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Grand Jury Targets Medicare HMO

Florida's insurance officials are recommending a state takeover and liquidation of Florida Healthcare Plus, a Medicare Advantage plan accused of submitting $25.2 million in phony bills to Medicare and Florida Medicaid.

A federal grand jury in Miami indicted a doctor and 10 others who worked for the HMO, describing an unusually brazen scam involving enrollment of residents of Nicaragua and the Dominican Republic in the U.S. health care programs. The foreigners were even flown to Miami to further the scheme, according to the U.S. Attorney's Office. 

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Based in Coral Gables, the HMO was marketed in 16 Florida counties, including the Tampa Bay area. In Florida, the HMO was sold under several brands, mainlyDayBreakand Sunrise. As of June 30, it had about 10,500 enrollees, according to records from the Office of Insurance Regulation. OIRspokesman Harvey Bennett said Wednesday updated numbers aren't available.

Enrollment was frozen by both federal and state authorities after the plan was accused of failing to provide needed medications to patients and after misstating its assets in a state report. As Health News Florida reported last month, the plans sponsored by Florida Healthcare Plus were erroneously listed as options on Medicare.gov for 2015 enrollment, which started Oct. 15 and goes through Dec. 7. The plans have since been removed.

Eight of those indicted are residents of Miami-Dade, and three are residents of Nicaragua, according to a press release from the Attorney General Pam Bondi’s office. That release said the state and federal attorneys have frozen the HMO’s assets .

The HMO, based in Coral Gables, was most active in South Florida, but had offices and enrollees in Tampa and several other cities.

Eight of those indicted are residents of Miami-Dade, and three are residents of Nicaragua, according to a press release from the Attorney General PamBondi’soffice. That release said the state and federal attorneys have frozen the HMO’s assets .

--Health News Florida is part of WUSF Public Media. Contact Special Correspondent Carol Gentry at cgentry@wusf.org. For more health news, visit HealthNewsFlorida.org.

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Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.After serving two years as a Peace Corps volunteer in Colombia, Gentry worked for a number of newspapers including The Wall Street Journal, St. Petersburg Times (now Tampa Bay Times), the Tampa Tribune and Orlando Sentinel. She was a Kaiser Foundation Media Fellow in 1994-95 and earned an Master's in Public Administration at Harvard’s Kennedy School of Government in 1996. She directed a journalism fellowship program at the Centers for Disease Control and Prevention for four years.Gentry created Health News Florida, an independent non-profit health journalism publication, in 2006, and served as editor until September, 2014, when she became a special correspondent. She and Health News Florida joined WUSF in 2012.
Carol Gentry
Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.
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