Medicare Fraud Strike Force Produces Several Arrests

The Medicare Fraud Strike Force has successfully dismantled Medicare fraud schemes in Florida and Mississippi. Special agents in the Department of Health and Human Services Office of the Inspector General (HHS OIG) and Department of Justice (DOJ) criminal investigations division have teamed up with agencies across the federal law enforcement community to investigate and uncover Medicare fraud schemes.

The HHS OIG and DOJ worked with Customs and Border Protection (CBP) officers in Florida over the course of last year to combat individuals in Florida defrauding the system with illegitimate home health therapy.

According to reports released this week, investigators arrested two individuals for providing unlicensed physical therapy and using bribes to obtain referrals for their health services company. Alexander Ros Lazo and Misleady Ibarra admitted to defrauding the system of $8.6 million.

Ros Lazo, the owner of T.L.C. Health Services of Miami, was sentenced to 87 months in prison. Ibarra will serve 24 months for conducting medical services without a license. Both will be required to pay restitution.

A Mississippi man will likely also face prison time for defrauding the healthcare system as a result of investigative efforts by the Strike Force.

Howard Randall Thomley pled guilty to his role in a $200 million scheme to defraud health benefits programs, such as TRICARE.

The DOJ release explains, “Thomley owned and operated a company called Advantage Marketing Professionals, which marketed medications for Advantage Pharmacy, a compounding pharmacy in Hattiesburg. For each prescription submitted by Thomley, Advantage Marketing Professionals and Thomley would receive a percentage of the revenue that Advantage Pharmacy obtained from TRICARE. Thomley and others associated with Advantage Marketing Professionals recruited beneficiaries of TRICARE and paid them a percentage of the revenue from each prescription – including refills – that they and their families accepted, in order to induce the beneficiaries to accept millions of dollars of expensive compounded medications that were not medically necessary.”

Thomley forged prescriptions using pre-printed forms “with the beneficiaries’ names, and obtained prescriber signatures, knowing that the medical professional prescribing the medication had not examined the recruited beneficiaries.”

The HHS OIG and DOJ worked with the Federal Bureau of Investigations and the Internal Revenue Service to make these arrests. Thomley currently awaits sentencing.

The Medicare Fraud Strike Force has been working since 2007 to “prevent and deter fraud and enforce current anti-fraud laws around the country.” The group maintains 13 strike forces in 23 districts and has charged nearly 4,000 defendants who collectively cost the Medicare program more than $14 billion.

Posted in The Takedown

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