday. The three family members opened a fully equipped dentist's without a licence or the necessary expertise in the central Czech town of Havlickuv Brod in 2023, police said. A 22-year-old man posing as a dentist provided check-ups but also extracted teeth, gave root canal treatments and applied anesthesia, drawing on information obtained online. A 50-year-old woman worked as a nurse, while a 44-year-old man providing the premises produced prosthetic devices for patients. 'The woman, who worked in the health sector, provided anesthetics but also other dental material to which she had access, such as fillings, cleaning powder, glue, impression material and much more,' police said in a statement. Asked by AFP if some of the patients complained, local police spokeswoman Michaela Lebrova declined to comment. The illegal clinic treated dozens of patients and raked in a total of four million Czech koruna (US$185,500), police said. Police detained the trio earlier this month and charged them with doing illegal business, money laundering, attempted battery, drug dealing and theft. All three had a clean criminal record. They have been provisionally released after pleading guilty, and face up to eight years in prison, police said. Facing a shortage of dentists, the Czech parliament last year passed a bill facilitating the employment of dentists from countries outside the European Union, of which the Czech Republic is a member. AFP
The Guardian
18-06-2025
- The Guardian
Fake dentist charged by Czech police after treating dozens of patients
A fake dentist and two assistants who treated dozens of patients after learning the trade on the internet have been charged in the Czech Republic, police said on Wednesday. The three family members opened a fully equipped dental practice – without a licence or the necessary expertise – in the central Czech town of Havlíčkův Brod in 2023, police said. A 22-year-old man posing as a dentist provided check-ups but also extracted teeth, gave root canal treatments and applied anaesthesia, drawing on information obtained online. A 50-year-old woman worked as a nurse, while a 44-year-old man providing the premises produced prosthetic devices for patients. 'The woman, who worked in the health sector, provided anaesthetics but also other dental material to which she had access, such as fillings, cleaning powder, glue, impression material and much more,' police said in a statement. Asked by AFP if the patients had complained, the police spokesperson Michaela Lebrova declined to comment. The illegal clinic treated dozens of patients and raked in 4m Czech koruna (£138,000), police said. Police detained the trio earlier this month and charged them with conducting illegal business, money laundering, attempted battery, drug dealing and theft. All three had a clean criminal record. They have been provisionally released after pleading guilty, and face up to eight years in prison, police said. Facing a shortage of dentists, the Czech parliament last year passed a bill facilitating the employment of dentists from countries outside the EU, of which the Czech Republic is a member.
