Guilty of Insurance Fraud

People who commit insurance fraud think it is a crime without punishment or concern. When they are caught, prosecuted and convicted, the perpetrator is so amazed that he or she is one of the few unlucky ones who were caught that they use their ill-gottengains to fund unfounded and frivolous appeals.

Peter Costas bribed dozens of people addicted to heroin and other drugs to enter rehab centers so the Red Bank, N.J. man and his cronies could illegally soak up money for lucrative referrals. Costas worked with several marketing firms to recruit potentialpatients who had robust private health insurance from New Jersey and elsewhere. Costas paid them up to several thousand dollars each. Costas stayed in touch with the patients at the rehab facilities. He instructed them to stay long enough to generate referral payments. Sometimes he directed patients to different rehab facilities month after month to generate multiple referrals. The facilities paid the marketing firms $5,000-$10,000 per patient referral, and about half went to Costas and other body brokers. Costas received 13 months in federal prison.

Thousands of healthy people plus patients with diseases like Alzheimer’s and dementia were falsely told they had just 6 months to live so they could be enrolled in Medicare hospice for $150 million of fraudulent billing.

Rodney Mesquias ran a hospice chain called Merida Health Care group, in Texas. In many cases, people were still walking, driving and even coaching sports when Merida’s marketers told them they were dying. Mesquias even sent chaplains to discuss last rites and prepare people for imminent death — while enrolling them at group homes, nursing homes and housing projects. People were kept in hospice for years — lining the pockets of Mesquias and his conspirators. Sometimes Mesquias had doctors do emergency surgical procedures to keep hospice patients alive and the false bills flowing. Physicians also were paid kickbacks to qualify patients for hospice.
Mesquias forged medical records to create the illusion that his patients were dying. He bought luxury cars, jewelry, clothing, real estate, season tickets for the San Antonio Spurs, and bottle service at Las Vegas nightclubs. He treated marketers to parties and tens of thousands of dollars worth of booze. Mesquias was handed 20 years in federal prison.

Read last two issues of ZIFL here https://zalma.com/zalmas-insurance-fraud-letter-2/