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Clinic biller nabbed for $400,000 Medicare fraud

By Jennifer Bresnick

- A billing specialist at a medical clinic in Florida has been found guilty of ten counts of healthcare fraud for his part in a scheme to bilk Medicare out of $2.5 million.  Cecilio Pelaez Delgado was employed by Viton Therapy Medical Center, and helped to submit millions of dollars in false claims for expensive infusion and injection therapies to Blue Cross Blue Shield of Florida and to Cigna.

While Medicare’s fraud detection programs have been the subject of debate for some time now, with concern over the Recovery Audit Contractor (RAC) program prompting questions among lawmakers and professional groups, a rash of collared criminals in 2014 has added to the expected financial recoveries of the Medicare program.  Last year, Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced the recovery of $4.2 billion in fiscal year 2012, and a total of nearly $15 billion in the four years prior.

According to the indictment and trial of Pelaez Delgado, Viton Therapy and an associated clinic, One Solution Therapy, submitted $2.5 million in false claims to the two insurance companies, of which $400,000 was paid out.  In order to further the scheme, the clinic paid kickbacks and bribes to HIV patients to ensure they would attend the clinic, says Assistant US Attorney Christopher J. Clark.  Pelaez Delgado will face sentencing on June 13.

Inflated and incorrect billing for therapies never performed or fraudulently performed is a common theme among healthcare fraudsters.  In Chicago earlier this month, three employees and three fake patients were indicted for their role to siphon nearly $3 million from BCBS of Illinois, Allstate, Aetna, and United Healthcare with the same basic plan.  The healthcare providers and practice billing manager involved in the fraud asked accomplices to lie about services received, alleges the indictment, and managed to procure at least $2.9 million in cash from the deception over the past decade.

 

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