Miami Home Health Company (unidentified)
Outcome
Three individuals were convicted by a federal jury of conspiracy to defraud Medicare and money laundering after billing over $93 million for home health therapy services that were never rendered to patients.
Details
Miami Home Health Company — $93 Million in Phantom Therapy Billing (2023)
Outcome: Three Miami-area individuals were convicted by a federal jury of conspiracy to defraud Medicare of over $93 million and money laundering after billing Medicare for home health therapy services that were never provided to patients.
A Miami, Florida-based home health company operated a scheme in which it submitted Medicare claims for home health therapy services — physical therapy, occupational therapy, and/or speech therapy — that were never actually rendered to beneficiaries. The $93 million in false claims represents one of the largest individual home health fraud convictions in the Southern District of Florida, an area historically plagued by home health Medicare fraud.
Three individuals were convicted by a federal jury on October 3, 2023 on charges of conspiracy to commit healthcare fraud and conspiracy to commit money laundering. The fraudulent proceeds were laundered to conceal their criminal origin. The case was prosecuted by the U.S. Department of Justice.
Primary Source: OIG Enforcement Record
How Crucible Prevents This
Crucible's home health therapy billing audit controls would detect systematic billing for therapy visits without corresponding therapist time records, patient treatment notes, or physician certifications. At $93 million, the fraud volume represents systematic phantom billing that automated claim-to-documentation cross-referencing would surface. Anti-money-laundering compliance controls for billing proceeds would flag layering patterns.
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