Could Healthcare Fraud Occur in my Backyard?

Many members of the Advize Health staff call Winter Park, Florida their home.  Winter Park is a historic city populated by private colleges such as Rollins College, boutique hotels with enviable veranda views, picturesque canopies of Spanish moss, and a small number of country clubs.  If you’re picturing a painted sky illuminating a boat launch on a breezy day and citizens soaking up culture at the local museum – then you’re on the right track to capturing the essence of Winter Park, which is why it may come as a surprise to learn that Winter Park has been home to a handful of expensive healthcare fraud schemes.

Hospitals under the umbrella operation of Adventist Health System came under fire for submitting fraudulent claims in order to siphon millions of dollars from both Medicare and Medicaid. The health system’s physicians were compensated with massive payments, benefits, and minimal administrative supervision in order to control referrals for different services in the areas surrounding the hospitals.  The lawsuit, which sits just under $119 million country wide – is largely comprised of charges ($47 million) from Florida Hospitals. And yes, you guessed it – one of those hospitals operates in the city of Winter Park.

Recently, in late 2015, a Winter Park dentist was arrested under the suspicion that she submitted over $5,500 of fraudulent claims.  Dr. Merys Downer-Garnette billed Medicaid for procedures performed on juvenile patients without ever performing these services.  It is also alleged that some of her patients suffered from medical malpractice, and that she billed for many procedures that were performed incorrectly.  This was Downer-Garnette’s second run in with anti-fraud taskforce. In 2010, she faced charges for voiding $87,000 in claims and admitted to charging Medicaid for procedures she did not perform.

Winter Park maintains a reputation built upon an understanding of safety, culture, and financial stability, which is why it’s so disconcerting to discover that Winter Park, and its home, Orange County, have been hotbeds for healthcare fraud for several years.  The good news is that the fraud may be on a rapid decline, as fraud’s once rampant reign in Orange County is being monitored and controlled by the U.S. Health and Human Services Office of Inspector General’s (HHS-OIG) Florida region.

If these high profile cases teach us anything, it’s that healthcare fraud can happen anywhere – and that it’s okay to be a whistle blower.