Major SC Medicare fraud case moves to the penalty phase | Business

Major South Carolina Medicare Fraud Case Advances to Penalty Phase

In a significant crackdown on Medicare fraud, authorities have charged several medical professionals, including doctors and a nursing professor. This action is part of a broader federal investigation aimed at curbing fraudulent activities that siphon millions from the healthcare system.

The case centers around an individual who managed or had significant control over 14 medical equipment companies. These entities billed the federal health insurance program for more than $216 million, claiming it was for essential medical equipment like back, leg, and neck braces, which were often unnecessary. The companies successfully received approximately $99 million in reimbursements. Additionally, a major private insurance provider, Humana, paid these companies around $1.8 million.

Law enforcement agencies have taken decisive steps by seizing nearly two dozen bank accounts belonging to the accused. They also took control of a luxurious 3,700-square-foot waterfront property in the upscale Hobcaw Creek Plantation in Mount Pleasant, which was later sold for $2.5 million. The seizure extended to two office suites and six automobiles, including a lavish 2005 Ferrari 430 Spyder.

After the accused agreed to a guilty plea in April 2021, the operation, dubbed “Operation Brace Yourself,” seemed to slow down. However, the investigation gained momentum again in June when the Justice Department announced new charges against several individuals across 16 states. This phase of the operation also saw the seizure of millions in cash, cars, and real estate. Among the new suspects was a New York resident who had established a call center with the intent to collect health information from Medicare beneficiaries and persuade them to accept medically unnecessary braces.

Since the indictment and guilty plea, the accused has kept a low profile. The criminal case has seen periodic updates, with the most recent filings being kept confidential. Public records last showed the Justice Department’s request to sell half of the seized car collection to offset more than $40,000 in storage costs, citing the vehicles’ depreciating value.

In a related development, the accused was expected to testify in a New York case against a medical supply business owner from North Carolina. The trial faced a setback when the jury could not reach a unanimous decision, leading to a mistrial. However, the business owner later agreed to a guilty plea after the government expressed its intention to retry the case.

The sentencing for the accused, initially scheduled for January, has been postponed to Tuesday in Columbia. This sentencing comes nearly four years after the unraveling of “Operation Brace Yourself” on April 9, 2019, marking a significant milestone in the fight against Medicare fraud.