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Recent Industry News

Healthcare Fraud

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The Department of Justice (DOJ) recently reported that a mother, Mildrey Gonzalez, and her daughter, Milka Alfaro, pleaded guilty to a $20 million Medicare scam. The women co-owned and operated seven Miami-Dade home healthcare agencies through which they defrauded Medicare. The scheme involved at least two other individuals that were previously sentenced to two and three years in prison, respectively.

Gonzalez and Alfaro’s fraud scheme involved defrauding several entities. The pair admitted to concealing their ownership interests from Medicare. The women then built a customer base by bribing and paying kickbacks to “patient recruiters” to refer Medicare beneficiaries to their services. In addition to paying kickbacks, the facilities billed Medicare for services provided to beneficiaries that did not qualify for home healthcare. The pair also paid off doctors and other medical professionals to boost home healthcare prescription reimbursement and gain additional patient referrals.

The case resulted from the Medicare Fraud Strike Force’s efforts to stop Medicare fraud. The Federal Bureau of Investigation (FBI) and Department of Health and Human Services (HHS) Office of Inspector General (OIG) investigated the case, and it was ultimately prosecuted in the Southern District of Florida.

The DOJ article is available at:

https://www.justice.gov/opa/pr/two-women-plead-guilty-orchestrating-20-million-medicare-fraud-scheme-seven-miami-area-home.

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