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Man accused of health care fraud agrees to $40M settlement

A Philippine born American citizen agreed to pay the United States government $40 million in restitution for his role in the largest health care fraud scheme in recent history. He is one of over two dozen suspects arrested and accused of partaking in this scheme.

Details of the scheme: Fraudsters accused of targeting Medicare recipients

The prosecution has allegedly gathered evidence to support allegations the scheme cheated the U.S. of over one billion in fraudulent Medicare reimbursement payments.

The government states the operation ran from 2014 through 2019. Those leading the scheme would run commercials that encourage viewers to call the accused’s call centers. Operators would receive phone calls and screen for callers who were eligible for Medicare benefits. Workers at the call centers would then begin a process that resulted in the sale of medically unnecessary neck, back and knee braces. The individuals behind the scheme would then bill Medicare exorbitant amounts for these products.

Participants accused by the government: Business leaders and medical professionals

As noted above, the government has charged over two dozen individuals with criminal activity as part of this scheme. The individuals include the call center owner, business leaders and physicians.

The prosecution states it was working with the accused to investigate allegations of Medicare fraud for months. The accused continued operations as normal and gathered intel for the U.S. government to use against other participants. The accused is credited with providing evidence that allowed the government to expand its case. Originally, the government estimated the scheme resulted in $9 million in losses. With the cooperation of the accused, the government was able to find millions in additional fraud.

Government informant in the operation: Evidence in exchange for a deal

The call center owner agreed to provide evidence to the government and has plead guilty to his role in the international fraud scheme. In exchange, prosecution has recommended he serve probation as opposed to a prison sentence.