Dive Brief:
- Although Medicare is not available outside the US.except under emergency circumstances, scammers, including two executives at Florida Healthcare Plus, have been caught arranging for former US residents to sign up under US addresses.
- The US reportedly paid out $25 million between 2011 and 2014 to cover medical care for more than 1,000 people in Nicaragua and the Dominican Republic who concelealed their foreign residency by using post office boxes, mail-forwarding services, or addresses of US friends or relatives.
- The scam in Nicaragua was openly marketed with newspaper and bus ads, and information sessions at hotels.
Dive Insight:
It's possible these scams are just the tip of the iceberg in international Medicare abuse. The investigation continues as the federal government looks into additional countries where scammers are recruiting patients, Bloomberg Business reports.
The issue is that healthcare companies receive a fixed monthly rate for every Medicare Advantage member they enroll, which creates an incentive to enroll as many people as possible wherever treatment will be as inexpensive as possible.
Those indicted in the current case include former Chief Operating Officer Pedro Hernandez of Florida Healthcare Plus, based in Coral Gables, FL, who enrolled former U.S. residents living in Nicaragua and the Dominican Republic into Medicare Advantage plans. As Bloomberg notes, five additional Florida Healthcare Plus employees were also charged, but the company was liquidated earlier this year and was not accused of wrongdoing.