Unnamed Home Health Agency (Miami, FL — Three Defendants)
Outcome
Three individuals convicted by federal jury in Miami for conspiracy to defraud Medicare of over $93 million by billing for home health therapy services never rendered, plus money laundering.
Details
Florida Home Health Network (Miami) — $93M Phantom Therapy Fraud
Outcome: Three individuals convicted by federal jury in Miami for conspiracy to defraud Medicare of over $93 million through billing for home health therapy services never provided, plus money laundering.
A Florida man and woman, plus a third co-conspirator, were convicted by a federal jury in Miami for operating a conspiracy to defraud Medicare of over $93 million. The scheme involved submitting claims for home health therapy services — including physical therapy, occupational therapy, and speech therapy — that were never actually rendered to patients.
The $93 million in fraudulent claims represents one of the larger individual home health fraud schemes prosecuted in the Southern District of Florida, where Medicare fraud through home health and therapy billing has been a persistent enforcement priority. The money laundering conviction reflects the defendants' efforts to conceal and transfer the fraudulent Medicare proceeds.
The convictions were announced October 3, 2023.
Primary Source: Three Individuals Convicted In $93M Home Health Fraud And Money Laundering Scheme
How Crucible Prevents This
Crucible's home health therapy verification hooks would flag $93 million in billing for services with no delivery documentation; an anomaly detection gate cross-referencing therapy session claims against authenticated patient visit records, therapy log signatures, and outcome documentation would surface phantom therapy billing at this scale.
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