On Aug. 25, 2015, a “now former” owner and operator of multiple health care clinics in New York City was sentenced to 87 months in prison and three years of supervised release after pleading guilty to defrauding Medicare of more than $30 million. Oscar Huachillo, the man convicted of Medicare fraud and tax evasion, was also ordered to pay $31,177,987 in forfeiture and $3,454,244 in restitution.

The fraudulent scheme was committed through claimed provision of infusion treatments and injection to Medicare-eligible HIV/AIDS patients. In reality, however, the patients were all recruited and made to visit any of Huachillo’s Clinics many times a week for many months in order to receive expensive “treatments” which included administration of very expensive drugs that were reserved for anemia and cancer patients. Many times, however, no medications were actually provided or, if ever these were provided, these were given at highly diluted doses to people who really had no need for said medical treatment.

The $300 paid weekly by Huachillo and his companions to the HIV/AIDS patients in exchange for their coming to the Clinics and undergoing treatments was nothing compared to the tens of thousands of dollars that Huachillo received as reimbursement from Medicare. And, to make sure that they will never run out of people to treat, patients were offered about $50 more for every additional person they will be able to take and refer to the Clinics.

Medicare and Healthcare fraud, which financially burden the Medicare program, cheat honest taxpayers, put patients at risk, compromise the integrity of honest healthcare providers, and cost the US tens of billions of dollars every year. According to the Federal Bureau of Investigation (FBI), the prime agency tasked to expose and investigate health care fraud in private and federal insurance programs, this criminal activity, which continuously threatens the financial aspect of various government programs, is committed in many different ways, like:

  • Filing claims for treatments and tests (lab test) that were never performed;
  • Falsification of names when filing insurance claims;
  • Making claims for illnesses or injuries that do not exist;
  • Over-charging the government for treatments provided to patients; and,
  • Filing a claim for medical supplies that were not used;

To be able to identify and catch, especially those who aggressively commit fraud, the FBI works determinedly with the help of: various federal and state agencies; private investigative associations; and, different insurance groups. Due to the overzealousness of authorities and prosecutors, the federal government was able to recover $5.7 billion in 2014 (this was $1.9 billion higher than 2013). Besides this, many doctors, sources of medical supplies, executives and practice owners, now also get charged almost weekly. According to the U.S. Department of Health & Human Services, during the second quarter of 2015, about 243 individuals were charged for their alleged participation in Medicare fraud schemes. The arrests of the 243 individuals, which included doctors, nurses and other licensed medical professionals, were results of a nationwide sweep led by the Medicare Fraud Strike Force; some providers were also suspended by the Centers for Medicare & Medicaid Services (CMS) for their possible involvement in the fraud that amounted to $712 million in false billings.

Recovered money and people getting arrested are definitely good news for patients and taxpayers; however, for those who have been, and will be, wrongly charged, getting arrested is already a nightmare, how much more if they get convicted.

From the website of the law firm Kohler Hart Powell, SC, it is mentioned that the government, in an attempt to recover losses from fraud, often makes mistakes which result to the accusation of innocent medical professionals committing federal criminal offenses. Sadly, it is also irrelevant for many government authorities how this wrongful accusation will affect a person’s practice, family, career, and reputation.

Clearly, wrongfully accused healthcare professionals can lose more than just their profession and credibility. It is their very source of livelihood and, thus, their lives which are at stake in the event of a wrongful accusation.