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Health News Florida

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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